Laserfiche WebLink
MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. <br /> ifennepinWELL RECORD 5484 6 5 <br /> Minnesota Statutes Chapter 1031 <br /> .yip Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed <br /> + <br /> t 117 23 06 34-Uj01 132' n. 6-29-94 <br /> Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD <br /> 4580 Vilest Branch Road Nano, Mn. 55364 0 Cable Tool 0 Driven 0 Dug <br /> 0 Auger [Rotary 0 Jetted <br /> Show exact location of well'in section grid with"X". Sketch map of well location. 0 <br /> Showing property lines, <br /> N roads and buildings. DRILLING FLUID <br /> I Bentonite <br /> , , ,USE 0 Heating/Cooling <br /> +_ _ _ .,__ _ ja Domestic 0 Monitoring 0 Industry/Commercial <br /> W I , I E i f. 0 Irrigation 0 Public <br /> T �V 0 Test Well 0 Dewatering ❑ Remedial <br /> 0 <br /> I <br /> 2'mi. CASING Drive Shoe? 0 Yes 0 No HOLE DIAM. <br /> --I- --1- ———r- 1L----A ❑ Steel 0 Threaded 0 Welded <br /> I r milr X Plastic 0 <br /> ✓ f <br /> c-S Lc <br /> f J�e A <br /> � 'Ac (---i� CASING DIAMETER WEIGHT <br /> PROPERTY OWNER'S NAME 4 in.to 128 rt. lbs./ft. 7 7, 4, 34. <br /> Dam Hager in.to ft. lbs./ft. 6 1)44013a. <br /> Mailing address if different than property address indicated above. in.to ft. lbs./ft. n.to ft. <br /> SCREEN OPEN HOLE <br /> Make Stainless Steel S=enia. <br /> 4" <br /> t Slot/Gauze 10/10 Length <br /> _ 4 Set between 128 ft.and 132 ft. FITTINGS: 4' <br /> NN V JI- STATIC TER LEVEL <br /> GEOLOGICAL MATEFtIoALS COLOR HARDNESS OF FROM TO ft. [below 0 above land surface Date measured 6-29-94 <br /> MATERIAL <br /> 87 r PUMPING LEVEL(below land surface) <br /> S 0 <br /> Clayft after hrs.pumping g.p.m. <br /> Sand _---- ) S 87' 132 t I WELL HEAD COMPLETION <br /> --- <br /> r-- t L,,. [ Pitless adapter manufacturer tLii E'.r Model <br /> 117•,' ,; — _, iii 0 Casing Protection 1:X12 in.above grade <br /> t�.= '- GROUTING INFORMATION <br /> .. Well grouted? EXYes ❑ No <br /> Grout Material 0 Neat cement L Bentonite <br /> from o 30ft. 2 0 yds. I](bags <br /> from to ft. 0 yds. 0 bags <br /> from to ft. 0 yds. 0 bags <br /> NEARES�ICNOWN SOURCE OFC TAMIN/�JONr C--Y(1'?:( <br /> rf . feet S direction r type <br /> Well disinfected upon completion? X Yes 0 No <br /> PUMP <br /> 0 Not installed Date installed 7-1-94 <br /> Manufacturer's name Myers <br /> Model number HP 3/4 Volts230 <br /> Length of drop pipe 84' ft. Capacity 12 g.p.m. <br /> Pressure Tank Capacity Challenger PC122 <br /> Type: x Submersible 0 L.S.Turbine 0 Reciprocating El Jet 0 <br /> ABANDONED WELLS <br /> Does property have any not in use and not sealed well(s)? 0 Yes 0 X <br /> WELL CONTRACTOR CERTIFICATION <br /> This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. <br /> The information contained in this report is true to the best of my knowledge. <br /> Use a second sheet,if needed DON S'IODtA.A WELL MILL= CO., INC. 27172 <br /> REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name Lic.or Reg.No. <br /> 6-29-94 <br /> Autho ed Representative Si at e'' Date <br /> F.P. MIl+lahon 6-29-94 <br /> Name of Driller Date <br /> LOCAL COPY 5 4 8 4 6 5 HE-01205-04(Rev.5/92) <br />