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Home My WebLink Aboutwell info STATF.Oh MINN1�:5()TA UF�.PANTMtNT01�Mk:ALTH I. L(�('ATI()N UI-WV-LL ��NNFSOTA UNIQUE WE/.L NO. �,., c��rN,��.• WATER WELL RECORD � `� �.,� J� r^ �� a�� . . IorWaferSample �, �./ �i�;�, '`� Minn �a SteNfet/SFA.lil�.11N T��wna�ip Name T�wnsh�p Numher Nan�e Numher y��{nn Nn. I�raiti�in J. YROPk;RTY OWNER5 NAMF: �� - ��lr� S� 6�E W �V�v. , �S/ Tiw � . . }f� ��G....'�:4Y I>Islani'e and ItKecl�un(rum k�uJ Inlers<tli��ns��r 51rce1 AJJreu anJ(l�y of Wrll L�ic��iun Addrcss �� 1��$�Lacs eut �'.�. S�ow es�cl I�ic�lion of wsll in xec�iun priJ wilh"X." Skelc�map of well I�caiiun. a. WlLL DEPTH(<ompleted) Date of Completion M +} �}g� �JJili��nName � f�;��'�"'(,}{j :� -�- - � - '---� - �.�rJ n. � C s i0c�nirm�d a❑e��.� ��nd.�� ioQo�e W -' - _�'y i-�- - L bl�rck Numhtt is ' � 2�Hnllnwr��d S�Air 8❑Bnred I1�� ' - - '- ' ;}e1L. J[�"��rY 6❑Jel�ed 9❑Yower AULer � � l Lol Numhcr 6. USE _'i_ ' __'' _' ___,__ 1��meslic a�Yu Alic SuOPIy Y�Induslry S F-1 wiZ� 7�Irrig��i�in S�Municipai e�C'nmmercial 3. FORMATIONLO(: ��p�pµ HAItI)Nh�SSOF 4'ROM TO InNMAI'IUN J❑Tr�t Well 60Air('nndi�ionin� I 9❑ 7. CASING HEIGHT:A�ove/Below HOLE UTAM �Yii�� elay & �rav�t. a IS ��b�+ck eOThreadeJ 3❑(:alv. S�Welded Sunc�e f(. q��j� ['�H�V ��, � �j ,l�las[ic �•� ��e Shoe? Ye�_ No� `i'•+ � fn.lo �� fl. Weight �� Ibf./fl. ��fn.1��(t. ��yp� e�� n.lo fl. WeiBh� IM1s./f�. -�n.Io_(t. n.to fl. WeiRh! Ibs./fl. in.lo_(t. 'L1..�a wj gyy � �� 1'�}G 8.SCRF:EN ropen ole . Y�.i.�17'�L+ �.acs� .L,�1 Make ��SQ� �rom tl.to ft. L =a� �,`( sva. oia. �itA V�ii� �y � �}i'� I '(Qr TYC� ataf ✓� = SbtJGauze L� � Lengt� ��41 F'ITTINGS: I Set between �,� ft.an0 1 SS ft.anA ft. 9.STATIC WATlR LEVEI, �g f1.�hNi�w ❑aM1ovr Dat<Measured �`S . � -- - lane•��ra�e 10.PUMYING LEVEL(below land surface) (t.af�er hn.pum0��6 6�F�m� ft.aftet hrs.pumping g.p.m. 11.Wk:LLHEAUCOMYLk:TION �[�Pitless edap[er,manutecturer model I�8asemen�of(se� J A��eaat 12"above greAe 12.WELL GROUTED? �ex ❑No li_yye�IC'emi•nl 3�Ben��ni�e 3❑ I � Grout material from ft..Cu.Yds. I�N�EARE$T SOURCES OF POSSIBLE CONTAMINATION �� feet direction IYV� wen m:��r«��a�Po��ompi�c�o�t vr:❑�N„❑ '. 14. PUMP Dale inst�lled ❑No�ins�alled Manufac�uretY Name ��„� Model Number HP �•0' Volts �,�,_ Length of drop pipe �� fl.capacilY �� 8.p.m. ' Malerial of droD D�pe �$x r�� Tyve: 145unmer:ihle ��L.S.Turbine sOReclpri�caling A 7❑Jel 4❑C'enlrifugal 6� Use a secand sheet.ilneedad 16.WATER WEI.L CONTRACTOR'SCERTIFICATION 15.REMARKS.ELEVATION,SOURCE OF DATA.etc. This well was drilled un0er my jurisdiction and tMs report ia true to the best of my knowledge and belief. n ictnxr uN eu Namt t o. ,,�..�,�+�{� � 12 6�3 �a�al� $�.aa.ia, :�3 Signed Dat< �� Authorixed ReDresentative ' R�i�p .�0�lIlSt1T1 �p-QF—�? n.�� LOCAL �i�.yt� .1 s`A +� f? �"'� NameofDrillm 5!l430M i t � 7/76 30M � .,.. .. -�. .. 7/7830M HE-01205-01 2/82 10M