ML20055B065
| ML20055B065 | |
| Person / Time | |
|---|---|
| Site: | Cook  |
| Issue date: | 07/13/1982 |
| From: | INDIANA MICHIGAN POWER CO. (FORMERLY INDIANA & MICHIG |
| To: | |
| Shared Package | |
| ML20055B064 | List: |
| References | |
| NUDOCS 8207200318 | |
| Download: ML20055B065 (4) | |
Text
4,6 )totiiC AL SU*Viv $AMPL E No.
WATER WELL RECORD MICHIGAN DEPARTMENT ACT 294 PA 19e5
'OF I LOCATION OF WELL -
PUBLIC HEALTH I
F t.m tson Ser tion Numbne town Nominus Mange Numtwe C omig
. Iownsnep N stre
'N d
e Yba,
W S.
f/W.
a
_ _.'t _ _e (
- JO H
ntL :
!t t}*,*=-
{*,
Dist.ent e And Desection feom Road Intersections
.C Cr e.
- 4-Addr ess IN **
%v-ed stre e t addre u & City of Well totation to. at., wIiY"iP n section below Sketch Map:
4 WELL DEPTH: Idornpletedi Date of Coneletion h
CW. %
ft.
1 I
6 C Cable tool Rotary Driven Dug O Hoiio* rod T aetted O so,ed O
i O indusirv 6 USE: O Domesi.c Public SuppiY
- - J l- - -
Irrigation O air Coadeiseasaa Con recciai l
l l
- -1{ ~T~ T -'
OTes Weii y A ( o a, r f_, c \\J Jru _
l 7 C ASING: Threaded [ Wetded O H.ght: Above/BT9N l
.s Deam.
m.==
f t.
Surface d
I
, un r tbs./ ft.
TMICENESS cEPTM TO in. 80 f t. DeDth lWeteht or soTTou oir STRATuu STR Af uu
_._.in to
_ f t. Deoth j Drive Shoe? Yes hNo {'l 2
FORMAT!ON 3 SCREE N:
'- - ~
)
r Type:
Dia.:
si oa so Lenoth u nau,e
/ f <f -
Set between b
ft. and ft.
' ! / ( " : I_
/ / [ ] h
(.
/(p 3
" "'"* i c i + t r a r h-7 S STATIC WATER LEVEL
.h'/A f t. below land surf ace
/
'[
/
to PUMPING LEVEL below and surf ace
_ pa L Lftfaf fem
.p me 9 0.p.m.
m
-)
f t..nf ter ___ hrs. pumping o.p.m.
11 W ATER QUALITY en Parts Per Milleon:
lion (Fel C hlor edes (Cl)
Hardness Other 12 wtLL HE AD COMPLETION: ] in App,oved Pit Pettess Adapter 2** Above Grade 13 weii c, outed?
ves %No O Neai Cernani O senioniie O Depth: F rom f t. to ft.
14 Nea st Source of possible cont ination Q4QJteQiort e(
Type d
1 Well dissnfected upon completeon M Yes E No PUMP; og installed Manuf acturer's Name Model Nurrber HP _ Volts Length of Drop Pipe ft. capacity G.P.M.
T ype:
Submersible Jet O aeciprocaiia0 USE a lisp siett? iFcottotD 16 Henwks elevation. sotace of data, etc.
17 WATER WELL CONTRACTOR'S CERTIFICATION:
This well was drilled under my turisdiction and this report is true Lk C 11/ J to t est of my k
- edQe a te i.
. b.e.. b k (
(y )
/
' d mErsl5TR Aflom ho.
'*f (
k
( g tf f (
h r, REGISTERES SuSINESS 4 AMg
.e, m
N Address (' E II
[ 3 %'
()
A LNk f
da 1
I L
- A D ate Sogned I
D67d 100M (Rev.12 68) 8207200318 820713 PDR ADOCK 05000315 PDR JLLING CONTRACTOR COPY g
~~
~
l c.t utomC At SURVEY SAMPLE No.
WATER WELL RECORD uiCHIGAN OEPARTMENT ACT 294 DA 1965 OF PUBLIC HEALTH l LOCATION OF WcLL ]
C r.oe tv lownship N4:=#
F r.K tion bettien Nurecer Iown Numtser Hange Niandseer a
-fg
/ [4 / Ni h'4 D
8'W.
!Ie f
DesteeK e And Disection from Road intersections 3 OWNER OF nl.LL:,
1Z l: I Address
(
i I.t sn..-t.i.t.i*
- w & C eiv of Well Location
~X Tit.r siiTi"i"Tn se.c t.on belo.
Smetch uap:
4 WELL DEPT,H: (completed) Date of Coneletion t
]
l ft.
4-
. _.1 _ l._ h _.
6 dCable tool
@ notary 6 De svea O Duo O Hoiion rod seited O sored O
t i
- - J l- - -
- 6 USE: O Domestic X Pubisc Suppiv 0 indesitv D irrieainoa u Air Conditionino c on-erc i a' I
)
i
- - 7 - - - - 6 "i-O resi Weii l
7 SING; Threaded k Weided O Height: Above Surf aca
[7 ft.
i un a
[,n,,, Mkt. Depth W
n /
lb s./ f t.
Twicn=tss atein To I eia t 2
FORMATION OF
'0 " 0" C' STRATUM STR ATUM
_ in. to
_ f t. Demth
[ Drive Shoo? Yes Nob 8 SCRE E N:
Tvpe:
M. F.')
? 'I N b De a.:
4
/b Slot /G Lenoth
}
f Set between (/ d ft. and Y f t.
t
- E
/k 4-Ie,
,e l, (\\
g
) '\\
L{}
& 1 u. i t. # b ll's. l,~$ -
^
9 STATIC WATER LEVEL
[
f t. below land surf ace 10 PU6 PING LEVEL below land surf ace b ft after irs. pu e ng g.p. m.
n f t. Af ter _ hrs. pumping g.p.m.
11 WATER GuALITV in Parts Per Million:
tron (Fe)
Chlorsdes (C O Har dnes s Other 12 WELL HE AD COMPLETION: C in Approved Pit Pitless Adapter 12" Above Grade 13 weil c,,,tedi Sves O N.
Neat Cement kBentonite O Depth: F rom /
f t. to k.
f t.
14 Nearest Source of possible contaminat on afrta t
- 8. - Oswe toda l.-
Type Well disinfected upon completion @ Yes
' No 15 PUMP:
..O Nut iasiaiiod Manuf acturer's Name lb
' 3/i
!>-b Model Number 2 b 2f 2 / NP Volts e
Length of Drop Pipe it capacity he.P.M.
Type: hSubnersible M Xdh C Jet O acciprocaitaa use a 2 o swatt & siatoto 16 Remarks. elevation source of data, etc 17 WATER WELL CONTRACTOR'S CERTIFICATION:
This well was drilled under my jurisdiction and this report is true to the best of my knovytedge end,belieff g
g g
REGISTERED SustNES$ N AMC R(61staaficie no.
A ddr es s
./'/i
-s o
t' //
D ate
/
7 Signed Y
D67d 100ki (Rev.12-68)
/
DRILLING CONTRACTOR COPY
t.{Oa OGIC AL $U:NEY SAMPLE fe.
~-
~ ~ ~
~
~
WATER WELL RECORD mCHIGAN DEPARTMENT ACT 2M PA 1965 OF 1 LOCATION OF WELL I PUBLIC HEALTH C oe,rit y townstwp N imo t ras teon Sec tion urntser Iown Number Mange Nunceir
[' / Y'dll0%
h
-44's.
lf -W 'W.
Distance And Direction from Road intersections f
3 OWNLR OF WtLL:
0.*
/4 0.r
./ /
ll
?'E lRA Y ** $ 5 Yh ^K
/
e 7'
5 / Ff '> /
&& ?",",IN * ' _C ?~,f. v.s's '
)
Street address & City of WetPtocation 74
. a./.
O
's Lot are wish "x" in sec tion below Sketch Map:
4 WELL DEPTH: Icomplet ed) Date of Concletion
,f j
h ft. f A :/ )
- _.hl
!l 5)U Cabte toot nota,y 0 Dr.vea O Due (l
l O seiied
.4'-
sored 0
1 Hollow tod 6 USE:
Domestic Public Supply 0 iadusirv i
l l
Irrigation l Air Conditioning Cornnercial
-- - T -
t- - - I""
p,#f,,,,ff,,
/. / c c T. w is l
f 7 C ASiNG: Threadedd Weided I He ig ht-(A bov e,'.B elow g-s D i am.
j
.~g i u.a r Surf ac e 5
ft.
[
. Depth l eight_/
THICRMES5 DEPTM 70 W
bs./ f t.
in. t 2
FORMATION or soTTou or sinaTuu sTnatuu
___ in. to f., Depin i Drive show? Yes No 8 SCRE E N:
.(
-.' t.
f t'
ll,
'~
. s* -
.e Type:
D, a.:
s-s e
-a M'
Slot 4 *prre j d Length 3 --
/,.,eb.
.[
/
Set betweeb Dt. and ~
E' f t.
,s
/
]
Fittings:
?
p
,,r e
c
- e
/..,
9,ST AllC W ATER LEVEL f
. /( i..
[)
/
f t, l'elow land surf ace 10 PUMPING LEVEL betr.w land surf ace buMny.
ft.
t e r _,_,
o g. p. m.
./ / /
f t. af ter _.,_ hrs, pumping e.p.m.
11 WATER QUALITY en Parts Per Million:
tron (F el Chloridas (Cl)
Hardness Other 12 WI.LL HE AD COMP ETION: ] in Approved pit L
Pattess Adapter, '
12 Above Grade vesM No 13 Weii crouted)
O Neai Cenwni sea'oaie Depth: F rom f t, to ft.
14 Nearest source of possible contamination
(
D ivec ts
'Y Type et Well disinfected upon completion hyes No 15 PUMP:
-tailed g o,,
Y Manuf acturer's Name '
Model Number MI(
HP V Its Length of Drop Pipe \\
ft capacity /.A G.P.M.
% /
Type: $ submersible
/ by, s'Jg #
Jet Reciprocating U S E & 2 4o sesE f ? IF ME RCE o 5 Hemarks, elevation, source of data, etc.
17 WATER WELL CONTRACTOR'S CERTIFICATION:
p
./ o This well was drilied under my surisdiction and this report is true
/. ' t' O 7" [.
,/
I, /
[ g /,p ggh in the best of my knowle 1ge and bejhsf.
/
h
.f]
e.
a
<(
.y 4
7 l'
/
/
REfetSTERED GuSINE SS N AME
, RE 5s sf e& TIC 4 h0.
- ). ; 1. at m,d
[,
j./ t /s.*i4 $ j l s r. e t.
a-
,s
- ,# Ya',
- t' Address '
s
()b kb~u.
j,/
!. z r i t a.>.
.//,
/
Date '
Signed D67d 100M (Rev.12 681 AuT ec ni2 E D AL7aESENT A fin t DRILLING CONTRACTOR COPY
UCOLOGICAL $U';VEY 5AM?LE No.
e
??ATER CELL RECORD ciCH GAN DEPARTZENT ACT 294 FA 1965 OF l LotATION OF WELL l
C owney, T.p.
Frec t.on Section No.
Town 9eng.
,W,.
__ W % /
y5.
[/3Mg/
_D stac e And Direct.on from Rood intersections 3 OWNER OF WELL:
D.,..,lW G w%r cas
~ 9-l a - 4 > ~ 1 y- -
I'"'""*-
I V"
t r,/ CGM Ad b
G st xt.u.s s a Cit,.I w.n L.c.v..n A /, 4,,,,
% d 3,'.'. "e m g,
(J.
-),
,. i c
~
g 4 WELL DEPTN. (completed)
Dete of Completion ),
/
Taic utss otrin to 2
F OR M A TION or soffou or sin af uu sinatuu it.
'),/. [ j ~ fq 5
ese to.i O Rotary 0 D,ie.n O 'D..
2 O Noii.. rod 0 ;etted O so,ed O __
/ /,_.
f; e,
, \\
6 USE: O Dom.stic Miic So,pi, O indest,y
~
6 0 irri. tion O Air Coed.tionin, O Commercioi ma /n /.
~r.4
~ ~
O Test weii O c,_
>. '. <,. Ms 7
,'N Threaded Mided O lNei.ht Aboveees
$[/ ft. Depth surface
/
ft.
/
- n. to a
[e
/fe,
- 7 Iweight
.a 2 lb s /f t.
[
- n. to
_Jt. Depth tDrve5ho.SYe:M 8 SCREEN.
Typer t's O d b lb/ Dia..
JD ste,i w e
//
tone,h n '- a n "
s.t6.t..en 3 's f t. on d <j g, f,.
Fitt.ngs:
l
.2 ##
< b". '.. f e _ _
b
_5 * ~ D *
- e i'r 9 STATip WATER LEVEL Z.qg_'Tt. beio. iona so,foc.
10 PUMPlNG LEVEL belo land surface j
S ft. offer hrs. pumping 7)
. p.m.
s,, or,er_ hrs. pompine g.p.m.
I 11 WATER QUAllTY in Ports Per Million:
l I Iron (Fe)
Chlorides (Ci)
N Hardne s a
\\
~I%
I2 WELL NE AD COMPLETlON: O in A,,,o.ed P.t b
k E M i.ss Adapter O w A6o.. c,.d.
il w.il cro.ted? O Yes M 13 GROUTING:
sgy M.teriei. O Neet Co.reent O
j Depth: From 8. ea it.
9 14 SANITARY:
Nearest Sevree of possible contamination aIee Quettip6
'e Type Well disinfected upon completion O Yes N.
15 PUMP:
Monufacturer's Name d
Model Number hh 5
Length of Dro Pipe I b ft. capacity
- 4.P.M.
Type:
metsisi.
O O
2.,
O Reciprocat.nt 16 Romerks, elevation, sovece of date, etc.
17 w ATER WELL CONTR ACTOR'S CERTIFICATION-
~
This well.os drilled under my jurisdiction and this report is tr e u
J
( '^,
'. '4' (
to the 6est of my kne.ied.e ond 6eiief.
.Y_
r, f.,
c j j q _ /);,7,
[]p,3 i
~-
asus te nto susuia ss aws n a s.s ta,io no.
ggg,,,,,f_fW ?
p, f f f) f 1,K 3
?C {jfsf y
cn o._/- Mk Dove 9-o- /f/
i
\\4,g p Si.nea
, u o e aps s.
,,,.,s D170 1004 6-66 DRILLING CONTRACTOR COPY
.