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Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD 6 3 3 5 8 9 ��enrie�in Minnesota Statutes Chapter 103/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed �rono lI7 23 6 �C,, S,y,; I�ys�. 12� ry 2/t3I00 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 345 Narth Az'IIi Lri. Orana, M ❑ CableTool ❑ Driven ❑ Dug ❑ Auger � Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ j J 3��j Showing property lines, oads and buildings. DRILL�NG FLUID WELL HYDROFRACTURED? ❑YES,KL7 NO I N ` ._.'f_� T'ia G� � i.t� Si .' 'C'`Z FROM ft.to ft. -i- -i- -i- -i- g USE ❑ Monitoring ❑ Heating/Cooling _T= _�_ _�_ _i_ .L; xv\'� � Domestic ❑ Community PWS ❑ Industry/Commercial �-�_i. ti �. ❑ Irrigation i i i i " Jf +� _ � ❑ Noncommunity PWS ❑ Remedial w e t �� ❑ Environ.Bore Hole i i i � ❑ Dewatering ❑ -r -�- -r- -r � i i i ��z�ia CASING Drive Shoe? ❑ Yes $1 No HOLE DIAM. _i_ _�_ _i_ _i_ �'� ❑ Steel ❑ Threaded ❑ Welded i i i i � ;gl Plastic ❑ S �-1M'ile� ' `-.� �' CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME `� in.to I 1� � •g Ibs./ft. 8��in.to�� n. - Dav� t�iliia�ns Cc�nt. (� in.to ft. Ibs./ft. �in.to�vFt. Property owner's mailing address if ditterent than well location address indicated above. in.to ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE Make C'��"�' n from ft.to ft. 1 Q�i �• J't'C2 �ti• TYpe ��.d$� � Diam. �.�5 L:i t@ 1 SIoVGauze 1� Length �Q f t. C h�s y'a� t�;7f 5 5 31� Set between �� ft.and �� ft. FITTINGS: STATIG„�jTER LEVEL y 2/8 WELL OWNER'S NAME �~ ft. [i below ❑ above land surface Date measured PUMPING LEVEL(below land surface) � t�� Well owner's mailing address if different than property owner's address indicated above. ft. after � hrs.pumping 3{� g.p.m. WELL HEAD COMPLETION '�] Pitless adapter manufacturer �+'}l l��k`r.�. �t'�Model �'� `�-�j1 ❑ Casing Protection ❑ 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? ��7 Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material ❑ Neat cement ❑ eentonite ❑ Concrete�] High Solids Bentonite MATERIAL from_��_to_�_.R. � ❑ yds.{� bags C�.a� �'�'O wT� ��)Z,� Q ?�� from to ft. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION c 1 a y g r a�r 3 C1�� 8..r's $0 feet �i�i S t direction S 8�'�1 C type Well disinfected upon completion? �Yes ❑ No t a r�'tf $f'9IICI S� ��,�.�' 17��WY) 30ft. ��J �O� PUMP ❑ Not installed Date installed sand br��i SOf+ 1�? �� Manufacturer'sname �4� '7c�'�'`'��t Model number HP�V�Its Length of drop pipe ft. Capacity g.p.m. Type: ffi Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Ves t�j No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes �,No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,i/needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. 7he information contained in this report is true to the best of my knowledge. I��eatnne.r W�11 Inc. I�12� Licensee Business Nam� Lic.or Reg. o. f i � ,,,�,:�. - �. � �� uthonzed Representative Signa ure ate M�tiric� i:. Leuthn�r 3/3/�0 6 3 3 5 8 9 Name ol Driller Date LOCAL COPY HE-01205-06(Rev.7/98)