Well Info - Laserfiche WebLink

Home Browse Search

WELL LOCATI�N MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNI�UE WELL NO. Count;�Name �„�� WELL AND BORING RECORD 5�6 4 9 4 Minnesota Statutes Chapter103/ Tawnship Nas�e Township No. Range No. Section No. Fraction WELL DEPTFf(compteted) � Date Wor7c Completed �_ �r��l'�td? 1 1�F �J� 6�-'� y� Y. Y. �VL7 f �/z'.i�� House Number,Street Name,City,and T�p Code of Well La:ation or Fire Number DRILLING METHOD �GJ� L�..}.}�].T4.L�rJil �''k�$ #�7.'+:113� ��I3. ��.�'!�+ ❑CableTool �_Driven ❑ Du9 .1' ♦ ❑Auger �ftotary ❑Jetted Show enact I�atlon af well In sectlon grid with°X°. Sketch map of well locatlon. ❑ howing property hnea, x�y�L roads and butldirtgs. DRILLING FLUID N ��'I�C�F'�t�.�? � � � � —,— --�— —,-- —,— I I 1 ' USE �Domesdc ❑� m�9 P� ❑ HeaUng/Caoting -�- -a- -�- -� ❑ Irrigation � ❑ IndustrylCommercial � i i � ❑ Nmicommuniry PWS ❑ Remedial yy E T ❑Test Well ❑ pewatering ❑ i i i i i i i -r yl� CASING Drive Shae4 ❑Yes O:�lo HOIE DIAM. I_ _i_ _L_ ,_ � ❑ Steel ❑Thread� ❑Wetded ` � �,+►�' j�.� ❑g.�astic ❑ � r+e F-,�-� �,��t � CASING DIAMEfER WEIGHT PROPERTY OWNER'S NAME `�� `��r `� in.to ��+ it �.'� IbsJR. �i�d,'��. ' In.to ft. IbsJff. �t��j��• Property ownePs mailing address N different than well locatlon address indicated above. in.to ft. IbsJft. _in.to_R SCREEN OPEN HOLE ��!�«s3 �iI'�L`�.T'� �t'. �e w-:"gea�c:,F3, rrom Rco n. �'�.�I�'c�ttl'r�'�"Lp r�l::.��:.'�!/'�„-. ryPe�'c".�1�3��.�� «�`�� Diam. c, F.,, SIoUGauze Length �:� Setbetween N.arM r-��R FfITINGS: G� +�S .a� 4v �`i`�,``,. STATIC W�jT�F�LEVEL WELL OWNER'S NAME `� ri�below ❑above land surtace Dete measured �"��'��' PUMPING�{,�EVEI(6elow lar�d sur(ace)� � Well owner's mailing address ff diifereM than propeAy ovmer's eddress indicated above. •Y f i ft. aTter � hre.pumpNg �'�� -�a.p.m. WELL HEAD COMPLEfION ❑:i'fUesa adapter menufacturer �tV�_L�4^.�"�_€�i' Model ❑Casing Protection � 12 In.above grade O At-grade(Enwonmentel Wells and Borings ONLY) �ROUTING INFORMATION WeII grouted? �3 Yea ❑ No HARDNESS OF Grout Materlal ❑Neat cemeM ❑ BeMonite ❑Concrete ��iAigh Solids Berrtonfte GEOLOGICAL MATERIALS COLOR ��R�� FROM TO �m �° to ��+ ft. 3•�" ❑ yda. O�ibags q trom ':f'� to��t �;;�i�:.C.2M.�s'�71ds. ❑ ba� ��..�.L.�� {.�i3�7 �� .�'., �i 1 F3 'F trom to ft. ❑ yds. ❑ bags ��l� �� j NEAREST I OWN SOURCE OF CONTAMINATION r ! � a s ° feet �.+�� dlrectlon °'��'�+�/�type Weli disinfect�upon completion7 ❑�es ❑No 5�;��:� �.�/fC�f t..7. ��,�/�` ,�.�;. �3 �i� �° �'c�.-s PUMP ��_z�1 f-�'tu ❑ Not Insfelled Date installed MenutBCturer'8 nemB 'o Model number � a$= �^" HP � Voits ��t7 Length of dmp pipe ��i�� ' ft. Capacity ��i a.p.m. Pressure Tank Cepacfty ��+�� Tqpe: f�Submereible � LS.Turbine ❑ Recipr�ating O Jet ❑ ABANDONED WELLS Does property have arry nat in use and rrot sealed well{s)? ❑Yes �No VARIANCE Was a varian�grented from the MDH for this well? ❑Y� ❑�No WELL CONTRACTOR CERTIFICATION Use a seaond sheet,H needed Thla well was drilled under my�rvision erM in acxordence with Minnesota Rul�,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The infortnetlon conteined tn thla report is true to the hest ot my Imowledge. ��'� i�`.��>�ll'�tt-'� ��'�°i� ��.t�a.d.�`++'�i ��+'r r �L�. Llce e Busineas Name �; Ltc.or Reg.No. �f c.- �,r.�� ;.�� -k �'_L^+'�-^JM'^ Autlio�ized Reprasml Nve S/grtature Date t�tF.3i�"l: �-��? �--��La Name of Odlrer Date LOCAL COPY 5� 6 4 9 4 HE-01205-05(Rev.1/95)