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STATE: OF MINNFSOTA <br />Vosionry <br />Toliml,olp Manor Township Numhet Range Numhoer Sectlnn <br />�a�aoo 11744 5 23-w W <br />Distance and 1lkeetit►n from Road Iniersectlr►ns or Street AdJ►ess and Cily of Well Location <br />Show easel IsKalson of well in sectWn grad with "X." <br />M <br />2 <br />5 <br />M"-...- 1 wi IS ----� <br />FORMATION LOG <br />HI <br />E <br />T <br />1 <br />AddtlNM Name <br />block Number <br />Lot Numhet <br />COLOR <br />Yellow <br />s l t <br />UEPARTMENTOf HEALTH <br />MINNESOTA UNIQUE WELL NO. <br />WATER WELL RECORD <br />Jo. l/'ia►er SdnrOfe <br />Afinrwtora Sanwret 134A.111..Ox 1 157870 <br />1 rastir►n 3. PROPERTY OWNLRS NAML <br />o X iii` ev Jaek 44th!�91 <br />Address 1390 ;;y <br />� <br />Oreso <br />Sketch map of well location. <br />10,.P)NII FROM <br />W, <br />�m <br />4. Wt LL DEPTH (completed) <br />Dole of Cam pktion <br />11 V <br />I ft <br />I h <br />S. <br />10L'shk Itxd <br />NEON <br />20Hrdlowrr►d <br />SOAor 60 Mired <br />2 R4P1°ry <br />6Olelfed oO Wrwer Auger <br />6. USE <br />Drive Shot? <br />la Domestic <br />401"uhltc Supply <br />21:1 lrtt#atlttn <br />SO Munlclpsl <br />10 lest Well <br />MENE <br />7. CASING <br />HEIGHT Above/below <br />Weight <br />_ Ito /ft. <br />In. to fl. <br />Weiahl <br />IM /ft <br />S. SCRV-EN <br />EM <br />Or <br />"Pen t <br />NERIEN10i <br />5 <br />M"-...- 1 wi IS ----� <br />FORMATION LOG <br />HI <br />E <br />T <br />1 <br />AddtlNM Name <br />block Number <br />Lot Numhet <br />COLOR <br />Yellow <br />s l t <br />UEPARTMENTOf HEALTH <br />MINNESOTA UNIQUE WELL NO. <br />WATER WELL RECORD <br />Jo. l/'ia►er SdnrOfe <br />Afinrwtora Sanwret 134A.111..Ox 1 157870 <br />1 rastir►n 3. PROPERTY OWNLRS NAML <br />o X iii` ev Jaek 44th!�91 <br />Address 1390 ;;y <br />� <br />Oreso <br />Sketch map of well location. <br />10,.P)NII FROM <br />W, <br />�m <br />4. Wt LL DEPTH (completed) <br />Dole of Cam pktion <br />11 V <br />I ft <br />I h <br />S. <br />10L'shk Itxd <br />40 Reverse ?l_.JI►tt,en <br />20Hrdlowrr►d <br />SOAor 60 Mired <br />2 R4P1°ry <br />6Olelfed oO Wrwer Auger <br />6. USE <br />Drive Shot? <br />la Domestic <br />401"uhltc Supply <br />21:1 lrtt#atlttn <br />SO Munlclpsl <br />10 lest Well <br />60 An ('t►ndrtioning <br />7. CASING <br />HEIGHT Above/below <br />100 out <br />110 <br />fblack <br />Threaded <br />20(.4Iv. <br />SOWelded <br />Surface <br />ft. <br />60 <br />Drive Shot? <br />YesAv— No <br />M. to •03 fl. <br />Weight <br />1 Ihs./ft. <br />in. to h. <br />Weight <br />_ Ito /ft. <br />In. to fl. <br />Weiahl <br />IM /ft <br />S. SCRV-EN <br />Or <br />"Pen t <br />70 Industry <br />BF-ii'ommerctal <br />OO <br />HOLT_ DIAM <br />. toil <br />nt. to fl. <br />in. to fl. <br />Make from ft. Ici ft. <br />07 Type as Dia. <br />Vol/C;iuse Length <br />FITTINGS. <br />Set hetween ..� ft. ano�ft <br />ft. and fl. ,Y" P•olar <br />ft. and ft <br />', SIAIIC WAt1.R LEVEL <br />I1 1 ftt.F.tw 00hote <br />land surface <br />10. PUMPING LLYt:i. (heluw land surface► <br />f ►alr Measured hal J <br />ft alter firs puml•rng it p.m. <br />It after hts. pumping R p.m. <br />If. NLLLHLADCOMPLLTION <br />�1'fUr„ adaptrr 20lisument offset t _At At trail 12 &N.,c <br />grade <br />12. Well grouted? <br />Yes AsNo Cu Yd► <br />1 _� Neat ( or 2LJ Beninnrte 3ij <br />Depth from fl. to If. <br />from ft, to ft. <br />13 Nearesl al)urCe+ of pusaihle ct►mamtnatlan <br />feet dwec wort <br />Nell drs�n/rcted u1mbn ao,mplrlkM' Ya] N"I A <br />14 PliMp <br />type <br />Dalr otsialled <br />Not tn,talled <br />Manufactutef's Name dos 46 . mwL <br />visas,1 - Model Numbers �' NP Yolts <br />1� <br />Length of drop pipe Tom` ft c apathy <br />CJ <br />1 Material of drop pipe <br />..r ;46 1W 0 <br />T 1 pe )i�1 "uhmrr,tNr 1 1 ... urhtne S14J Net tpr#K still# <br />r' <br />I�-J let a < nt�.t.,t11 W-1 <br />, <br />16. WATER WLI_L LON I RAL IOR'S t I R I If ICA IION <br />"is well was drdlyd under my lutisdtcturn ani this repeal to Ihir Io <br />r <br />the terse of my knn,►tedge and t+etief. <br />_ rnr1llKiffila I. ent'e T <br />I to, a fee -find thrrF. of needed <br />IS. RIMARK5.1_Lt.VAt10N.SOUIKt O/ DAIA.ctt <br />r• <br />Signed <br />Awhe►rterd Hrpresentatrw <br />Join Dears* <br />Name of Ihdlrr <br />1►ate _ �� <br />Wit <br />5 '4 10M <br />7 ft) 401101 <br />