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HomeMy WebLinkAboutwell info STATE OF MINNESOTA DEPARTMENT OF HEALTH ��� WATER WELL RECORD MlNNESOTR UN/QUE WELL NO. /� ��C � H . CauntY�M Mr��esola Sfatrta/56A.01�.08 /�Wafn Soinple �'� U ownship Name� ownship Numbpr Range Number $ection No. Fraction 4.WELL DEPTH(comple[ed) Date of Completion �i�t"3�i(� i 1� ;_«" 23 " ' 3:� !���' "��.� SC�� L41 r�. �� i�t3�t t3� Distance and Direction fran Raad interxction w Street Address and City o(Well Location 5.DRILLING METHOD �� ����t,'„� t�.��� r���� ���#„� ti}�,��� 1�Cabk tool 4O Reversc 7C]Driven 100 Dug i €� RG iow exac[lacation d well in section grid with"X." Sketch map ot well lorrtion. �Hollow rod SO Air 8L]Bored 11❑ N - � � � i Addi[ion Name �.�_�„� �:ip Rotary 6O Jetted 9O Power�auger - _� � _1 _1 ti 6.DRILLING FLUID - , ...__� _. �€t�Tt�#tiTE DRILL t�� _ --�- '1_ �_ �_ Icek Number R � .:f.:- . W i ; � E � 3�"'<.4 ;�::_ . 7.USE _1_ _1_ _'_ __ : '� lO Domestic 4O Monitoring 8C]Heat Pump I ', � � I Lot Number � ! q�� � �� �Imgation SO Public 90lndustry f mi. � i I : �""� } 30 Test Well 60 Municipal IOO Commercial --�- �- � —r- 1 } � �""""""�--�.R......._..�:.+ � � 70Air Conditioning II❑ � /rMik'—� �� ' 8.CASING _ HOLE DIAM. �� 2.PROPERTY OWNER'S NAME HEIGEJT:Above�ffelow 10$lack qp Threaded � t YTV ffL � - Surface ��� tt. a��� �' 2O Galv. Sp Welded Address �{,(�}� �'�� Drive Shce? Yes_No— L 3O Plastic gp GKT�FxLt �Y 1 �� 3���� �in.to�tt. Weight�S�Lal�Ibs./(t. �n. to�t. , 3. FORMATION LOG COLOR HARDNESS OF FROM TO in.to ft. Weight IbsJft. �n. to�t. FORMATION in.to ft Weight IbsJft. �n. to�t. 9.SCREEN Or open hole rt A V AnY �Au C ��{ Make from ft.to. ft. bi.A f flA� Ai{ J V � . � TYPe r=vrnz����� e�rrr� Dis. �p�_ rt p V 1'ttya� i Ey 7� SIoVGauze—an t�•+} �� FI� ,�NGS: rri.tt� tiE��1 �V aNJ Set between�ft.and�—tt. C�Y WLrt� �3 IU 10. STATIC WATER LEVEL � �ft;D below ❑a6ove Date Measured��i �7 land surface ��� �� 7,j ��� 11. PUMPING LEVEL(below iand surface) �ft.after�, hrs.pumping �.f'�_ g.p.m. ��� ��� �� ��� . t[.atter�_hrs.pumping �� g.p.m. I2.HEAD WELL COMPLETION /�1 h y /•p/i V l i;r?� t ftrl SD Pitless adapter.manufacturer T����� model�� 46n F UiE�T1 i f t1�4J i FV 20 gasement otfset 30 At least 12"above ground 4O Plastic wsing prolec[ion �R ���q{� t � /�y p�p�, �} r il�SFf i�� f CL!!i �w's�I�� � G�� 13.WELL GROUTED? T�y� t D Yes ❑No IiV�i�� i/�5A G�7V GJ� 1�NeatCement 2C1$entoni[e 3O � -���--- �- -a1ti� Grout material trom to ft.cu.yds. 14. NEAREST SOURCES OF POSSIBLE CONTAMINATION .. ------` ._ _.. , . ' feet �_direction S type Well disintec[ed upon completion? �Yes ❑No � 15. PUMP � � � Date installed h�{�*�7 ❑Not installed Manufacturer's name r"��— ;�� Model number�TL. Y:�! NP�_Volts� Length o(drop pipe—�� ft. capaci[y—9�g.p.m. J . __ Material ot drop pipe - Typet-7�kSubmersible 30 L.S.Turbine 50 Reciproca[ing � •t 2OJet 4�Centrifugal 6O 16. EXISTING WELLS Unused well on property? �:S�es ❑No Use a second shnt,if needed 17.REMARKS,EIEVATION,SOURCE OF DATA,etc. Abandoned �'{�r'Permanent❑ Temporary O Not sealed • 18.WATER WELL CONTRACTORS CERTIFICATION f�i s I s �(i4 s��.��d� ��� Q� L�a L� ��t 6 ��� This well was drilled under my jurisdiction and this report is true to[he bes[of my rras �cradtrert.e�tl�t rtti�d by ��tt1n9 ttie s�reep. knowledgeandbeliet. Seca�nd +r+�11 �s l�ft north afi' t�t ]�t r�e11. � t an � ����Liceusee us�nu�cs Name�� �• Lrcense Na. r Address_ � R , `�t...:,� r' .* Signed i• .�,.':.f ' ... = Date��'�y f - Authorized Re resenta[ive DatP 1-���] ��� �a� iller 5/74 30M 7/76 30M LOCAL COIPY 4 316 4 8 �,�8�, HE-01205-02(Rev.10/85) p�gp�q„� Field Engineering, Inc. ; � ^ WA TER ANAL YSIS 7��8 11�:h Lane North • Champlin, Minnesota 55316 Telephone: 427•0826 �� 1;r r�-_�;:�i� :�r. 1','�; / Approved Minnesota State Board of Health, Bacteriological Laboratory 42788-000 �i-�,;��'i' ad,;; : �i�t 1.� Wisconsin Dept. of Health & Social Services Licensed Laboratory � FED. 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VROIlRTY OWNCIl3 NAML ORONO 118 5 23 w 33 N�"SEx S�'� CITY OI' ORONO IFy�wc��M IMK��.�f�.lw Mi�w1 1wl�nwt�.M�����rr��AJJ��u�nJ l��I o!WA1 4w��pw ' Addnv BOX # 6 6 Fil1CKBERRY P11RK--160 IUICK�RRY IIILL RD. CRYSTAL II7�Y, M�- 55323 !b��.r�M.�wo�d wM�w�e.�yN�Y�"1{." 3�.1t�Iw��o!ww11..c��� �. wlLl OEITN ` (��.MIN) DNI o!Ca��M11o� ""'"......,....�,-.. 2 4 0 "�"""".�' � �E�,q ,,. November 19 B 7 - � - - - -- -- -. . . - � � �. ►+ - - - -•- ---I- - E rJ a � � i�, �o��.�.�.�. .oN...�. ,a�.�., �oo�„ � � � ������� p )�IM�IM�wn�1 fOAY �Mr�1 11❑ - ;- ' -- - �,�. � Y ---� w.�rr �3 ,m w.,... .o�.,,.. .o...,..�.... b - r o0 0 _�. . , l �.,�.��. ,� .. �_. _� ._. _. � • � � y I�I1.��weuk ��hN43y�N� 101�I�Mry .` h-l.il� l�lr�y.i�.w fOM�wIs1�Y •..•�... �Ol'�rwwfl► L �011MAilOMlOI: l'OLOM NnMI1H1.S50f /�110M TO �I)MMA(IUN IOTn� W�11 {QAM('��w1111nMw� � 7.CASING NEIGHT:AMw NOL[DIAM CI,AY DK BRO O 5 'a"'"` '�"'"'°'' �Oc.i.. e�w.u.a s...r�. �2 n. CLl1Y DK Tl1N 5 10 �❑%��u< <O a�..s�..r r.._ w� 4 �..�0 2 3 2 �. W.,..� 10 .7 9 �...fi. —�.�.—�. CLAY NOV 1 �A� l� I8 M.�o n. W,y., ,w,m. —�•�.—n. �..�e n. w.w.� ia../n. _M.ta_R C7�Y RI,Y 18 �v M.M� JOIINSON r.e..� � n.�e n. T�w 304 Stainless � te e: GI271V�L 3II 4 3 R , 4n1/Cw�� �O CJ�O� L�ql� " � IITTINGS: • �.,b.,,.... �� ��..� �$�. �t x 3 ��4�cordin to M ��#e e ula �io� �� ,,...a ,,. 9,STATIC wATk:R LE�lL SANDY CLI�Y GI2�Y 70 75 100 �.��,� o,h,,,, 0.aM.r.nd 11-19-8 io. ruwrinc�cv[��e.io�i.�w...i«.� CL�Y GR11Y 7 rJ I Z� r, i;-- n..n.. 6 �,..o,,.M.� 5� �.r... GRl1V�L TAN 12 13 0 "�'`��� �M1 w"°�"� "�� 11.WlLL 11k:AU CON�Ll:TION t�f�] �Q Pl�lw�W�pur,m�aul�nu�r Open �� �Q `�j C�Y CiR�Y 13 16 5 ��e...T.��on..� 70 w�i«.�ir.se..n.r lL MLLL OROU'C6D1 GRIIVEL & CI.AY R�D-BRO 16 180 ��^ o"� �oN..,��.,�.�� ��..,,,��„ ,a 19 IIags , CLAY GIZAY 18 190 ���m��•� B�nseal ,.em 240 ,. Surfa��,d. d N/� MY GR71V�L & CL7�Y BROWN 19 2 0 0 -- 17.NLAR[8I'BOURC69 OF P068IBIi CONTAM WATiOH ��f�r1 �dlr�clbM y��I/M GRl1VEL G�1]�—ii �-K 2l� 2I5 w.naw.r«�.a.w•<o.�w..A.� r.,D n..QY 1�. IV M► CLAY IIROWN 21 217 Not installed yet a�.i.n�w ❑Ha i..�.w� G�VrL TAN 21 22II M��wf�cl�nf\N�w� waa�n�.sw --x►---' •_� C I.11 Y G Rl1 Y 2 2 2 3 0 �„„.,,,,,.NM V%~ ,,.<..«w, �;.,�: wa,ir o�a.00 aw i i I� GRIIV�L T11N 23 258 T,,.: ,p�1s�,.,,.,,,�,,, T SOM�clp.rc�l�iy • ,J,a,.� . . .a _ 'I %; ��J](V�(l������ � C�� u����������"------ �� 1�. wATERWEILCONTRACTOR9CER i1CAT10N 10.R[MMKH.[L[VATON.BOURC[0/DATA,wo. Tl�h w�M w�r ArY1N�wdw wf W Wk11w W I�Y nprl Y Irw 1� UPON COP�IPL�TION OI' TII� W�LL, TIIE• BOTTOM ,...,,,,,,.,�,a,,.,„...,,,,,,. OF THE W�LL Wl1S CI��CKED RUINING TII� SCR� sN. r_ II, RENN�R & SONS, INC. 710I5 The ATTEMPT TO PULL TI3� Cl�SING I'�IL�D. . �.�.�......,....,�.... ,..�....N. WELL WAS BAIL�D DRY AND GRIINUL2IR I3�NTONI � 15688 J1IRVIS ST. NW. WAS POUR�D INTO TII� W�LL. 4+T�LL TOOK 11LL �� �LK R V MN. 5 S 3 3 0 VULUM� NEC�SSl1RY. PIP� CUT OI'F 11T 11' �' � ��� --o.�. BEL047 GRl1D�. SCR��N STILL 71T BOTTOM. . . S""° � �w�:o.,... Rqrw�ulM � W 0 R K C O P DRL�� JOHNSON a„ 1 1-1 9-87 �....o�o.�..