well info - Laserfiche WebLink

Home Browse Search

WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL RECORD 525263 14 E>n%^ Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section No. F ctio WELL DEPTH(completed) Date Work Completed Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD f 1 / r _T ) ❑ Cable Tool ❑ Driven ❑ Dug "f , 6 t +A � e , W 4 � ❑ Auger I kRotary ❑ Jetted Show exact location of well in section grid with"X'. Sketch map of well location. ❑ Showing property lines, N roads and buildings. DRILLING FLUID USE �rn Domestic ❑ Monitoring 11 Heating/Cooling W i ; i E �Cz o rigation EJ ❑ Industry/Commercial 6Ll Test Well C1 Dewatering O Remedial 1,11 F'^" n CASING Drive Shoe? El Yes o HOLE DIAM. --'- - —r- I k Ut LISteel ElThreaded ❑ Welded i � 1 I mile Aplastic ❑ CASING DIAMETER \\ WEIGHT PROPER OWNER'S NAME i �) n.to d�' t.1 ft. bs./ft. in.to�.�C'ft. (j to`+��j Ca N^ in.to ff. lbs./ft. in.to 1�. Mailing address if different than property address indicated above. in.to ft. lbs./ft. in.to ft. iG �� SCREEN OPEN HOLE R 0, Make 4,V_ 4 r� from tt.t Type `5 S Diam. C LC. �g 5 �N fll\1^ -1 �3 1 `7 Slot/Gauze 1 Length f r / Set between `�L( ft.and ft. FITTINGS: HARDNESS OF STATIC WATER LEVEL GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO t( ft. l,,pelow ❑ above land surface Date measured PUMA PPIING�LEVEL(below land surface) ) �, 6 L_N �. (, �� 1! ��ft. after � t"'� hrs.pumping ` .J g.p.m. r / WELL LHHEAD�`COMPLETION tt Leff f `+.. rq ( „;,r 61,/\ r ;j �Pitless adapter manufacturer ��"• l �nj [ Model G� A y X �.J ❑ Casing Protection OL12 in.above grade + i r GROUTING INFORMATION ` Well grouted? p Yes ❑ No 4 1 7 Grout Material Y9 Neat cement E'Bentoniter !- from to N-, ft. 4-yds. ❑ bags ,r 1 from to ft. ❑ yds. El bags �*�✓01 . , 3.1.,�- from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF COJ4TAMINATION r^ "l feet direction type Well disinfected upon completion? 011.Yes ❑ No PUMP ❑ Not installed Date installed Manufacturer's name to.':--I Model number ) HPLC Volts �'•,i,? Length of drop pipe ! �" ft. Capacity 1X- g.p.m. Pressure Tank Capacity t,1 X f ", Type: pC$ubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ 1994 ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes ;"o CM OF FKM WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,if needed f� v,(I t;.V "�I a 1/y REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.or Reg.No. S Au rized Representative Signature Date / Name of Driller Date LOCAL COPi � 525263 HE-01205-04(Rev.5/92)