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Home My WebLink Aboutwell info ',WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO County Name WELL AND BORING RECORD Hemewrpth Minnesota Statutes,Chapter 1031 715850 1 Township Name Townsh • hiip No. Range No. Sect+ioon No. Fraction WELL DEPTH(completed) Date Work Completed+� 2 3 11 Oran) $11 23W —04 GPS Latitude degrees _ minutes seconds DRILLING METHOD g LOCATION: Longitude degrees minutes seconds • 0 Cable Tool 0 Oiling'. 0 Dug House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑Auger VeRotary ' ❑Jetted •Lake 02,3 Old Dd. t DRILLING UID' • WELL HYDROFRACTURED? ❑YesX]No Show exact location of well in section grid with"X'. Sketch map of well location. Pts Showing property lines, ' FROM ft.TO ft. N * �... roads and buildings USE 0 Monitoring - ❑Heating/Cooling --• Domestic 0 Environ.Bore Hole 0 Industry/Commercial Noncommunity PWS ❑Irrigation ❑Remedial -•-i i'------t------t--- - 0 Community PWS 0 Dewatering 0 yy - CASING E Drive Shoe? HOLE-0IAM. ❑Yes No F i ❑Steel ❑Three ❑ ed . h Mile 1(�Plastic s 1 CASING DIAMETER T' IG HT --I in.to ft lbs./ft. al in.to ft. I---1 Mile ' In.to ft. lbs./ft. '!�, 2t in.toI ft. PROPERTY OWNER'S NAME/COMPANY NAME Darrial �' 011 in.to ft. lbs./ft. in.to $: SCREEN (OPEN HOLE Pr r ailih ad rens' r t than well location address indicated above. Make • ; , Mt S'�1 SbUGau2e F Diam. : ft. TO ft. LengID •th Set betweenLAW_ft.and 113 ft. FITTINGS t" . STATIC WATER LEVEL = ft. below,❑above landsurface Date:measured • � . WELLOWNER'S.NAME/COMPANY NAME • PUMPINf,LEVEL(below and surface) ., Darrell Anderson , � it.after hrs.`pumping q.p.m. Well owners mailin`address if different than propertyWELL HEAD CONtFPLETION 9 owners address indicated above. Pitless`adapter manufacturer Amps- ,Modef • acing Protection 0 12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING.IN FORMATION Well grouted Yes ❑No Grout materiel Neat cement Bentonite 0 Concrete �❑High Solids Bentonite from ' ft. ❑y'ds.. HARDNESS OF from to ft, . • ❑yds. bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL '.from t4 ,ft. ❑Yde ❑bags NEAREST KNOWN$OUROE OF CONfAMiNAON . ye .11 0 feet. . direction Well,disinfectetl uponcorylpleti©rt'iiYes ❑tie... c PUMP ❑Nofinstalled. 'Date installed _ . �+ 0 It rray .. Manufacturer's name , - , ' - Model number HP Votts. sand grill' 70t 13 Length of drop pipeSO .g C apex . • g.p:m. Type.'i Submersible. ❑L.S.Turbine ❑Reciprocating 0 Jet. ❑_. ABA!• ED WELLS Does property have,any'not in Use,and not sealed yyell(,$) 0 Ye.@No.,, VARIANCE - ' Was a variance;granted from the MDH for this welf2_,❑Yes, No TN# L ... ',WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and inraccordance with Minnesota Rules,Chapter 4725. The iidormation contained In'this report is true to the best'of my knowledge. ' Use a second sheet d needed . REMARKS,ELEVATION,SOURCE OF DATA,etc. Stemma Drilling a Envirennental see Business Name Lic.or Reg.No. ,. 1� r .. - C)5 Authorized Representative Signature Date LOCAL COPY 715850 Name of Driller IC 140-0020 HE,01205=oe(Rev.5/02)