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48
<br />STATE Ot MINNtSMA UFPA4tTT,IENTOF HLAL 1
<br />t. LOCATION AF WF LL i 41LVNfSOTA t/N/QUF. WELL NO.
<br />!'county Nan+e WATER WELL RECORD for We fro, Sewrpk
<br />11�2u Nrnnrtwe Sratutes 1344.t)f-.OK 1 142834
<br />T►jwltshlp Nose Tnwnshrp %umher Range Numher %ecta+n Nn 1 ratlurn t PROPER I Y OWNER'S NAME.
<br />nr or
<br />s In Lona id 0 •R0113j,
<br />Distance and ;)erection hum R413J inlersectwins lot Street Address and l►Jy of NI LnclUnn Addre+s /1
<br />}:harry va.. 1
<br />Shnw esasl Ir►cauon of well in sevll.►n geld with "X.- S►elite mar nr Nell Ir,cal►40n 4 N'I.LL UI.PTH (eumplelrJ) Dale of C41mrletor►n
<br />M 4
<br />N
<br />S
<br />F_-._ --- 1 tri to
<br />2. 1,0MMATION LCX:
<br />Yellow V1V
<br />ill" clay
<br />Sud
<br />Clay
<br />Addition Name
<br />EblrKk Nurnher
<br />T
<br />Fj wi.
<br />Lot Namher
<br />COLOR
<br />d rom
<br />r
<br />4 rRy
<br />GrMLy
<br />fta ! clad - - --� cant'
<br />4,*
<br />Gk dro"r,
<br />3+�na AltcLv(wAddyj
<br />Sand & CbW
<br />wmvel tic Aonen
<br />Braga
<br />at"
<br />cc, we
<br />It RIMAttkti I-LIVA11UN-SOUR11 ill DAfA.elL
<br />i I '? ,.1;
<br />� T lilt _ •
<br />L..Ocf.'_ COPY
<br />ItA14DN/SSI)I
<br />I()k061AIION
<br />0
<br />v —W _
<br />40 Reverse 1n Drl� r 10� 1►vg
<br />00�
<br />0
<br />SOAlt SLI Wired
<br />g'
<br />25
<br />ti USE
<br />1211.,mes1K
<br />4011uhllc Supply 713 Industry
<br />201trtgato„n
<br />313 Test Nell
<br />SoStunlclral ROCorrmcresal
<br />t)1:] Air OmdN►nn41,g vt]
<br />1U
<br />T CASING
<br />HEIGIIT Atx»e/lielnN HULL: UTAM
<br />S
<br />F_-._ --- 1 tri to
<br />2. 1,0MMATION LCX:
<br />Yellow V1V
<br />ill" clay
<br />Sud
<br />Clay
<br />Addition Name
<br />EblrKk Nurnher
<br />T
<br />Fj wi.
<br />Lot Namher
<br />COLOR
<br />d rom
<br />r
<br />4 rRy
<br />GrMLy
<br />fta ! clad - - --� cant'
<br />4,*
<br />Gk dro"r,
<br />3+�na AltcLv(wAddyj
<br />Sand & CbW
<br />wmvel tic Aonen
<br />Braga
<br />at"
<br />cc, we
<br />It RIMAttkti I-LIVA11UN-SOUR11 ill DAfA.elL
<br />i I '? ,.1;
<br />� T lilt _ •
<br />L..Ocf.'_ COPY
<br />ItA14DN/SSI)I
<br />I()k061AIION
<br />S.
<br />1Come 141401
<br />v —W _
<br />40 Reverse 1n Drl� r 10� 1►vg
<br />sola
<br />0
<br />SOAlt SLI Wired
<br />g'
<br />25
<br />M 76
<br />w
<br />A
<br />103
<br />" 121
<br />193
<br />19y
<br />12. Well grovied7
<br />MY" D No Cu. Yds,
<br />iL3Nest Cement Iwnlun,le d~D
<br />-- Fhplbfrr,m 11. 10 h.
<br />from h. in rt.
<br />1. Nearest suunes of pr►ssahle rnnlarr,►nala,n
<br />feet rflitetllou - -- t t r
<br />Nell d►sonfested urr►n tomplefoon• YrsEx N�A3
<br />I -s I'1 �1P
<br />Date installed
<br />❑ Not /tsstalled
<br />1Vlrnufaclure!'s Name A�
<br />M,►del Numhet HP Ann% �-
<br />---- l enpb of dr41p pipe 25 ft capasily 12 R r' rrr
<br />Mal"W of drop pope AAffla
<br />type: 111Xhrtsrrs1►4a• JUL. Llurbitre 1-i_1Rr4rper►ealrng
<br />16. WATERWILUCVNIRA< luk'SCl.pTlilt'A11UN
<br />Tho well was drilled under my jreresdretion and this repixt is true to
<br />the hest of m► knotalrJgt and be1Nf
<br />L,*, thwr bi *U Cm, any 10125
<br />__- Lit 0-nrrr I?unnrrs '.gnu
<br />ict r•la• I I4. rf"'
<br />Address ----_ 4—__— ----
<br />1012 Aush,rrrrt-1 Rel+reNntah.e
<br />Nome fit t►r►Ilet
<br />It, 74 P 0
<br />7, 76 30M
<br />S.
<br />1Come 141401
<br />v —W _
<br />40 Reverse 1n Drl� r 10� 1►vg
<br />..JHI%Ilrm trod
<br />SOAlt SLI Wired
<br />)OR,►lar>
<br />At�lrlted o0P►wser Auger
<br />ti USE
<br />1211.,mes1K
<br />4011uhllc Supply 713 Industry
<br />201trtgato„n
<br />313 Test Nell
<br />SoStunlclral ROCorrmcresal
<br />t)1:] Air OmdN►nn41,g vt]
<br />1U
<br />T CASING
<br />HEIGIIT Atx»e/lielnN HULL: UTAM
<br />•)
<br />I�Illack
<br />k�hreadrd
<br />c,aly
<br />S[�1Ae1drJ Surface 1 ft
<br />r
<br />l►}
<br />t'�
<br />!rive Shoes Yes No
<br />rn.
<br />In ,}j� It. Weight Ihs 41
<br />►n.
<br />tri ft.
<br />Ir► _rt. N'rrghl Ihs./fl. `—"""
<br />I
<br />1+► h. Wright IM./ft. ---. ,+, :. ft
<br />johmm/��
<br />��ict� 1r:+m _ ft err _ --- It
<br />lu'
<br />•]
<br />i 1111•.t.ti
<br />117
<br />Set hrtNren
<br />11 and 1t
<br />r; ft f iXt►!i"�t��
<br />_t
<br />and _ •
<br />rl and
<br />+. SrAtIC W'AII.k LEVEL
<br />It r��alw►re irate Mrasuted
<br />land susurfafa ce
<br />PUMPING 1- VU (htluw land sutface)
<br />�.3
<br />F
<br />ft. rafter hrs pumping
<br />fl. after hts pumping —_—__-- f t n+
<br />11— NI:LL H! AI►CUMPLF.IIUI'!
<br />1(Wtlevs adapter
<br />2D Basement unset .10 At haul IV alsn►r
<br />�rtde
<br />12. Well grovied7
<br />MY" D No Cu. Yds,
<br />iL3Nest Cement Iwnlun,le d~D
<br />-- Fhplbfrr,m 11. 10 h.
<br />from h. in rt.
<br />1. Nearest suunes of pr►ssahle rnnlarr,►nala,n
<br />feet rflitetllou - -- t t r
<br />Nell d►sonfested urr►n tomplefoon• YrsEx N�A3
<br />I -s I'1 �1P
<br />Date installed
<br />❑ Not /tsstalled
<br />1Vlrnufaclure!'s Name A�
<br />M,►del Numhet HP Ann% �-
<br />---- l enpb of dr41p pipe 25 ft capasily 12 R r' rrr
<br />Mal"W of drop pope AAffla
<br />type: 111Xhrtsrrs1►4a• JUL. Llurbitre 1-i_1Rr4rper►ealrng
<br />16. WATERWILUCVNIRA< luk'SCl.pTlilt'A11UN
<br />Tho well was drilled under my jreresdretion and this repixt is true to
<br />the hest of m► knotalrJgt and be1Nf
<br />L,*, thwr bi *U Cm, any 10125
<br />__- Lit 0-nrrr I?unnrrs '.gnu
<br />ict r•la• I I4. rf"'
<br />Address ----_ 4—__— ----
<br />1012 Aush,rrrrt-1 Rel+reNntah.e
<br />Nome fit t►r►Ilet
<br />It, 74 P 0
<br />7, 76 30M
<br />
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