Loading...
HomeMy WebLinkAboutwell info STATE OF'MINNESOTA UEPARTMENT OF HEAL'1'H �.tiocnTioN oF ws�� WATER WELL RECORD �ti��^'^'r,so�A c,��reuF�iti�ezc n�a ������ County vame - �pny'1R�7'y� blinnrsola Sfatu(es]SFiA.OI-.08 lor R'ulr�r Sampfe ..--a Township Namr Township Number Kange Number Srction No. Fraclion 4. WF.U.DEP"PH fcomplet�d� Uate o(Completion Uro¢�o 117N s ?.3i�i w IO �w�"� `3a�e '" 216 << 2j7/�1 Numerical Street Address and City of Well Location or Distance from Road Intersec[ion. 5. DNII,I.ING METHOD 1�� yt���� ��� ❑Cablc"lix�l ❑Reverse ❑Uriven O Uug «�� Show exact la'aGon of H�ell in section grid with"X." tikeich map o(wcll location. ❑Hollow-I:ud � ❑Air ❑Rored ❑ � N � i i Addition'�'ame �Nutary ❑Jettrci ❑Power Augcr '_r_'y_ _1 _1_ i M li. URI_�LI,s1�!`G E���A .. i�ii iJc � � � � Block Numbcr '-�- --- - �- 7. 1:5E W � i � E � � �)omestic � ❑Momtoring ❑Heat Pump _1_ __ __ __ I i ' I,ot Number `� ❑Irrigatioo � �❑Public� ❑Industn� f-mi. � i ❑'fest Well ❑Municipal ❑Commercial --�- �- -� -r' I ❑Air Condi[ioning ❑— � 1 � � m-��,_� 8. CASING HOLE DIAM. 'L.PROPERTY OWNEH'S NAME Mailin Address if differen[[han ro ert�address HEIGH"I':Above/kielow B P P � ❑Black ❑Threaded indicared ubo��e. Surtace ft. " ❑Gak. ❑Welded ��k J(X� �y25 �1,� 1I�s �Plastic � Drive tihce? Yes_ No� ���a,raa� 1'�i7 �J7� � �� in.to ���(I. Weigh[ �sj� Ibs./(1. ��n. tu!➢f. 3. FORMATION LOG COIAK HARUtiESS Ot Fk��M TU in.m —ft. Weight Ibs./(t. _�n. tu-�t. FUNMA"IIUti �- in.tu tt. Weight IbsJft. �n. to�t. �y ��1 Q � 9. SCKEEN Or�open hole �,�� trom ft.to. _ - (t. Makc ,{2�, y,�, �'�r$� �ILV�K�- ... V :JO TYPe� Diani. `Y.iU•G�.L. ��� tilov(;auzc �v1�iVL , Length 5 ft __ t7��d ����' i�D :7Z SP L11 t�.and Zl� ft. �'�dt ��(;ti� �, Set betwe . ����� 8��p�� ��� 10. STA"I'IC�EK LEVEL arVlRa �2 -_�� CL�beluw ❑aboce Date Measured�f��_7 f�� land sur(acc Il. PUMPItiG LEVF.L ilx•lou�land surface� ��+�� � �� �� (t.a(ter _hrs.pumping ��� g.p.m. t_ (t.a(ter hrs.pumping g.V�m. Ci�yl�a� �� �� ��� 12. HEAU.WF:LL C:OMPLE'I'ION $��� �Pitless adapter mnnufacturer— _ �tr�dcl — C�� �� ��� �`��� �O Basement,o((set �L]At least 12"above grnund ❑Plastic casinK protectiun 13. WELL GROUTEU? �II Yrs ❑Nu San�il vel Yellaw 202 216 � �M1eat�ement ❑Bentonite ❑ --- Grout m32erial #rom�__�o-��ft.cu.yds. _ In_ NF:AHEST SOURCES OF POSSIBLE CONTAMINA7'ION (eel direrlion type Well disin(ect�d up�m mmple�iun? �Yes ❑No I5. Nl"MN Uate installed �,���� ❑tiot installed Manufacturer's name ���� « Model ny�Snber — HP 3/4 Volts 23a Length u(drop pip.. �� (L Capacity �-a H.p.m. Material o(drop pipe �� � Type: �Submersible ❑L.S.Turbine ❑Recipraating ❑Jet ❑Centri(ugal {7 16. ABANDONED WE?LLS Unused well on property? ]QYes ❑No L�se a srrond sheet,i/needed Scaled � Permanent ❑ 9�emporary ❑ Not sealed 17. REMARKS,ELEVATION,SOURCE OF DA"I'A,etc. � 18.WATER WELL CON"1'RAC7'OR CEKTIFICATION 7'his well was drilied under my jurisdictiun and this report is Irue to the best of my knowlcdge and belie(. St�vQ.ns well llrillirx� Co � Tnc z7194 Licene'ee Business Name /ieensr No. �24a A' • 12 v+Tes Plain :�N 55359 A ress Signed � � � Date ������� ��j��� *i_ Autliortzed ltepresenta(iue 1r1LIS.0 iS.L�`'�'! Date ��12�g1 Name o(Driller LOCAL COPY ��� .� � � ii�s oM HE-01205-03(Rev.9/88) ziez ionn STATE OF M[NMESOTA DEPART�NT OF NEALTH ABANDONED MELL RECORD • i ����� � ��� MINHESOTA UNIQUE MELI N0. (le�v� Al�nk II not knorn) co���r N��» I;ennepin fOvntA1P N�w� ►ovni�l0 NwA�r Il�nqt Nu�Dtr S�ttlon No. Fr�ctls� �. YELL OEPTN (to�pl�t�d) D�tt s��l�d N E � � 01 y Orono 117N sr 23W Wr 10 SW SW NE 99 �� 2/3/91 Nu�erlul Stnet Addrtft •n0 Cltr oI Mtll Loutlon or Dittant� Iro� Ro�d 5. ORIILING METH00 (II knarn) IntentcHon iQ CaAI� tool �R�wrs� �f Orlv�n tCQ Duq 1025 Hexitage Lane 2Q Nollor Rod S[�Alr e�eo�.a iip _ ][]Iloury 60 JKt�d 9[]Vor�r Aug�r SMr ��ut loc�tlon o/ wll (fn tectlon qr10 rltn '1') Sl�tc� �a0 0/ rtll loc�tlon 6. OSSTIIUCTIONS N 4ell obstruct�d�11ei � No ` . _ ` ODftructtons nwov�d[] u �No If o�structlons c�nnot De , . � � � � reroved, contut MOM , � � b�fort te�llnq. v _ : . . .�. - E . . i l. USE � }S�Doe+efHt �Ibnitortny �N��t loop ' ' ' ' "— y.:. . . .'. _ , ., � ?[� Irriq�tlon 501uD11c � Industrr �]Test w�ll 60 MunIc1D+1 ICQ Commerct�l 7[]Illr CandlNonleq 110 r--I w!i 2. /NOVERTt OMNE�'S NAIIE W 111n9 Addr�ti I! dlller�nt th�n e. CASING(S) � prop�rty �ddr�sf Indtut�d �Cov� 1�tluk 1�Thr��d�d 7[� 1025 Heritage Lane �[I G�lr. 50 Y�Ided Maz'k Johnson �p vi�sc+� ep sa��t�:� sc..t HAa0NE55 OF 4 In, t0 It. 7. FOAIUTION lOG COIOA FORMIlTION FROM TO II not �nown, Indlute forw�tlon loy fron n�w wll or n��rDy rtll. 1n. to /t. 9. SCIIEEN Cla Br � 8 �Scr��n�d wll Iro�_ ft. to 99 rc. 8 58 �tr ��aw�� Sand/gravel Br p oo•� �o�. r�o._ re. co _ ic. Gravel/clay Blue brcxrm 58 72 �o. sr�r�c YA�� �cvei /t. [�D�lor []�Oav� _Cla /sand Blue brawn 72 84 �.�a ��.r.�. o,�. n�.���.e 2/13/91 Sand/gravel Br 99 tl. VEllHE110 COMVLETION 1�71tl�ss �d�pt�r �FounO turl�d t(]e+se�e�c orrs.c sQ �w.�t v�c 16. NEw1��c5. EIEYATION, SOUIICE OF OATI1 - CASINGS NE110YED. C�SINGS ►E�f011ATED. ETC. 12. GROUTIMG INFORINTION Foxmation log taken from new well drilled �N..c c.�.�e �e.�ca��e. �p 2/7/91 - unique well # 471132 c�o�c ..c.�,,i 8baqs r.o. 0 �99 rc. ��. ras.32 17, NEA11ES1 SOUIICES OF CONTAMINATION h�t dlncHoa tyt• Mell dlsinl�tt�d W/ort f�+linqi ❑ 'Itt 11. DUMP g]Rerov�d �Not irlfent Typt: 1�Submrslbl� � 1.5. Turbine �Aetiproutlny 2(]Jtt �Gntrl/uq�l 6[] 15. EIIfSTING YELIS (Il��t� fk�tcA louttam of �Dandon�d �nd �cNr• wlls In raurkf f�ctlon or on D�ck.) Oth�r unus�d v�il(s) on OroD���Yt ❑Y�� � no ���ndon�d: �/�r��n�nt �TMpar�ry (]Not s��led 1). MATEA MEII CONTMCTOIIS CERTIFICl1ilON Thtt ��Il v�f f��I�d ueder .�y Jurlfdtctlon �nd t�lf nDort is trw to tM E�tt o1 ey knowl�dq� �nE D�I1eI. Stevens Well Drillin Co. 27194 62�b��Hiq�iway �i"� West ���Illff N0. �ee�ess M le P MN. 55359 siy�.a� o�c. 2/13/91 Dan Maas o+c. /i1Cl�l �WIOOM[D VEII �E[OIID (M+r E� uf�A for IroD�rty �r�n�hr) N��e oI Or111�r � Il/PQtTAl1T t llla �!'S Od6D ,