appendix a local water supply well logs -...
TRANSCRIPT
APPENDIX A
LOCAL WATER SUPPLY WELL LOGS
GEOLOGICAL SURVEY NO LJ MICHIGAN DEPARTMENT OF PUBLIC HEALTH
WATER WELL AND PUMP RECORD 111 l[D[ 1111 PERMIT NUMBER t,/
LOCATION OF WEU
I Fraction I Sect ion Number I Town Number IRange Num ber
//l11.d,£11.5E. 1/•I /~. / y N/S' f ~/W
Township Name
0/:, ( . .i!.-<}-I__AX-
3 OWNER OF WELL• J;r(L,,-._. -:;-~ Address 3 /~ /~L
~ _.u, nu. 'Ii·;.> '79
S1'""' ,~r1r1ress & C,tv of we11 Locat,on Addres s Same As Well Locar,on? 0 Yes ~ No
2 FORMATION DESCRIPTION
ft .
9 STA TIC WATER LEVEL:
Q /,, ft , below land surfac e
IO PUMPING LEVEL below land surface
Oth er
[S{' Yes
D No
0 Flow
9' & ft after --L hrs. pumping at _.L.Q G P M
---- ft after ___ hrs. pump,ng at ___ GP M
11 WELL HEAD O P1tless adapter O 12· above grade COMPLETION
- --"- - ----------- --- ------;----- t-----t---- - ---~ O~ B_a_s_e_m_e_n_t n_. f_f5_e_r __ C8,Annrrw?.d ;i,r _ __ -1
~ - -M· n c lo; E l V E D · · rch. Dept. of P , t-.1·-,, ~
12 WELL GROUTEO J D No O Yes From ___ !o ___ ft
D Nea1 cement D Benton11e 0 Other - ------
No of baqs of cement Add,1,ves
13 Nearest sou rc e of possible contamrnat,on A - . ~ ,.1
Type .,,t/,?f' kf.. ,< Dis tance =' 0 ft . Direc tion _/Y.....__,,f.,V""---
Well disinfected upon completion? [& Yes O No
Was old well plugged ? ~ Yes O No
14 PUMP D Not Installed O Pump lnstal lat ,on Only
Manufa r. turer·s name _ _ F._-_..,_y_l_U _______ ____ _ _ Model n•J mber ( ' ~.2 w 7 1-H Length of Drop Pipe L(} L
HP __ / __ Volt s ,l 10 ft . capacity /.,., G.P.M .
TYPE O Submersible l}q' Je t - ---- - - - - -
!---- - - --- - --- -----..;.MLL.c:u.AR ...... lf. __ i!'n'1,r,"1+-" ---1------1 PRESSURE TANK. ., '"'~ '- Manufacturw·s name _.f;_.1"",'""'IJ'-'[...._.iC.="O.._._f _ ____ ~----- -
US£ • 2ND SHEEr 1F ~f .'l. fJ f1 C 1a n 1, n ~ _ , Model number ,~) / d O;}.... Capacity qSJ:., Gallons
15 Remark~. ~levat1on. source of d~CtJP,~ TIONAL" H ,vEm .':'" 1 ~ LA, 0 6. WATER WELL CONTRACTOR 'S CERTIFICATION: ' AL I H-GWQS This well was drilled under my 1urrsdic11on and thi s report ,s true
17. Rig Operator 's Name:
067d 2/89
to the best of my knowledge and belief/I
7,/ J u·.J /.IA,,,,-,v' V.u_,..i fl!./1./, tJ93 ~-- ~GISTEREO 8US1NESS N6MJi. • _ , (! AEgJS TAATI~ NO.
A<Jdre& ] .h1J .,.. r / //_;_ . "\' (/. '-/'/A ~ /
s,7J..o,14,1,/i_.t1LL { 'V t,,/tf?·"rtn ) !P/ 9/9; ... UTHOArzeo AEPAESENT ... TII/E
Authority : Completion : Penalty :
Ac! 368 PA 1978 Required Conviction of a violation of anv provision is a
GEOLOGICAL SURVEY NO D MICHIGAN DEPARTMENT OF PUBLIC HEALTH
WATER WELL AND PUMP RECORD I i l IITJI I l I I PERMIT NUMBER
1 LOCATION OF WELL Counry Township Name
J lMC!IOn .I Sec rion Number I Town Number I Rang7umb~W
O,,.:.·.:. () WI• .,,. ..,.
/ ;j/ N/~ n~,,.,,3,.., 1"" A S!:v. Al.c11. / ;_ Distance And D 1rect 1o11 From Road Intersec ti on 3 OWNER OF WELL:
0 S2:; 95th Avenue D i:, :i Prich3.rd -Address 952d - J st:1. :\ve.
-C:v:i. .:-t, ?}i. 4) 6 31 S1ree1 ALl (l r~, 5 & Ci ly of W~li Locorion Address Same As Well Loc~t,on' ,.,Q YP.s D No
L oca l e wirh · "<. • 1~ S1::1 c l•an Belo w Sket ch Map , 4 WELL DEPTH: 1 Date Completed ' ~ ~
I. I MO I o,v ' veAR , New Well
l L I 1 ) 2 FT
I I I ;;; '.)1~: 0 Replacement Well I I I . . ·' ~ . I (,,,,.._. I _ _ J _ _ I _ I \ I ~ ·' ,. 5 Q.eable 1001 Q,-,rotar-,
--I J.I
-,-- ,'t- D Dr•v~n D oug
I I I I\. 0 Holl ow rod 0 Auger O Je1:~(1 D ..., ... - .J - ·- ·..I- - _ ,_ - - E V 6 US E ~ 0 Type : Publ ic 0 Type Ill Puchc I I I T I\.; es tic y'v- . ;., 0 tmgal1t)n 0 Type ;la Public 0 Heat pump I I l ' ' \ ,- - -1- - T - - ,- - ! Ml . 0 Tesl Well 0 Type lib Publoc D I I I J_ I
7 CASING ~eaded
I I I I D1ame1er S1eel I Heighr .i. b ove / B.e.lla--
~I .. 0 Plasti c 0 Wel de,1 MILE:
-I-in : Su rface-./-- fl
THICKNESS DEPTH TO 1oq11 deprh 2 FORMATION DESCRIPTION OF BOTTOM OF 1
We1gh1 ___ lbs.lit
STRATUM STRATUM ___ in. ro ___ Ir. depth I ~ Groured Drill Hole Oiam erer
( hi u q, ~ ',/ I/ :; I 7'-I 74. + 1n . to ,4}..tJ... It depth I Drive Shoe
I D No in to fl . depth
f:!. v{ ,1 J 8 SCREEN· D Nor lnstelled
0 I
,; " 'J ) 1>, · J l.oiamere r I ,, c/:_; - 7__/" ,,,. ..!.. Type < //
I 7
L:~ ..,.. ,
/~i /., ./ d ,· /~: ,,,,. ;~ ;' Slor / ~ Length ;::/ ,., , ) /i !.. :.:: 7 /s/2 . ~ - ,.., . .. ,/ .. .. / . Set belween 11. and Ir
/<;f Jr! /a FITTINGS B'K-Pa~~er D Lead Packer D Bremer Chec k
/I G's1ank above screen ~ It 01her - 9 STATIC WATER LEVEL·
:~ ,, .. ... L ,r tr below land surface D now
ltfir~1 / ... r- I :; ~ 10 PUMPING LEVEL belcw land surface I .. ·)~p
'• : ·:i .... 6_;,. , :.-.. ::a r-:-~-
. ,/
.6. 2 It. after ,J. hrs pumoong at _LQ_ G PM
tr alter __ hrs oumping at ___ G.P M . .)FD 1. "\ <q.~ _, _, .
:-1~,:_~~,.'i:j :};" ;.:t. 11!,=t~ j;.: tt .:, .. · ,, ., •: ~; u;a"( \j . i-ir..:·\u ,·
U!! A ZNO 5HEU If NCCOCO
15. Remarks. elevation. source of data. etc.
, 7. Aig Opern1or·s Name/ J ~ ff (;- .. , / 0 () 6 , .;.:, [, 067d 2/89
11 WELL HEAO ,!less adap1er 0 12· abovP. grade COMPLETION
0 l:!asemenr off set 0 Approved p,r . . I f'/ ! 12 WELL GROUTED> 0 ~s -F~~;,,.·-:zz_ 10 /-Y ·cJ. Ii .
- 1/wu.e: No
D Neat c ement ~tonite D Other
No of bags of c emenr _LQ_ Addit,ves
13 Nearesl source olr;ss1ble con1am1nat1on _.,,. Type < "- ,., I ' Oistance b 0 tr. Direction ).) ;..---
Well disinfected [upon completion? ca-v;; 0 No
Was old well plugged? 0 Yes 0 No
14 PUMP D Not lnsralled 0 Pump Installation Only
Manufacwrer's name tJ. !. ',' •,:i. ,l t :) / Model number if . ........ Q HP
y., Vol rs .J. r d
Lengrh of Drop Pipe / ( I t. capacity .!./:' G.P.M.
TYPE ~ m ers,ble 0 Jet
PRESSURE TANK.. x· - f,,. o I Manufacturer 's name
Medel number l;jj:.J...;) (J. & r.anar.1ry .f/ 2-. Gallons
16. WATER WELL CONTRACTOR'S CERTIFICATION:
:at
Th,s well was drilled under my 1urisdict,on and this report ,s rrue 10 rhe besr of my knowledge and belief
1Y~L~ro:1 :·I.all 1Jrillin:.J 09iJ7 REGISTERED BUSINESS NAME I REGISTAA, TION NO.
Addr.Q170 - ,,,-1 nile :ad. - EVa.J:"t, ~u. Signed i<f fth_}~/ l~t.rvYo.te
UTHORIZEO REPRESENTATIVE A1nhorlty: Completion: Penalty: .. .. ..
b / i t/J~ ~ -Act 368 PA 1978 Required Conviction of a violation of any provision is a
'
:-.,:;.. .
J
DE-1 (MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY DRIN1<1NG WATER & RADIOLOGICAL PROTECTION DIVISION
•; TAX NO: WATER WELL AND PUMP RECORD PERMIT NO:
C. '7 1 ..,_, €. Completion is required under authority of Part 127 Act 368 PA 1978
1. LOCATION OF WELL Failure to comply is a misdemeanor 98- -0')()7 Co11nty Township Name ! Fraction
I Section No.
I Town No. I Range No.
Osceola ()~--,.. 1., ~T,' 1/4 < Vl/4 C'T.71/4 It:. , t) .. 0 n
Distance and Direction from Road Intersection 3. OWNER OF WELL
Address Michael Fo.5ter 9057 95th Avenue Evart, MI. 49631
Stree t Address & Cit):'. ol Well Loca1lon G'lti\ AvPrllt<-> Address Same as Well Location 0 Yes 0 No
:t.l .&3
.. Locate with ·x · ,n Section Below Sketch Map 4 , WELL DEPTH: Dale Completed New Well • /fr r,
I I I It I I~- I ~~'r-' u Reolacement Well ''
- --4- - i- .j_ - 5 . CJ Cao,e Tool ~ Rotary 0 o,.ven Doug
I i I [J Hollow Roe 0 Al;ger/Bored 0 Je::ec D w ..._ r-- ' T i .T ~ Housenold
,--, 0 Tyoe Ill Public 6 USE : U Type I Public
~J.. I L- 1 0 lrriga:,on 0 Type Ila Public 0 Hea: Pump - 1-
I i I 0 Tesc Weil 0 Type lib Public D Os,ee1 0Threaded I ,~u--:---i 7 CASING: Heigrn: AbovelQelQw
r . , ,. l . : Ii'.]' Plastic 5'J Welded ·' J ft Surface: 2. FORMATION DESCRIPTION THICKNESS O~PTHTO Ooit,e, Of, ijOT:OM QF
STRATU~ ST~ATUM Diamecer: ,- .
to ...l.i:J1_it. depth Weight : 5/.)t .' 7 lbsJlt. _____;:i__ ,n.
"··' . 10 I g ·11. depth <"..., I ul I
R,- • I "?" I I ~1n.
'"'.1"' BOREHOLE: LJ Drive Shoe - - " - -- . lo 1::r-c, ft. uwµtl, 0 Sh:\le P111;k11r I"' )111 ,, P,_,, .. I . I Dio.111ctor: ~In.
I ...,,
~ --In. to -1l!J1. depth - ' , · I " I ~'11 1Jd : ~ / d ,, I 4x I /"..;JI 8. SCREEN: 0 Not Installed 12! Gravel- PacKed - . ,.., .
r/n'. ! Type c::,7 .,, ,,Ir · ~ .s.ltiJ__ Diameter "R I 4 f"I
~
Sloci.Gau;.ie LO Length: c-: <111 .. ,l , I r:,,. t/ J ( I l6C t't-: I Set Between ft. and II. . ··' FITilNGS: (11 K-P.ir.kP.r 0 Bremer Check ' ~ Blank Above Screen 3 ft. Other
9. STATIC WATER LEVEL:
'. ':t; ft. Below Land Surface 0 Flowing
.· 1 O. PUMPING LEVEL: Below Land Surface
. ~S- ft. Airer ___ L._.hrs. Pumping at !D G.P.M .
l I 0 Plunger CJ Bailer 0 Air 00Test Pump I
1 1 . WELL hEAD COMPLETION:
@ Pitless Adaorer 0 1 2" Above Grade
0 Basement Oifset 0 Well House
0No ~Yes From -G-to_/.:iµ)ft. , 2. WELL GROUTED?
0 Neat Cement Ip] Bento~ite Oothe,
:;. ·,· I : . ~ .'' ': No.o·f Bags ! Additives ... . . t 3. NEAREST SOURCE OF POSSIBLE CONTAMINATION: --
/ Type__ "fµ.1..LL_. Distance $() t ft. Direction ltd ·' Type -- -- .
Distance ft. Direction USE A 2ND SHEET IF NEEDED
1 4 . PUMP: 0 Not Installed • CJ Pump Installation Only 15 , ABANDONED WELL PLUGGED? 0 Yes D No
Manufacturer's Name f:' , Y. L ;;ii,
i Casing Diameter ______ _in. Depth---·-· IL
I Model Number ...::.J. ,CI f\ fl()'):~ HP J/-4 Volts dtl U PLUGGING MATERIAL: 0 Neat Cemen! 0 Ben ton, ,e Si urry Langth oi Drop P:pe __ J.!f[:.__.ft Capacity ID G.P. M. I
0 0 Concrete Grout 0 l I Cement/Bentonite Slurry B"n torn te Chips TYPE: ~ Suomersib!e O Jet Dorr.er
No.of Bags Casing Removed? 0 Yes 0 No PRESSURE TANK:
I 1s. REMARKS: (Elevation, Sour,:e of Data. etc.) . Manufaciurer's Name ___ _Lljf / I v - Tl'c. I I
II · &
I 17. DRILLING MACHINE OPERA TOR:
~Employee D Subcontractor
Name ___ £.A.t l 1° Da rJ. IC ·-
\D~ 7
18
: Model Number t...l { \ ;J .;(} Capacity Gallons /I . ~ ..
WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled Jnder my fUrisdrctior. ar,d ,h,s report is tr\.e to the best of my . knowledge and b~lief
t.utf/~ S, S l.:\t.91, !:'.'. l/ 3 · / 79 2 REGISTEREO BUSINESS N.AJ,IE ReGISTAATIOll 110.
Address rzt:11 · Mt -~b.-· _ch,.'1$.c_f
Signed. _ ___,1_..\J..,...u..,,,LM ..... I...__/...,._b11 .... w.=-.~=' c...,"i.,...--__ _ Oate _ __.fw.0'-"/c...;.:J .J:..." -1-/ ...:..~1 ,,._~_ ( I AUTHORIZED REPRESENT A rove
1°', • .• · ··,. ' l:-1 lf:,.:t\ ; ; •.t ,·'; \:.:i·; EQP 2017 (12/96)
l
DE.:}. MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY DRINKING WATER & RADIOLOGICAL PROTECTION DIVISION
TAX NO: WATER WELL AND PUMP RECORD PERMIT NO:
1. LOCATION OF WELL
Completion is required under authority of Part 127 Act 368 PA 1978 Failure to comply is a misdemeanor '98- -0089
County Township Name Town No. Range No.
Osceola Distance and Direction from Road Intersection ~ \,-)
'\{ j\~ .\ v ''N," ~\. , c{.'<:: 0 ~~~\l '°' OWNEROFWELL K -1 B Address - ev .... n eggs
, \~ \J ~(\\.-.. S · c1"' 6\ ' !' ; .
v -· Street Address & Cit of Well Location '-1 \
. .... ,•
... , I~ •.
I \ l . ' l.
7595 80th Avenue Evart; i'lI. 49641
Address Same as Well Location O Yes ~ No
Locate with ·x· in Section Below " I
+ - 1- .j._
I I I T~1 -1-1- L
• 1----1 .. u~
1 2. FORMATION DESCRIPTION
• .... ·--
. ~ . ,'
L:.J (. ')
::_1
,(~ . . .; ~
,,.. ·-...,.91ietch Map
\
J . I \ \ . \,\ \ ' ).· ·~--- 1 . .
THICSNESS Of
STRATUM
.- .
DEPTH TO BOTTO"' OF
STRATUM
4 , New Well
Reolacement Well
5 Rotary Doug I :')Lger:Sored
7 . CASING: 0 Steel O Threaded
~ Plastic O Welded
Oolher 'Jd _ Diameter: ,_.,S___in. t --2.:_11. dep1h
in, to __ ft. depth
o __ D Type !fl Public
D Heac Pump
0 Height: A~o
Surface: l · :) It
Weight : lbs/ft.
BORE HOLE: 0 Drive Shoe
Diameter: ~iri. co I } <.pit. depth D Shale Packer
in. co __ rt. depth
8. SCRE~l.\.....0 ~or installed ,:· 0Gravel-Pa:C~ . Type - -\ _ , - \ L::.-' Diameter .>6 SloYGauz~ _ _ ..9._Q_r~...------ Le,h:_~_._--..-_\ __ _
Ser Between \ \ G Ir. and \ 1j It,
FITTINGS: =E:!K-Pilr.~r O Aremer('lt'leJ:11... Sv l";Q 'lJ Blank Above Screen .,;J. fc . Other .;I.~
9. ST11C WATER LEVEL:
_ 0 It. Below Land Surface 0 Flowing
1 O. PUMPING LEVEL: Below Land Surface
··-· --··- - .. _ft.After_ =>4. Pumping a1 ____ G.P.M .
0 PlunQer O Bai ler - CJ Air O Test Pump
r- .. -~--6-; .. ... ~.~. 1 !~ELL 1"1EAD COMPLETION:
~~-----=-:.:..·.:.:.· __ ._,_.,;._ ___________ _,1--- --,:-----I - 0 Pitless Adapter X
0 1 2" Above Grade
0 Well House
J 6 ' ·. 0 Basement Offset
1 2 . WELL GROUTED?
0 ·Neat Cement
No. of Bags \ C)
0 No 0 Ye~
~enconite
Additives
From to -~---_It. Dottier ____ _
13 . NEAREST{5QURCEOFPOSSIBLECONTAMINATION: V'J ~ L---------------- -----------+-----1-----1 Type:S:-~''- ··--· Distance li~ ft . Direction l-~ \
Type ____ ... __ -·· Distance fl. Direction
I :5 .
USE A 2ND SHE a IF NEEDED
ABANDONED WELL PLUGGED? 0 Yes O No
Casing Diameter ____ in.
PLUGGING MATERIAL:
0 CemenuBentonite Slurry
No.of Bags
Depth ____ ft.
0 Neat Cement
0 Cor.crece Grout
Casing Removed? 1-----
16 . REMARKS: (Elevation. Source of Data. etc.;
I 7. DRILLING MACHINE OPERATOR:
~Em:!ee O 5:!·~')tra:!S-· Name ~~:,JIM ~.)t}~~
\.J~(.L ) b ~ t.f
0 Ben,onite Slurry
D Bi,ntonite Chips
0 Yes O Na
14 . PUMP: 0 Nor Installed O Pvmp Installation Only
Manufacturer's Na/1'\.e~ '5. , \ ,\ Model Nut;1ber"-' ~"'\~._.
1 \1:5 ·- - HP_"...,l....---Vol!S~
Length of Drop P:pe ~~ft. Capacity , -~ ~r:-'M. TYPE: · ..i:) Submersible O Jet O Other __ , ____ _
PRESSURE TANK:
Mar ... ractL;rer's M.ime-1"'~~-F--'.-W._..,_-=
Model Number
18 . WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdict1or. and !his report is true to the best of my . knowledge a d belief.
(~ 1
~O!STRA~~O." iS
s ,gned--.J~~~~-+ll~~~c::::..... _____ o.<e~~ ~ EOP 2017 (12/96)
]GEOLOGICAL SURVEY SAMPLE No.
1 1 LOCATION OF WELL I
[DDJDI I I I IITJIT I I WATER WELL RECORD MICHIGAN DEPARTMENT
ACT 294 PA 1965
Fraction
OF PUBLIC HEAL TH
, !Section No. !Town I Rango
!4 £~ J ~ I SI Nl j . S" (/W . Distance And Direction from Rood lnTorsections ,.
1----------..
1 ~-O~W~N:.:.::.E~R~N~o~·========:::.l.
l Street oddress & Ci IY of Well Location
I 2 FORMATION THICKNESS
OF STRATUM
DEPTH TO BOTTOM OF' STRATUM
4 WELL DEPTH: (completed)
Ft .
Date of Completion
1 5 )cl Cable tool O Rotarv O Driven O Dug
0 Hollow rod O Jetted O Borod 0 I-------- -------------- - --+-- ----+-----!--:--- -==-- - - --==,------..::;~_;__;_ __ _;::=-:;;:::~ 6 USE :,C@. Domestic O Public Supply O Industry
16 Remarks, elevation, source of data, etc.
~ .. ... _ ...
IOOM 6•66 '
0 Irrigation O Air Conditioning O Commercial
l---:=,..,-;;~D:;_T.:...::.:es::.:t_;_W:.:..:e:,.:l.:...I -=o=--====::;;:=========-l '' 7 C ASING : 0 0 I Diam . Threaded Welded Height: Above/Below
I . 7!/-in. to __ ft. Depth \ surface ft:
I Weight lbs/ ft . :
1 Drive Shoe? Y esO NoO ~ ---1t. Deoth --in. to
8 SCREEN: :r T ~ ype: ___________ Dia.: ________ _
Slot/Gouze _ ___ _ ____ Length _______ _
Ser between ____ ft. ond ____ __.h.
Fittings:
9 STATIC WATER LEVEL
ft. below I and surfac e
10 PUMPING LEVEL be low l .. nd surfac" :
_____ ft. afte, __ hrs . pumping ______ ..,n,p.m. ;
-----Ft. ofter--hrs, pumpinnlJ.----- --Q.p.m. : ;
11 WATER QUALITY in Ports Per Million: ; Iron (Fe), ______ Chlorides (Cl)---------=!
; Hardness. _____ _ '
12 WELL HEAD COMPLETION : D In Approved Pit
0 Pitless Adopter D 12" Above Grade
;
! 13 GROUTING:
Well Grouted? 0 Yes 0 Na
Material: 0 Neat Cement D Depth: From__ft. to __ ft.
14 SANITARY:
Nearest Source of possible contamination ___ feel ___ Oirection _______ Type
Well disinfected upon completion O Yes O No
15 PUMP : Manufacturer's Nome _______________ _
Model Number __________ H P.-------Length of Drop Pipe ___ ft. capocity ___ G.P.M .
Type: 0 Submersibl<t O --·----------0 Jet O R11ci ptocotlnq
17 WATER WELL CONTRACTOR'S CERTIFICATION:
This well was drilled under my jurisdiction and this report is tru<t to the best of my knowl<tdge ond belief. /) 8 tt _
/l / ~ /2, )n .H?-7 / - ,..- - ,- ~ ..., AEGl.3T~RE.O BUSINESS NAME flEGISTRAttOH---HO.
Addrus~4Citl'r/~Tp-/ <~,£.. ///,; ¢ ~ft-0/ Sign•./ Dote//. ~ c., / q / t/, :J
.._A-UT-HO-,.-, Z:- EQ- ,.E-P,.-E-SE-N 1'- A-TI-YE___ ( /
i I
:.\ GEOLOGICAL SUHVl:Y NO
DC:· I. ·,' .. l ~ MICHIGAN DEPARTMENT OF PUBLIC HEAL TH
WATER WELL AND PUMP RECORD I I IJ I.__._______. PERMIT NUMBER
i>Ai1T 127 ACT 368 ? .~ 1978 LOCATION OF WELL
w
I I >, /.-,-.11 - ~ - -:- -:- - ------1H-----------i S O dc1e ,oo, ~ry ~ Dug
I I I O Hollow 'Od O Auger LJ Jet t'ed ·_j __ _
- ...J- - t - -:- - cT 6 USE ~"': .- 0 Tvpe I ?,ioh: 0 Type" ~,Dk
I \ \ LJ ''' ,Ja'. o,, 0 Type Ila ?uoi.c O Hear ~u,..·D
- -1- - T - - ,- - i """1
• 0 T~.;,' 'v\Jt?1I O Tvoe llb Puo!:.:- 0 I I J_ I ;I.'#Y - ; .,ti.·~ ' CAS,NG ~ r, • ._.
1 " A /.'"ft•-... '--...;_ _ __. __ ..__..., c.,rt;;, / ~p~ ..__ Didme:c, • ~ 1:1ade<J I He •g•1I bove~
1-t::=:;..!,' .:""~'sL;.;E~==:=;... __________ l_!..~--..:.--:-----~ I P~.asr,c Welded • j__ ") ,. ' Surlaca t, fHICKNESS DEPTH TO _._ '" IC l dep1h I -::1 • ') ,-
2 FORMATION DESCRIPTION OF BOTTOM OF I We,gh! ~ lbs ft STRATUM STRATUM --- ,n 10 -- fl dep(h
, .. _, .--.....
. -... ,·--~ -· . ' . . "'"-.. . ·,
..- t.G,·, ... ...,._
[;c7fil TO riOP<
~· -~t _;;1 - .. --:., .. , ' .. ........ -·· ·
,.•.
1. I.,. I I
Grouted Orrll Hole O,ame!er I ,n 10 __ 11 depth \ Drove Shoe
__ ,n 10 __ fl deorh I !?Mes 0 No
8 SCREEN O Not Installed
Tvpe ::J"oJ,~o,amew I ;l; /.I S101:G.;i- "7 Len·g1h --~..c::..:. _____ _
Set betw.aen 9 Z II and _-4--....._""',... FITTINGS ~lacker 0 mer Check
fl below lond surlijc" 0 Flow
below land surface
?~ fl al!er + hrs pumping at -II- G,P M
---- fl after __ hrs pump,ng at ___ G.P M
I I WELL HEAD COMPLET!ON
I c WELL GROLJ TEO-'
0 f',tle~ s adaoter
D Basement offset
~hove grade
0 AoorOved _PU
CJ, 0 ·y~·s·, From•_· .. _,. __ . t~· -· __ ,. _ It
0 Other-------
No of ba s ol r.cmcn! ___ Addot,ves
13 eare1 t ~ource of ooss,ble ~on1am,na 11or. ., .
Tvoe.$ ~//& , ,(.¥1?7-i/Noorec!IOn __
Well d,s,nfec,ed upon comple11on I ~ 0 No
14 PUMP ~ installed O· Pump lnsrnlla11or, Only
Mar.uta,:!urer s nam~ - ~--- -------------
ModHI number----- -- HP ____ Vall s -----
Length al o,oo Poe----- f: caoac-tv ------ G O M
TYPE [J Suhmer,;;ot?. D Je: --------PRESSURE TANK
Man•Jfaccurer 5 name------------------
Mode! number
16 WATER WELL CONTRACTOR'S CERTIFICATION Th s well wac; drilled ~nder my 1ur,sd1ct1on and th •s r'!'cor! •s :·ue ro :n~ oest of my knowledge and bel ief
--~--Er,1~:2-te&,) s; nda~f/P Address~??/~ #,1';9 ~r'~~ S,gre1 _Af#z~frfvr«'-9oa1e t f'3~ =; 5LJ ~
. ..
TAX NO: f, 7-1 ')-{11 Q_/)()L,._()()
,. LOCATION 0~ WELL
Callnty
f\oron1<>
DE~ MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY DRINKING WATER & RADIOLOGICAL PROTECTION DIVISION
WATER WELL AND PUMP RECORD Completion is required under authority of Part 127 Act 368 PA 1978
Failure to comply is a misdemeanor
Township Name 1 Fracuon I Secuon No.
(\,,,...,,..,, " 1/4 1/4 1/4 1 n
PERMIT NO:
98 .()L,._nr1,q,i:.
I Town No. I Range No.
'T' l t)~T
,... ___
Distance and Direclion lrom Road Intersection 3 . OWNER OF WELL Pete Grusz~cki ~ q I'""-".. ,,..,; .. t,__.~,4 I Io d__ Addrnss 3785 Willow Drive r, t,,. r,
·l~ . i.,_.. .;{' I , r:,.-;,1-f Grand Rapide, MI. 49525 ... .,,·~ Stree1 Address & C11v or Well Locailon a \f-!1.:> Qnn.-1 Address Same as Weil Locauan 0 Yes l:J No
Locace wich ·x· in Section Below .211 Sketch Map 4. WELIDH: . l )).rte C;pleted ,~ New Well . - (.,.,. It. · I : I ,Cf} 0 Replacement Well I I I : -1- i.- - · o 0 Cable Tool 15Ratary 0 Driven Doug - -,... / . I 5 ,
i I I 0 Hallow Rod D Ac.ger/Bored 0 Jer.ed D I .1~-~ .. L...- -r-r- • "T .T 6 . USE: ,a' Householc 0 T fpe I Public 0 Type Ill Public
:.-- .J. -1- .L- - T"''· 'I ·1 L
0 Irrigation U Type Ila Public 0 Heac Pump
I I I l 1_., --'~--~ Orest Weil CJ Type lib Public 0 Osceel .0 Threaceo
/ ' I • 7 • CASING: Heighi~~'!jiBelow , .... '='~
;{J Plastic O Welded Surface: ft THICKNESS DEPTH TO
<- or UUI !UM OF STRATUM STRATUM
ronMATION DE,:ION 1 ~Other Diameter: in. co7 0 it. depth Weight: lbs/ft. --- --
Q_ 1 3o .)o _ __ ,n. iO __ ft. depth
BORE HO:$ I . J_ - 0 Drive Shoe ./ 0. D1ame1er:u_!j.._in. 1 Cl ft . depth 0 Shale Packer , _.,,. L/ 0 1 0
.__ a,, rr_.. () d Q . in. !O ft. depth
\O 0 8. SCRE~ Not~ ~Gra~el-Pack~ C I I Type . ,._ . - O,ameter ... I
SloVGauze ___ ) -.) - --= Lengch: I 0 Sec Between It.and ft . FITTINGS· nK-Packer O sremer~
(._) D Blank Above Screen ft. Other
' l,;J <,,
9. STLTIC WATER LEVEL: .. 0 Flowing . - . ._, ~ 0 ft. Below Land Surlace
' . . ~ ~ .. .. - 1 0. PUMPING LEVEL: Below Land Surface J) ' _LO _ ___ ft. Alter f l:lrs. Pumping at G.P.M. ' --- :~ I ·.~.
0 Plungvrr: 0 Bailer ,g) Air DTest Pump (
.. -~ ·· 4···· . ..
I 11 . WELL i:1EAD COMPLETION:
·- ~ Pidess Adapter D 12" Above Grade , . .,. . . D Basement Of/set 0 Well House _ ... ,
..J 0No ~Yes Frame) 7u _ .j 1 2. WELL GROUTED? to ___ ft.
5? Neat ~e":tJ [irBentoni te JJ~-;-: ·. Addl!ives -~ '(' ·1..; \ ::i ~ No.a/Bags · Ao A
13. NEA~CEOF POSSIBLECONTAMINATION: 1
,_ Type · _ Distance .. l.- ft. Direction ..5
/' Type . .. - Discance ft. Direction USE A 2ND SHEET IF NEEDED
1 4 . PUMP: D Noc :Th 0 ,fump lnscallation Only ABANDONED WELL PUJGGEO? D Ye{ D 15 . No
Manufacturer's Name ..:i.. ...,,_:::r~ I Casing Diameter ____ in. Depth _____ ft.
Madel NurT1ber HP 'l 1_ VOits l ?. Z, PLUGGING MATERIAL: 0 Neat Cement 0 Bentonite Siurry Length of Drop Pipe i --s--··-.,-1.- Capacity I 0 G.P.M. 0 CemenvBentonite Slurry D Concrete Grout 0 B1,ntonite Chips TYPE: ~uomersible 0 Jec Ooeher No.of Bags Casing Removed? 0 'les 0 No PRESSURE TANK: . -,. /) ~ L
. l.,.~ y. l,.J 16 . REMARKS: (!:levarion, Source of Data. ere.} Manufacturer':; Name,___ . - ' ·
i Model Number .l_Q__ l,, C.:apacily~Gallons
18, WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled ~nder my jurisdiction and this report 1s m;e ,o the besc of my. knowledge and belief
nol -I. ~ 17 . DRILLING MACHINE OPERA TOR: 1\n0°0
r1( l 1r, l1 I .Y/'°) (/ 0 Empie yee O Subcon1ra1;,r REG1&Tl!l'ft;O trosmess NAME /), • / ~ v ~ ReGtSTRAT!Ol'I NO.
/; . ( 1 ' \ i Name r fl. '"-Address J / 5 J ~ ~--·: J I , ,:: ..... I_ ~f-'i""'.:. V r- - l ·----- .. ·-·-
' ,, . ..... 1 . - . \.JE.LL I D = 2 S-
Signed ., ___ , Date
.-. ,_.. ,_ , r , •.,,..._" I ,:.·, 1 •:,\, ~··./ .- r· ::, •;
"r1-)t---~ EQP 2017 (12/96)
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u,. --~•'-AL SURVEY SAMPLi: No.
FEB 2 2 1980 1 LOCATION OF WELL I
I---,
2 FORMATION
[0[001 I I I IDJ[I I l WATER WELL RECORD MICHIGAN DEPARTMENT
OF ACT 294 PA 1!)65
PUBLIC HEAL TH
!Town Numb~r I R.inge Number
/Jr" ' t:, . -.. N,~. ,.:5 A :w.
/ - rt. 9 - / I - 7 c; ~- --"'- ~~~---------------------1 5 0 C1bl~ tooi A[] Rotary O Driv~n 0 Du~
O Hollow r(Jd O Jettf.ed D aored D ----==-====-i 6 USE : ;K)oun,~$11<'. D Public Supply D Industry
0 lrriy;.t,on O Air Conditi0n111-a 0 Qr.,st WHII 0
THICKNESS DEPTH ro OF BOTTOM OF
7 CASING: TIHL:,l<lut.~ Vv't:: 1ded O I H~t~Jlil : .l.Uuv~1~ Di.un. I /
I Surf Jc" __.c ___ ft.
.-. e:;y -171--< i11. to L.2......ft. Denth l Weighi-,_.:._lbs . .' ft.
STRATUM STRATUM ------- -·----- ·- - 1n. to ft. D"Pth I Drive Shoe> Yes.Kl No n -----i-.a~s=c=R=E~-EN :
// ,( : / ,(/ te,.·,. ~ \.
-
v ()
I
/5 I
,, /•,-_,
1 I
=-'. ~, ,.
I .:J- I
I I t.7
,f ,,
/
,::/3
3J /
&, c:; /
7,;;_ I
f7 I
le>;;
Tv~-1t...,,c.rµ-c..L D a.: -~/-)!__,_{._· '_· ----Slot.'Gnule b er Length -~Y'-"'-1"_-_,_· _____ _ S,,r belw~en 9 J;·· ft. and IO v ft,
F, ttings:
9 STATIC WATER LEVEL
I/ { ft. below land surface
10 PUMPING LEVEL below land surface
'-1-t.1 ft, after j__ hrs. pumping / C.l g.p,m,
--- ft. after hrs, pumping g.o.m.
11 WATER QUALITY in Parts Per Million:
I
Iron \Fe) _____ 7 /ides ICll
Hardness Othe,
12 WELL HEAD COMPLETION: 0 In Approved Pit
n Pi Liess Adopter J('] 1 2" Above Grade•
( 13 Well Groutad?O~t: , No
'- _[] N•rnt Cement c ntonitc L---------- --------------1-------1-----~ o ______ _
.:lepth: From ft. to ft .
14 Nearest Source of possible contamination
1----~ ~feet ,qi.$ Direction 0 e,() T/ C Type
Well disinfacted upon completion :'.S<'lve: 0 No
US[ A 2ND 5HF.f:T :, NEE.OtP 1.....-
16 Rem.irks. elevation, source of doto. etc.
"''f)(O fNFO flY DRILLER. HEM NO.
'CORRf:CTEO BY ST •"ADDITION BY
ELEVATION
DEPTH TO ROCK
~---------------- -----------' 067d 100M IR.,v. 12·681
W£LL ~Cl"\I r'lr':. l r A I
15 PUMP: ;(} N~t i nstalled
Manufacturer's Name---- ----- --------
Model Number ________ HP __ Volts
Length of Drop Pipe ___ ft. capacity __ G.P.M.
Typu: 0 Submersibl,a
D Jet 0 Reciprocating
17 W.A.TER WELL CONTRACTOR'S .CERTIFICATION: rh is \veil wns drilled under my jurisdiction anj{,this r~POft s true
'W !CE~Cl2~~WJ:.Vi A5!A..du-;,.-<j - C79 3S~ '1£G ISTE RED 9USINESS NAME REGISTRA1 10N NO .
Add, .. s&?/·a.J'. /JJ '/y?-3/
C:1 I PV V rr..ov
1-
GEOLOGICAL"SUAVEY NO. D MICHIGAN DEPARTMENT OF PUBLIC HEAL TH
WATER WELL AND PUMP RECORD I I I !OJI 1111 PERMIT NUMBER
1 LOCAJ!ON OF WEL L
Co.unty / J J [ ,, .5 C. .::. cJ A
Townr, ,Name ]
U~ C. to A I Fraction ,,.E -J 1/4.) 1:.
,;; , - 'Sec1ion/)u. ber 1·Town0
~uyber
1/4 .} t: 1/4 ;J _./ I ?f N/'s I Rang~um ber
.. '6/w OWNER OF WELL: £ 11/tJ f JI[) / s (.' ,._/
"'::/ 1· . .[)1.-1,' :J r/\ ' . ~
_. ~ ;''·\ , C j
Distance And Directrqn From Road ln1ersec110.;,
I /. .. / .-\\/()(Jr)-, ! I ··;.. ) <.-' • 7 • " : ·>;-·_,-!/ /Yr~ / f A ~ 1d L
Pd.. 3
Address
j:I."~·'' '
Streel Address & City of Well Locot,on Address Same As Well Location? ~,,. 0 No '1-L:-o-c-a-,e-w-H-:-h-:.-:-:x-=-· -,n""'s=-e-c-:-1-,0-n-:8::-e-:-lo-w-----------S:-k-e-lc_h_M_a_p------+-4-,,WcoE:-cL-:-L-::D::c:E:-::P-=T:-H.-· --:,-::0:-a-,e- C""o- m- pleted ' r.;;r:
N , ~o. 1 oAv , -.;e"R t L-J New Well
L I ' I ; ·17 I~ 11·1•\,(.j10 I I I -:" r FT. 1 / 1 , I -? 1 1 Replacement Well
_ J. __ I_ -:- _ ..._ i 5 0'cable rc.,1 E:fAotary O Dnven O Dug
: : I ;0
\ 0 Hollow ,nn O A,tQnr O Jelled D
1
w - - ii_,_ ~II - -1:- - - cT ' \. x' ,~, J < 6 USE· [1oomac. t,c
... ..-,,,,< 0 lmga11on
~--1
1
1--~
1
--
1
:-.~- J_\"''· \ X,,_, i/ Ore,1Well
0 Type I PubPc
0 Type :111 Puhllc
0 Tvu• llb Public
0 Type Ill Puolrc
0 Heal pump
D n 7 CASING : n;:r,: rPI', I
Diameter LI Steel w Threaded
h---- I Mr5c< J O Plastic O Welded
THICKNESS OEPTH ro ..:;J.._ 111. lo .l2.2,_ II. depth
I Heigh:: Above/~
I Surface _j_ fl. 2 FORMATION DESCRIPTION OF BOTTOM OF
S,RATUM STRATUM
- I • ') A 1.) C:.- / '.) / t)
__ rn, lo __ ft . depth
Grouted Drill Hole Diameter __ in, to __ ft, depth
in. to ft. deo1h
: Weight ...LL_ lhs./ft.
I I Drive Shoe ~ I 0 No
I /"i, / 8 SCREEN ; ~ 0 Nnt lnst.alled
-- J l { "-- \. ' A I ' y' . .,-) ./:/ .J LI d -\ . I . 7 ).L ·'' 1-----=:>-'J'-. .:..· .__.::....,,::....o·· .. ···..,-:;_..,_, _ _,_..._.L...·--V+----t--,L--'-i.,;_l_l-__ ..:__--l Type (I;) w A , '.: , 1'\•\ • t1 01ame1er __ ...._..:;7...:f,..,_f( ____ _
/' I Slot/~ / ~;t Length---"''---'-------
/r
/ ·I / ./ 1 I / ) / . , . ) J ! .,, ; · .,-' Set between , ,..: -'- It. end ..1 ·: ft.
/ I <: , . , I / ·7· _/ ... ·,I r-/ OFITTINGS: ~ -Pecker _.,D Leed Packer 'o Bremer Check . I r ·· .,\ ' f, ,,_, C"\ ,- ~ / Blank above screen ,: ft. Other
I 9 STATIC WATER LEVEL: -
ft. below land surface D Flow
10 PUMPING LEVEL: below land surface
---- It, after __ hrs. pumping at ___ G.P.M.
---- ft. after __ hrs. pumping at ___ G.P.M.
11 WELL HEAD COMPLETION
0 Pitless adapter O 12· above grade
0 BasemJnt oftsAr O Approved pit !---------------------- -· -1------+-----t--,:---,--------==--"7"''-'-----==-..::..::...:....;..;...~ -----i 12 WELL GROUl W? ~ 1J::1" No O Yes From ___ to ___ ft.
0 Neat cement 0 Bentorne O Other-------
No. of bags ol cement Addit ives
13 Nearest source ol possible contamination
Type ""i -;: f ' ~ C Distance ~ (u ft. Direction ' I J Well disinfected upon completion? ~ 0 No
Was old well plugged? 0 Yes O No
1';;/jcs.. N ~ (; c:: 14 PUMP: D Not Installed O Pump Installation Only
''· De,~· ~ J ,. - - 1'' ·: . 1 ,,... f------------------------"-'''"-1"~+-,-.:..v~hl-+'~---i Manufacturer's name 1 ,, J-..,\ 1) ( . ") ·r
~, ,·•llb/1i, V _. - • l ., LJ Model number I/ 7,1 H~ :v;.( Volts !. :.f ,,-·
I' ,, 17f:e.ftt, ) . •/ 7 , L~ ~/ Length of o~ppe I I L ft. capacity_.....;../_···"'· _ .. --- G.P.M,
BU ' 199 TYPE ; 0" Subme<s1ble O Jet---------
-'1C:.41J f\r- - . 0 PRESSURE TANK: ·/ ..,- I V(;(, LJ_:::,A ',_. .'· iY!l/ '1()•,A Manufact,urer's name-----·~/ _1_...: :-'----------
. ; ! ~·(::; r J..· ~-•. -.!f{l:r, ,! ; i .:· 1_} ·/ :._,._,?" · · ·<, ; J) / r - ' · "' l A ••- Model number - Capacity X · I USI:. A iNO SHl!!l!T If NHOCO Gallons
1 5. Rema1ks. elevation. source of data. etc . - '11·& ~/~ <1-JATER WELL CONTRACTOR'S CERTIFICATION:
17. Rig~,·, Namei
/J',,?. ,\,) i oS7d 12,es
I 1 \ I lv~ d ' ,( C: .u
WE.Lt (D = 22
This well was dnlled under my jurisdiction and this report is true to the best of my knowledge and belief.
(J ~\ \ J V •• w CJ 1; I l Dt '\ l REGISTEJlEO 8USl"iESS NA'!'~ . •
Address i: II I\ ·, t }i .. \ ' /,,
,'· :·,· .) 7 : ,.; ;~ • . . l•
Signed _ ... J<."'-'·'=~_.1_· --"(,,,.'--',J"-"''J""'""; __ j_.·7._..,a.. . ..,_.-1..,Jc:.... __ Date 1 AUTHORl~rn REPRESENTATIVE
Authority: Completion: P•n•lty:
.. ; /;J < l:i<?- / 7 I
Act Jee PA 1978 Required Conviction of a violation of any provision is a
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GEOLOGICAL SURVEY NO I I MICHIGAN DEPARTMENT OF PUBLIC HEALTH
WATER WELL AND PUMP RECORD I I I IITJI I I I I PERMIT NUMBER
p .i. :- ' 2 7 ACT 368. P A 19 78 1 LOCATION OF WELL
Co'}Q IV T~h,i; -\lame
(J ,J} ~ p ~,A.,/ _j/1 _,tf ,/ /I j a .,,
I Frac11on · I Sec1-or, \lumber
r/1)) 11. t1uJ. ;0,1J;. ,.Q o I 'own Number I Rango. Number
Jf? NI& cf' Y/W O•srance And Q1rac 1, on F,om Road lnters~c t1on ;;(; v_.,.. .~_/Ji.,
3 OWNER OF WELL ,b~ ~;t;±__J~ -<" f / '; .. ,J--l q 7,•,...1.:l ... tc.., ...-..... . ,:..:.LfJ./·-·;o:. V .J 19° i fl !./ t.)_ ~--4--; . ..
}}?.,/ --Address _,, , d' ~ ;J.d--~J ..,~-<---Y_'. "' - ,. \ ,-: .· ~~.._,
S Jri,e! Actdrn•;c:. & C:tv ol Wt?II Lor: Ht!on -~dd ress Same A~ Well Locat;on] 0 Yes ()(Ne Lor.ate w•lh - ~,"' ,n SP.ct•on 8P.1ow : Dale of Completion Ske:-:"" '., ;.:: ~ WELL DEPTH 1c .J mol~ced,
X I I I /7~; ft t:, - I<:;: :-.:_~- / l I I
..,._J __ I _ I ~ CJble tool ~Rotary 0 Driven Doug I I - , .. -I I I '.J Hollow rod 0 Auger 0 Jetted D
w ... - ...J - - .L - _ (_ - E .. SE ~OomP.'5f ;: 0 Type I Public D T'lpe !II Public T -
I l l I I l 01rr1gar•or. 0 Type Ila Public 0 Heat purno
- -:1- -T - -,- - j Ml . 0 Test Well 0 Type lib Public D I I I J_ I I I • ,:.1 51;,,G ~ Sw1, !5?Thr11aded
I
$ ') a~•er~r l He1gh1 ~elow
~1 Ml LE 0 P1a~1 c Owelded l Surlace _!i:__ It THICKNESS OEPTH TO ~1n 10.2L11 oep1h I ..3..2S:i
2 FORMATION DESCRIPTION OF BOTTOM Of 10 ___ 11 deo1h 1 Weight 11,s.ttr . STRATUM STRATUM
___ ,n
Grouted Ord! Hole Diameter I ~Yes
/} / 1 /1,{ _,,)
I ,n ro_· __ lt deo1h I Dr1ve Shoe
t:, b I ---ft deorh
I D No ,n to I
I I 8 SCREEN D Not Installed 'lJ__ t/tJ I L/(;;. ,·
( .,/I .LA ,t.;, t.,L,;, 5.5. !.. 1/'t.j '· Tvoe O,amerer
/}/; •ti f. ,1 / Slot1Ga11 :P. r;1~ Length ~i--· l /.::_,.-, ,·j /J i)
y __:;,: / I ;.: l J ~ ( /j I Se! be1we1:11 It and ft ' - I ,/; ~ K Packer D ~Bremer Check
/J .. M !f:jk./-(..1-?- "' 9 / ,,.-, C / F•TTINGS Lead Packer
/,1 ;; .A / /) 11i!/,/L /...J 0 Blank above ,;creen ft Other I /
/ ,
. i
I I - ------
I
I
I I l i I
I I UfiE A ;;!1'110 i),IEeT :F NH11~1J I
15 Remarks . el~Yat1on. source of da1a e1c
! 16.
9 STATIC: WATER LEVEL
,:;;) 0 It below land surface LJ Flow
; 0 PUMPING LEVEL below land c;urface
d/0 It alter __ /_ hrs pumpmg at JO GP M
It aftdr ___ hrs 011mp,ng at .... --- GP M
I
I 1: WELL HEAD 0 P11less rtdaorer 0 12" ahove grade
•'OMPI FT10~J 0 8,:1c..~mP.'ll offset f"5rAocroved.p11
I ' WELL (;ROUTED' I 0 No. 0 Yes From ___ to ___ It
I ~7 D ! 0 "JHar • ernen! Other
No ot hag, of cemenl Addl!LV~~
I 3 Nearec;1 -;ourr.e of oossible conram,nat,on
Type 4-1:~h O,sranr:e <: ft. 01rect1on 70 Well dis,nlected upon completion I ~Yes 0 No
14 PUMP D Not Installed D Pump !n5tallat1on Only
Marh;far:ture f 5 r'lame F :d. ;.,L)
I Mod~l ~:;mbP.r d_µz,, r HP i'.~ Volt,;
Length of Drop P,pe ~< fr ca oar:,tv .:1-/r.7 I TY?E 0 Suome•s,ote (2K Jet I I ~'IESSURE TANK
(~;~~ ,,-
i Manufactur"?!':; name ,1./;,c';. !I
i Mo1Je1 c. -.,mne, _ . -- - Capa,:,rv ~:L WATER WELL CONTRACTOR'S CERTIFICAilON
Th.s well was dr·lled ·;,...der m"' 1ur•sd1ct 1on ar.d th1s reoort :5 :rue to ;he oest of my kr-owledge and t:el1ef . ·"') .
--·-;-,.,....# ,~; U~'/ S,gr,{r,,~-~-<- . .,,.,_...z-~ AUTHOR tZEO REPRESENTATIVE
GPM
G~llon5 -
.,.. -AC-f-<- i (../ . ..,, .
TAX NO: MICHIGAN DEPARTMENT OF PUBLIC HEAL TH
WATER WELL AND PUMP RECORD PERMIT NO:
1. LOC~T OFWELL
County ; ,, 5C..zo ,,.,
Towns~me J V5c. to A I Fr~ycn J/.,, ~ _, I Se<:!lof!,No1 5 114 /' Lit4 )~ .L I
Disca~ D;:,cti;n J: Ro~;r;ai) O ~ ?/ ,y, 1 J L
9.> t'~ ,q.; t.. e,, J We.:; ts 1,J L-
Street Address & Citv ol Well Loca11on
Locate with ·x· in Section Below •
I I I - -l- -1-·- .I- -
I I I "~ ,~,-1- -L -1- L -
2. FORMATION DESCRIPTION
1 Sketch Map <..11
:I",; I
,D_s /"~
2 M : )l
THICKN~SS c,;
STRATU"
~~ f y
OEPTHTO BOTTO" OF STR•TU"
j/{)
¥5 .:5-y
3 . OWNEROFWELL . // J.I Address 5 ..e:_;;);:;:,)r.;'19j:t-;:i/Y.l CJ."'.'!:~
4359 / s outj 95th Av2~u2 ~v:1-rt, :·1i. 4S Sl_v
Address Same ~s WAIi l.ocation O Yes L:r No
4. WELLOE~T~;I: I Date Completed l Q ~Well
..5--' Y It. I / ..,/ I b t 9 t, I ~eplacement Well
S . B&1e Tool otary O Driven ·O Dug
D Hollow Rod./ D Auger/Bored O Jetted 0 6 . USE: 01(ousehold O Type I Public O Type Ill Public
D lrrigo11on D Type Ila Public D Heat Pump
D Test Well D Type .!ll).,Public D 7 . CASING: ~el CJfhreaded
0 Plastic O Welded
Height: Above/~
Surface: J ft
°?:'-..,..,,...,....-Diameter: in. 10,il.___11. depth Weigni : // lbs/ft. ___ in. to __ It. depth
AORE HOLE: , . /
Diameter: "'L_in. to 0 It. depth ~Shoe
0 Shale Packer
in. to It. depth
a. SCREEN: .CJ ['jot ln~mlled 0Gravol P:ickod ... A ,,/ Type ] D h ,u ~ a J Diameter ..:f d
~~tu~n ~~.C lt.~ngth:5-F'
Fl~ B('Packer ""? D Bremer Check
ITs1ank Above Screen ..L:--' f1. Olher
h.
9. STATIC WATER LEVEL: ;,-t} ft. Below Land Surlace 0 Flowing
1 0. PUM~N~VEL: Be~ L:_nd Surface ..-:' _,,. ft. After hrs. Pumping at
0 Plungtlt O Oa, ll!r O A r ~-- ---------, /~.P.M .
ffiest Pump
1 1 . WEu.;.6o COMPLETION:
1----------__:.------------ -+----+--- -; ffiirless Adapter 0 Basement Offset
D 12" Abo~e Grade
0 Well House 1:, ' j . , · ~· ! .. .. .
0 No rn;'s From CJ to Y ..:5 ft. .. . ., . . 12 . Wf::LLGROUTED?
.... ... -:-
USE A 2ND SHEET IF NEEDED
1 5 , ABANDONED WELL PLUGGED? 0 Yes No
Casing Diameter 1n.
PLUGGING MATERIAL:
D CemenUBentonite Slurry
No.of Bags
Depth ____ It.
0 Ne~! Cement
0 Concrete Grout
Casing Removed?
16. REMARKS: (Flevation . Source of Dara, etc.)
1 7 . DAIL~ACHINE OPERATOR:
[:l'Employe,..._o Subcpntractor
Name (J O :• cl O .J
GY/•2·220 919J
We.LL \D ,s J L{
0 Ben1oni1e Slurry
D Bentonite Chips
0 Yes O No
D Neat Cement " No.of Bags 5
0 Bentonite O 0th.er ____ _
Addi tives
1 3 . NEAREST SOURC,E OF POSSIBLE CONJ(IMINA TION: S ,,L -Type 5.z )::'I / / C Distance _j O h. Direction. ___ _
Type 7 Distance h. Direction
1 4 . PUMP: 0 Nor Installed A~ 0 Pump 7s1allation Only Manufacturer's Name /I < Y n-J O q V-V Model Number A · / .::;_ HP ~ Volts ..2..)'( Length of Drg~ :p;r ft. Capacity / ...Z-G.P. M. TYPE: D Submersible O Jet D Other, ______ _
PRESSURE TANK:. V - 0u J Manufacturer's Name, __ .:_.,,. ___ ____ ..,..,,..,,,. ___ _
Model Number /. v " ,,; 0 b_ Capacity ?"%ions
1 S. WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and 1h1s report is true to the best of my knowledge rd bpliJf ·-;-)
0 fc; 1 tv;1 le!. , o ~~ h, IA . .,) ti
,· I . / I IIEGIS/TION NO.
fi7< ,,i i/ ~ r r9 t./ ____ .;_,_.....:.., _____ _
.... .. .... , ·-·, _ ...... .. Aulllo!tO,: Ac< 3" P• 1?74
a---1 .. ,, r .. - .. 1 .. t1 ..... ..,, • vlAl•fl- ..,1 •nw m,t1vil~~,:r.:d~n:.
l
GEO LOG IC-"L SURVEY NO I__J LOCATION OF W ELL I
MICHIGAN DEPARTMENT OF PUBLIC HEAL TH
WATER WELL AND PUMP RECORD !>AR T 127 ACT 368. P A 19 78
111 =rJ I 111 PERMIT NUMBER
Count v.,. ..
lo~~_, I Townsh,p Name
i ~
0 1st a'nce And D1rei:! 10n From Road lnters':!ct1on 3 OWNER OF WELL . , .
/ / L / c -;~;? _. , .• ?/_ ,9-r..., ~ ~ U~,!....,-,, i 4..;. c:,...,-,_.-,-_,.-. ....LA-(_, Is / ,. -'~ Li. .-;:) r.-r, -, -~ Addre ss ~p 1? -~ 9 5-a. lL~
Cf-\ C£ (_.l_r.~L [ ::_r.-1,,1..,_7 i-r~ V,Ci tc. .=- I Slrf-!P. ! At1t..1re• . .:, & C 1v of \NF.-1 1 Lor:a,,on Addre~s Sdm e As Well Loca t•on J ~ , es ·o No LaCJ! e w ,•h - ~ - - Sec11on e~,o~, ~~~~~~~~~~~=s~k.-.. -: --~~~1-.-c~ ~ ~ ~~~ ~ ~4~ ~W~ [ ~LL~ D~[=r=r~1~1 ~i-c o-m~p~le_t_e~d-1 ~ ~ T,~D~a~t~e-c~•~:~o-m-. o_l_c_tl_O_n~~~~ ~ ~
I ' I .-:, .~ t -- / - r, --
1 I I :) u It I 7 -- I - 6 ) - - ~ - : - :- - 5 0 (J ble te o l 12}:'.Rotarv ~ Driven O D~g
I I I O Hollow rod O Auger U Jetted 0 w .... - _JI_ - ..i.l - _11_ .!. CT 6 USE r.,!' \Al D1)mP.st1c.
I I I O 1rriga1 ,011 0 Type Il a Publ1.:
0 Type I Publ,c 0 Type
D Hear ourno - -,- - T - -,- - i MI , 0 Tes, Well O f yo e llb Pubhc D
I I I J_ 1 1 1 ! CASING ~ .. 0 T I
Oiam eTt:"' ~ ~leP.I hread~d I H':?' yh t ~/Below
f--- , M15c £ ,.1 L.J Pl as 11 c O Welded I Sud ace _.¥-, ft
~ ,n 10:J__k_f t. depth I 3 .,,. Tf<ICKNESS
2 FORMATION DESCRIPTION OF STRATUM
~/J/1~ I~ I
'11' JI) I
/
/{) I
4-1 /C /1 ;; t1
~-~---·
., : : I ! , , .- .. , ' •
uSE A .! ND SHEET if NEE-OED· I 15 Remurk~ ele·,ar,on. source of data. etc
·"•• :o-eo,
WELL ID~ \9
DEPTH TO BOTTOM OF
STRATUM
/h I
&?0 I
/ /(.! / .
f' ;;:J /
I i
1 we,ght ~ lbs :ft
I I Dr,ve Shoe
I '
___ 1n to ___ ft c1er,th
Grouted Dnl' Hole Diameter ___ 1n to ___ ft deplh ~Yes
D No . ,, to t1 deo 1h
8 SCREEN 0 Not Installed
Tyoe {!/«df k, .... ~ ete; -~/-~~y_ ··-----Slot, Ga u:e Ro Length __ __.)?;...lf..___"_· -----
" ~' be1w~·~ _ _ 7L...J(;...,.'-''-- r, d 11 <.J -~·~p_-~?~·'-· _ r1 FlTTINGS [&' K ·Packer O Lead Pa ~<e• (a' Bremer Check
0 Blank aoove i creen It Other
9 STATIC WATER LEVEL
ft below land surface 0 Fluw
10 PUMPING LEVEL below land surface
~ r) ft af1er __ /_ hrs pumping .it ~GP M
---- ft after ___ hes pumping at ___ GP M
11 WELL HEAD COMPLE' 'Oi'l
D No n Ye; F,om --- 10 --- ft
[J Other---- --- -
1tJ 1t Direction ..;5 . t)J
Well d1s ,nfected upon completion i Ciif' Yes 0 No
1 d PUMP O 'io: 1nsralled O Pump lnsrallat1on Only
Ma~ =J t,:t ··~ J~~· · .; •1,:-1m ":! _ _./Jc..<..R"'-1.6".L~"'A:,...,-,L/"""'---------- -
Hp 3!0 Vol •s Moo~I ... ... M:::~· ------- ~ , - --- - -
0· .f ft cacac ,1y --~7 ___ GP M
?P E5S';" E ,A7',K
Man ,,f ac:-. •~r s name --'U=-..::Cl;:-,<-<.=-..,<i-="'-=----_,,O,._~ .... -:::\,,,,-i:;;..
0
-0::.· ____ _ I
V-t o'-· Cacac ,r y l/,.,....,. I ti WATER WELL CONTRACTOR 'S CERTIF!CATION
-0'(
JS5J
~l
l
GEOLOGICAL SURVEY NO . D 1 LOCATION OF WELL
)5. VY\ I I c.. Street Addr~5s Er Ctrv of Well Locattnn
Loc.atF.! with - x~ 1n Sec11on Below .. I I I I I I
-- - ~ - -:- -:- -I i · I
w __ _J __ -1-'t._1 ___ CT I I I I I I
--""""1--T--,-- iMI . 1
I I J_ I I I
2 FORMATION DESCRIPTION
MICHIGAN DEPARTMENT OF PUBLIC HEAL TH
WATER WELL AND PUMP RECORD ._____.____.I DJ I I ! I I PERMIT NUMBER
L
Ske!ch Map
\ 9 ,.,, . I : V< d. ~, J(u.1"1! ~""'.:) ""~
' "\ (J..,
THICKNESS DEPTH TO OF eonoM OF
STRATUM STRATUM
..c/1.J '//)
3 OWNER OF WELL
Address
Gary Gilders Evart , ~tli • 4 9 6 31
Address Same .i.s Well Locac,on > 0 Yes X~ No
_. WELL DEPTH. 'Dote Completed ' 1 MO , oAv I ve.-\R I New Well
///) FT.
5 [}(:;'ble i OOI
0 Hollow •oa
!)USE ~esc,c
. 0 lmg.at,on
0 Tes< Well
: 7 : / '/ ;9 ,J : 0 Replacemenr Well
~dry O Dri ven O Dug
D Auger O Jerred 0 D Type I Public
0 Type Ila Public
n Type lib Public
D Type 111 Public
0 Heal pump
n 7 CASING ri../""
Diamerer ~ tdel readed I -1 He1gh1 Above/B.&J,ill,Qoa --
~_/ D Plas1,c _..0 Welded
~ 1n 10 _/..2j_ It. depth
___ in 10 __ Ir. depth
Grouted Drill Hole Diameter __ 1n co ___ le depth
tn [O It. dep th
1 Surfac e __ /_ ft
: We1gh1 --,/..L lbs./ fL
: Drive Shoe ~ I D No
4- '1 p;-/ 8 SCREEN· l D Not In lied
I----- /~_./: /,.~A~t.. /~4'-· _ _,\_..,........_,.d,-"/-'. -'--='----+~"'--..£--~~"'---i Type ./t,ld/", .,/ Sa 1 , ho1.amete r ~~' , J ,,{ \ J Slo1/~ I ti Len~th ___ <.__' _ ____ _
.2 < //0 /,.{,/ ,4 T 1· ,,-- l ~ ~.,I ;_, Sel between / I/ L ft and / i I.) f t
FITTINGS · ~-Packer D Lead P;cker D Bremer Check
U6i A lNO SiHEET IF NF.er,IF.('\
15. Remarks. elevation. source of dara. e1c
/}
067d 2/89 l
0 Blank above screen --3.:..._ ft. Other 9 STATIC WATER LEVEL.
..t//j ft below land surface 0 Flow
1 O PUMPING LEVEL: below land surface
t O ft after _Lil... hrs. pumping at -2.t2. G P.M.
---- It alter __ hrs . pumping at ___ G.P.M .
11 WELL HEAD COMPLET•ON
., P1tless adapter D 12· above grade
0 Baserne111 olf s111 D Aµprovo,d p,t
.
12 WELL GROUTED > ~ D Yes From ___ . to ___ It.
D Neat c ement D 8enton11e O Other-- -----
No of baqs of cement Additives
13 Nearest source of possible con1am1nat1on
Type )/J ,J ): D1s1ance ____ f_t. Direction-----
Well disinfected upon completion? 0 Yes O No
Was old well plugged? 0 Yes 0 . No
14 PUMP 0 Not In stalled O Pump lnstalla11on Only
Manufacturer's name _ _ .,_J/~· ,.._· .,_·(_...,. ,.....,,,._.\::~. _, ~· ~·,.--------
Model number __ 1)_-~L~·~·;,~,~) _HP I Volts J :~ ,)
Length of Drop P,pe --t.1-f__,f.___ ft . capacity - - ---- G P M
TYPE ~bmers,ble O Jet---------
PRESSURE TANK:
Manufacturer"s name --- --------------
Model number Cocec1ty Gallona
16. WATER WELL CONTRACTOR'S CERTIFICATION: Th,s well was drilled under m y 1unsd1ct,on and chis report is true to 1he best of my knowledge and belief.
h)~ ; . ./ " ' J I,./.; j I JJ, I/ 1-1/ ·' , (! y l.J I REGl~REO BUSJINESS N~l-4e - • . REGIST~noN NO ••
Address ){ N'\ • • f<. J. }:-_ !I IA •/' r 1../'4 C:? I
S,gned _...£.}<:-1,4.J..:::.,;L../·_L.;/,· 1....,~:..'~~~L·~ t},•&r!:...:~::i:.....=_j;_ __ Dace I AUTHORIZED REPRESENTATIVE
Authority: Completion: Pen•lty:
7/11/ 9..2-_. Act 388 PA 1978 Required Conviction of I violation of any provision is a
l
GEOLOGICAL SURVEY NO ' ! I , ,__J
1 LOCATION OF WELL
MICHIGAN DEPARTMENT OF PUBLIC HEALTH
WATER WELL AND PUMP RECORD PART 127 A: "'.' 368. PA 19 78
..____,,_____._l I CIJ I I i PERMIT NUMBER
D1srance And Dir-: ,::,on Frorn Road 1ruer-r;e c1 1on
;/.;:i ~ - 77 . '7 8 ">r~ r?'v 9 5 ~.(,
(! .t7 ,.,., :!' T ,(/_~ '1 u)~ I I -
E ' ,I_ £j) - ' ~aJI-
;:ree~ .Aatiress C :: · ..., of Well Loc.:Jt :Of'\
S,e1ch Mac ----------._,.. ___ _ LOr:Jt1: 'Nl!h · ~ · r; 5e,: r,ori 80lt)W
I I I I I I
~ - ~ - -: - -:- -I I X: I
.. ~ - ~ ~ - t - -:- - -.T I I I
L... - --1- -T - -1- - i Ml .
I I I l_ .._ _ _._I __ .__, __ _,__, _ _,
~ 1Ml'!iL(
4 W~LL DEPTH (r.omplot<>dl 1 Date of Conioie-1,on
.:5"~ f(.
5 0 Caole 1001 IB,~otarv
0 l--!01;ow rod O Auger
6 USE LJ Dome~1,c lJ Tvpe I Publ,c
~ 1rriga11ori D Tvoe Ila Public
0 Tes1 Well O Type lib Publ,c
~ - 7-% ~ 0 Oroven 0 Dug
0 Jeltec D LJ Type Ill Pu~lic
0 Heal pumo
D ; CASl~H~ D f"'ii - I
o ,ame:e, S1ee1 \£-'\ ' h,ead,d I He,gh1 Above/8..i-.
0 Pl~;, D Welded I Surface ~ft
I I
' THICKNESS · 2 FORMATION DESCRIPTION OF
DEPTH TO BOTTOM OF
STRATUM
-e:2..- ,n 10 ~ fl oep1h I :::) ..., _-I We,ghr ~ lbs./fl
. ___ ,n, 10 ___ fl . depth j STRATUM 1--~~~~~----~~~~~~~~--1~~~+-~~----t Grouted Dr,11 Hole Diameter I
IA,Yes
D No
--- ,n ro --- ft. dep1h I Dnve Shoe
fl deprh I
~.o 1 I S IJ / 8 SCREEN 0 Nol Installed
/I /I -r -L I / /<-I ., fvoe '-"a."//A2> Y2t ,l -<l)Qmerer ----'--'-/ - •_.__ ____ _
.I
Slo1 : Gau:e ',,{(2 Leng1h ___ 4t'-"'/__.,-'-'-----So>1 beiween - --~ __ Q _ _ _ fl and j :I 11
FITTINGS _ [2i K-Packer (JJ: Lead Packer ~ Bremer Check
0 Blani< above screen fl 01her
9 3TATIC WATER LEVEL
ft below land ourface 0 Flow
10 PUMPING LEVEL below land surface
...:?J' fl airer __j__ hrs. pump,ng a1 __LQ GP M
---- fl after ___ hrs pumping a1 ___ GP M
! 1 WELL HEAD COMPLETION
0 P,1less adapler ~ 2" above grade
0 Basement off$et L] :C.oorov~o p,1 1--- - ·---------- ---- ----~------1------,-------1-- - -------==---'--'-----'-'----==--'----"------! j 12 WELL GROUTED'
,_ ~ '
,.., . ; \ :; ?:~
,. .,
\V:. !..: ~- . - .. • . .. ' .. 't , •. ,.· '\
1-----------~:(:-/;.:: . .I, ~- ~ ~
1-i'"'" (
,. ... ... . v ... ... . . C.=, • ,:' .. .
use A, 2ND SHEE! 1,: NEEOEO
15 Remarlo:5, iliva11on. sourr:e nf r1Mil Plr
---
.
. .. , ... .. . ,
f·r;::.. ·,o B'r ORil!...ER, lI.iM ti
,: ... .
D67cJ ,~ev 10-801 • -.,
.:·:~ [ly
: ;:, 3'( ..... ·- ,..,.
Wt.\\ ID,. f s
' 1
1 n I
~ No • 0 Yes F_rom ___ 10 ___ . f:
D NP.;H ::emP.rit 0 01her _______ _
No of bags ol cement Add,r,ves
13 Neare:H c;ource ot poss1bl~ contam,nar•on
Type - ------- O,srance ____ f_i Direction -----
Well d1s,nfec1ed upon compler,on' (X" Yes D No
14 PUMP D [] Not Installed , • Pump lns1alla1,on Only )
Manufac:urer s name & P l ,I, JLJh4d /J~~ Model number HP VOii~ - ---- -
Length of Droo P,pe _____ fl capacqy ______ GP M
TYPE O Submer5,ble O Jel --------- -PRESSURE TANK
Manufacturers name ---------- --------
Model number Capac,1y
WATER WELL CONTRACTOR'S CERTIFICATION· Th,s well was drilled under mv 1unsd1ct1on and th1-s report is true to the be11 of m•1 lcr.owledge and bel,ef
Gallons
J65} - r-f""'l t I""',.,...,,.....\ I l"\I 11'""\\ ,,-, I
1
J
'""T-AX_N_<"'-.-------, MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY r-PE_R_M-IT_N_O_: ------
1, LOCATION OF WELL
WATER WELLAND PUMP RECORD 900701
Cour.ty Township Name
Distance and Direction from Road In tersection
77 1..:.i
I Fraction
.: •• 1/ 4
Secuon No.
I Town No.
I Range No.
,1 ;., ::_ 1'/4. ,·. ,.._1 / 4 J I
3 . OWNER OF WELL
Address '. J. ....... .
~~rln ~ Hil l ~d~; a ..::OX i Ju-·/7 l. '7
S ·v ,... r t. , _ 111 • .:J.:; ci .J 1
Streel Address & City ol We"-11;..;L::.;o;;;.;ccca""uo""n"-------r ... _,:j""'~"'"._'<.._' -·'----------+-- A_d_d_re_s_s_S_a_m_e_as-,-W_11_II_L_o_c_a_1io_r1 _ _ ~'---Yr-e_s--,-[l ___ N_o _ ____ --1
Locate with ·x· in Section Below Sketch Map 4 . WELL DEPTH: I Date Completed 0 New Well • I t7 ' I 0 I J I I i h?"-vt'.....il. ~: l :j ft. ::, I..:: :3 I ·J 5 Replacement Well
- .. ( .. -1- +- - - -~1-_.:.--'-'---- 5 . OcableTool GfRotary 0Driven Doug 1 1 1 .:) 1 ·-- ,-~...J.,., 0 Hollow Rod O Auger/Bored O Jetted o __ _
w ~ • )'.) t.i. /_,,....... \ l•Y~ T --r-- I - T ! I. \ ~ ·-•: .:.. 6 . USE: 0 Household O Type I Public O Type Ill Public
I I L I : . -- ' '\ \ l vi . . D & D
.... -_+_.___-_..,..-_~-~- T
1M,. f . 1 \ \ Irr iga tion Type Ila Public Heal Pump
I I I \ \ :\ \ \ 0 Test Well Type lib Public 0
, , .!u ~ \ \ ·,;. \ 7 . CASING: 0 Steel O Threaded Height: Above/Below
DPlastic @ Welded Surface: l It Oolher ______ _ 2. FORMATION DESCRIPTION THICKNESS OEPT>HO
Of' BOTTOM OF STRATUM STRATUM
Diame ter: --3-in. to --5..-1t. depth Weight: '-. lbs/It.
·..;,, ;;; " ,~( ~ .- ..,r, s a .a-"·,__ _________________ ___ ...,_..._, ~in. 1ow.o,.1t. depth
BORE HOLE: 0 Drive Shoe
i •) 7 :;, Diameter: ~in. to'.) l c.::; ft. depth O Shale Packer ___ in. to __ ft depth
' ,.. · \ :,, ,., -'·· ,, , I 1 ., i A ri 8 . SCREEN: 0 Not ln&tall11d 0Grav,;,1-Packed
• .! ' :i 1 ..... J' •, ;• .:;_'\ o I - ,
Type ~ lj a i C 1 -:.·, S 3 Diameter _~".._1· -"---
Slot/Gauze 1 i,.i - 1 ::i - J / i 2 1 S Length:_~~~-:"=~-·----
Set Between 1 j O It. and ?, l :, It. FITTINGS: ~ K-Packer O Bremer Check
~ Blank Above Screen ) ft. Other
~--------T_~_,,---- -----------+----+---·~ 9. STATIC WATER LEVEL:
It. Below Land Surface 0 Flowing .. )
1 0 . PUMPING LEVEL: Below Land Surface
...; 7 _ _ It. After __ £_hrs. Pumping at 1. .:i U G.P.M.
0 f'lunger O Bailer G3 Air O Test Pump
• - - --1-----+------1 11 . WELL HEAD COMPLETION:
l2l Pilless Adapter 012· Above Grade
0 Well House
15 .
.. ,. -·::J
USE A 2ND SHEET IF NEEDED
ABANDONED WELL PLUGGED' 0 Yes O No
Casing Diameter in . Depth ___ __ _It.
PLUGGING MATERIAL: 0 Neat Cement
0 Cement/Bentonite Slurry
No.of Bags
0 Concrete Grout
Casing Removed?
0 Bentonite Slurry
0 Bentoni te Chips
0 Yes O No
0 Basement Offset
1 2 . WELL GROUTED?
0 Neat Cement
No. al Bags ?: \.i
0No 12Jves
~Bentonite
Additives
From G lo 1 8 :) It. 0 Olher ____ _
,.:,.-, ' , i ... , T :i
13. NEAREST SOURCE OF POSSIBLE CONTAMINATION:
Type ___ .:i E ::!_;, C Distance l :)i) -!- ft. Direction-'i"'~"'.E.~' __
Type _ ___ Distance ft . Direction
1, . PUMP: 0 Not Instal led O Pump Installation Only
Manulacturer's Name i< ~ G J a .~ ,•; ,.~ c Model Number .:5 i"'·P') HP L J Volts_lll__
i ,:!.,: G.P. M. Length of D~ Pipe ~ !b": It. Capacity ll'PE : L.Lf-submersible O Jel D Other _ ____ _
PRESSURETANK: ,i-t..:1nt..:~ 1 6 . REMARK!'; : (EIP.varion. Source of Data. etc.) ;.:; (: r .. l:i ,.~ i'l '-i.
1 j_ n -? C ;~ .. i: :;.: Manulacturer's Name __ •j .,~ ·, .!. ;s c 4 .:, I ·r
::;. ·: L:. :; ~J ::; ;) :; t O X! l '.J - l. .::. - l :;- - l " - :. .;;: · ·' "-' i -~ •_; i.t ·. · .-1 • i , t' Model Number w ·., .:, , l j Capacity~ Gallons
.J fl B t , a ,.;:.:. .) I .ull!" i c:l •..t .:· •:! ;;,.a r :3 'C .! :ee . WATER WELL CONTRACTOR'S CERTIFICATION:
, ; :t .. , 1 ·" -~ VU t'I -1 •. , r ,:.; 1 ,· : ( · > - 'n '1 l" L :, . •
1 7 . DRILLING MACHINE OPERATOR :
[Jl-Employee D Sub~ontractor
w~LL \D ~ l, \ ·~c:..-.1
This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belie f.
~2Ll2r n a l l C~ll iinJ , In~. 1 ~~1 REOISTER£D BUSINess NAME REGIS'tAATLON NO.
.a_. 7
I •
• l · GEOLOGICAL SURVEY SAMPLE No.
;\11 .~.R
I
1 , l9~'2 J. .1.
l86r r r dr;'/j
! WATER WELL RECORD : ACT 294 PA 1965 ! i
CDCDDI I I I 
t· \'.
) GEOLOGICAL SURVEY SAMPLE No . DJDJDI I I I l[Dl I I I WATER WELL RECORD
' I PUBLIC HEAL TH 1 , LOCATION OF WELL ACT 294 PA 1965
MICHIGAN DEPARTMENT OF
l ~ty
r A u A i:--4__., 1To~,osr,, p Name .,
/~,' .·, . --:.-' .,.; .:1./.;9~
ttction z. ,, • ..5 f. '1.ofr" f y., !Sec~ ;umber 1T:;~/um:~~- 1
Range Number
~ EW. Oisrnnce Ara.J Oi,ection from Rou d Intersections .,. 1 ,. J OWNER OF ~ ~7~0 fl ?t,.;_~ ~ 1( 9 7) :,LL· (77'.., t?t.,. ,__,_ a~.:.:.. - ;{-. ·d7~
I Address , R . ( vJ 4-,r c.i.,_, , .. ~ J /c,:.",,.;;/ c r~-:.1, Pv. '-/<i03 / Street address & C itv.·ol W"l I Luc:ution LOCilttl with "X'" I n section be l ow Sketch Map: 4 WELL DEPTH : (completed) Date of Completion ..
I I I II? ft. % - ,;) 7 - ,,!' c)
l I I I
~ - .! - - ' -I 5 0 Cable tool ~ Rotary 0 Driven 0 Oug I I -1- "}.
0 Hollow rod D D D I I I , Jetted Bored w '-- - --l-- J.. - _,_ - - £ 6 USE:~ Domestic D D I I I )( T Public Supply Industry
I I I D Irrigation D Air Conditioning D Commercial - -, - - T - -,- - f Ml .
nTest Well D I J_ I I 7 CASING : Threaded,29 WeldedO : Height: ~/Below 1 I I
J....- 1 Ml5t.t::
Diam. I Surface ~ It . ;
THICKNESS O!YIH IU ,2 in. to //'/ ft. Depth I We ight.? -;J; lbs.ltt . 2 FORMATION OF BOTTOM OF
STRATUM STRATUM i na to ft . Depth I Drive Shoe? YesK"J No n
/)4/}'l_d 8 SCREEN:
I O.f~J/J ~a' </£'.'.?) TvPMa.y/..-. ... /JUL,{.,A- Dia.: / "/..f ~ ~
(lyt~ ti / / Slot/ Gauze C:· D Length 1../~ dO 7cJ Set betweer/J/ 9' ft. and//£' ft.
/) (j __/. ,_gt) I I oc) / Fittings :
V )/L11 /.. - l./i c:,7,1_,,.-7J
k;µ.-:;;1~ I {_ , , I 9 STATIC WATER LEVEL
S , A /0 //0 00 ; C7·1 £..t. t-e- ft. below land surface
0)/J/M~iv~A.M i1a J 10 PUMP! NG LEVEL below land surface
~ I
tcO ft. after ~hrs. pumping /u - g.p.m. -,
r7 / ,,
.)·-- - ft. after hrs. pumping g.p.m.
( 11 WX\TER QUALITY in Parts Per Million: \
1rr}n (Fe) / /hlorides ICII __./ 7
Hardness Other -12 WELL HEAD COMPLETION: 0 In Approved Pit
/' ~ ISll Pitless Adapter n 12"' Above Grade
\~ I Grouted? 0 Yi:J:2. Neat Cement E;. onate D
Depth : From ft. to ft.
14 Nearest Source of possible contaminat i on
2£1eet W Direction ~ Type
Well disinfected upon completion 8) Yes ·n No
15 PUMP: ;gJ Not installed
Manufacturer's Name
Model Number HP __ Volts
Lengtn of Drop Pipe ___ ft. capacity __ G,P.M.
Type: 0 Submersible
0 Jet 0 Reciprocating
ust lo 2:HO 51-4(.ET i, HE.EOl:U
16 Remarks. elevation, source of data, etc . 17 WATER WELL CONTRACTOR'S CERTIF_l.~ATION: .. _. , t:) 1;;i 1,.:.tH. ll~M i'lu. This well wDs drilled under my j uris~llc;.rlon and th is report is true
.. : . \ ~~ :":-, [7~;.r'.-t!:h~~~;_V,,.idk-4 - Cc? 3J..-•• ~ ..ii'. .j. : · i ' ~-, IIEGIS~O BOSINESS fM"( l- RE!)'fSTRATIOH NO.
F: C·: ; :· :·r-i '-, , p· /:k. ~~3/ I Address ~ iru-<.- . Qj ;: !•;-: !·"; i;: :w~ '---'<•
. ......, . Sig,U/
C "-7 ),.l {~tn.---' Date p , __,;l 9 -...-CV f ·-::.~::: ~ . 067d 100M (Rev.12·68)
AUTHOR I ZEC RE:PIIESENTATIVE
DEil. MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY DRINKING WATER & RADIOLOGICAL PROTECTION D,IVISION 1R ~
TAX NO: WATER WELL ANO PUMP RECORD PERMIT NO: -;- a .-r .. ,71Q ,..,-,,c::: co Completion is required under authority of Part 127 Act 368 PA 1978 ) ·
1. LOCATION OF WELL Failure to comply is a misdemeanor 96-11-0.325 County Township Name
I Fraction
I Section No.
I Town No ,
I Range No. OCEOLA OCEOLA NE,,4 NW1,4N/J/4 28 18N ew
Distance and Direction tram Road lntersecclon 3 . OWNER o:= WELL 1/.~ MILE SOUTH EAST CORNER OF Address SPRING HILL CAMP
I 1~10n-1 AtJENIJE AND EIGHT MILE 7717 95 TH AVENUE
E'JART I j.;I, 4%31 Srr eet Address & Citv or Well Location NINTY FIFTH AVE. 7,1, Address Same as Well Location WYes 0 No • I'"' I
Locate w,tn ·x· 1n Section Below Sketch Map 4 . WELL DEPTH:
it. I
Date Completed ~ New Well I .
)A ~JJ- 2.35 1214, 0'1197 i ~ I I 9 LJ Replacement Well I
- __j_ -i- .i-. - qsti Ocable Tool 0 Driven Dou~ ! s . gRotary
I ' I ·1100~.J
0 Hollow Roe Augeri Bored 0 Jetted D ' '" -,-!-r- X ~ 6. USE: 0 Household O Type I Public 0 Type Ill Public I --1-!-L- 2- ... ,.~, 0 Irrigation 0 Type Ila Public O Heat Pump I
J_ Orest Welt ~ Type lib Public 0 i i ! I I
CASING : g s teel ~readed I • I 7. Height: Abo1e1~ ,.,.LE----, PIMrfr: 1jlr,let1 Surf;1r.e· ft
2 . FORMATION DESCRIPTION THICKNESS OEPTHTO Olher Of BOTTOM Of STRATUM STRATUM
Diameter: __ 5_,n. 10 23;;/ depth Weight: 3 lbsJft.
l
I ___ in. to __ ft. depth
B80bl~ Cl QY 17 17 BOREHOLE: 0 Drive Shoe
BROWN SAND 73 90 Diameter: __H__in. to __ ft. deprh 0 S!iale Packer
___ in. to ___ ft. depth
RHQ'.l B8DW~ fl8~D ErnE ____ l9 109 B. SCREEN: 0 Nor ln5rall ed 0 Gravel.Packed : HARD GRAY CLAY 12 121 Type PLASTIC Diarr.eter 5 in. I
Sia~~ 12 Length: ft, MEDiUM BORWN GRAY SAND 14 135 Set Between SEE jt~ ft . and ft.
F ITIJNGS: !)cl K -Packer 0 Bremer Check --~ ~· .- -... ~ - ....... t::' . ,. "' bZI Blank Above Screen fr. Ocher '-'"' .... ,_ ,..,_ - ., ...... - . ·-· GRAY CLAY 10 150 9. STATIC WATER LEVEL:
1 a!t rt. Below Land Surface 0 Flowing I ~- - ~· - · -"-tn -ALI- ~ • C'.,.
! .... " . ---· .... _ - .. ,~ - -~- 1 0 . PUMPING LEVEL: Below Land Surface
GH9Y S8ND 1 1!";4 --2.,4.__lt. After !:' hrs. Pumping ac cf r::0 G.P.M. ! 0 Plunger Oea1ler ~ Air . Tesl Pump ;
i 111-iH IJ. l'J t'UiY ., •' • 1 1 H,..:i 11 ·. WELL HEAD COMPLETION:
r.:iJQY r.1 av ot.m c::at.1r. 5 170 ~Pitless Adapter 0 12" Above Grade
Basemenc Offset 0 Well House - - - · - - --
0No ~Yes From . 0 ~ ft. prH\U U1w, T SJL.r I L. 1 IL. 12 WELL GROUTED? to
GRAY SAND 8 180 0 Neat Cement fX)'.Bentoni te Do~ No.of Bags B: Additives PIYMER
- --- -·' :! - . ~-f 1r,"LJ u " r ........ , ... ·-- 1 3. NEAREST SOURCE OF POSSIBLE CONTAMINATION: ..
Type---BEP-T-H;- Distance ft . Oireccion ---· ·-----...... ,...., -' n I 01 -zr:: so. ,-1..1 LU1 n • ·-- ,f '-'-· .. - I .;J.
Type Distance ft. Direction USE A 2ND SHEET IF NEEDED
0 Not Installed 0 Pump lnsrallacion Only
115. ABANDONED WELL PLUGGED? 0 Yes 0 No 14. PUMP:
Manufaccurer's Name RED JACKET Casing Diameter _____ in. Oeptn ____ rt.
Model Number 10EC HP 5 Volts-2:321._ I PLUGGING MATERIAL: 0 Neat CemenC 0 Bentonite Slurry Lengch of Drop Pipe &0 fl. Capaci ty 80 G.P.M.
l 0 Ceme~l/8entonite Slurry 0 Concrete Grout 0 81,ntonite Chips TYPE : ~ubmersible OJ.et Oo111er No.or Bags Casing Removed? 0 Yes 0 No PRESSURE TANK:
i 16. REMARKS: (FIP.v;ition , Source al Data. etc.) Manufacturer's Name CU5+0M~R +Q IM!;+Pbb. I - Model Number Capacity_ Gallons .. I SEE PAGE TWO FOR REST OF 18 . WATER WELL CONTRACTOR'S CERTIFICATION:
I r=nRh1QTTnt.l ni:-!=;r.RT PTTnN This well was drilled under my jurisdiction and this re pore is crue 10 the besc of my. knowledge and belief .
I 17 . DRILLING MACHINE OPERATOR:
QrillinJ ' ~ Employee O Sub~ontractor REG•sreReo~~~e IJe l l Inr, liil'") .-. I I A£GISTAA i,j h'o.1
I Name JEFF ALLSHOUSE A.ddr11SS 3766 Noble Brighton MI '+8116 I ---·--
Oare & -~ t.f 11 - ,., .... ~ . ..... . .. -.. ..,.... . ~ -........ , .. EQP 2017 ( 12/96)
DEil MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY D ,.----------, DRINKING WATER & RADIOLOGICAL PROTECTION DIVISION r---------.:..f ~ (. TAXNO: WATER WELL AND PUMP RECORD PERMIT NO: 1 i
1. LOCATION OF WELL
Completion is required under authority of Part 127 Act 368 PA 1978 Failure to comply is a misdemeanor %-11-0325
County Township Name Fraction Section No. Town No , Range No.
1 ~O~C~E~O~L~A ____ --:----:-:--"--O_C~E_.O_L_A~~~~~~ ~_,___N_E~,,~~-w .... 114 ............ '4-----2-a _______ 1_e_N ______ ...... ~8~;.;...--...... Distance and Direction from Road Intersection 3. OWNER OF WELL
t !8 MILE SOUTH/EhST CORNER OF 100TH AVENUE AND EIGHT MILE.
Street Address & C,1 ol Well Location 717
Locate with ·x· in Section Below , Sketch Map M _Jz
2. FORMATION DESCRIPTION THICKNESS O!PTH TO OF BOTTOM OF
ST~ATUM STRATUM
GRAY SAND 193
GRAY SAND 1 195
4 ,
s.
6 .
7 .
Acdress SPRING HILL CAMP 7717 95TH AVENUE EVART, MI. 4g;31 ·
Address Same as Well Location n No
W[LL DEPTH: Date Completed !1J New Well
235 ft. 041 0'1 I 97 0 Replacement Well
D Caole Tool litRucJ1y 0 Driven Doug
0 Hollow Rod 0 Auger1Borea 0 Jerted 0 USE: 0 Household 0 Type I Public 0 Type lff Public
lJ lrrigario0
n 0 Type Ila Public D Hear Pump
0 Test Well ~Type llb Public n w
CASING: Osteel 0Threaded Heignt: Above/Below
!2S-P1a~1ic !2l-welded Surface: l ft Oother
.:} Diameter: ---in. to __ rt. depth Weight: lbs/ft.
---in. to __ fl. depth
BOREHOLE: 0 Drive Shoe
Diameter: in. --- to __ ft. depth 0 Shale Packer ___ in. to __ fr. depth
8. SCREEN: D Not lns,alled 0Gravel-Packed Type ____ _______ Diameter ____ ...... ~
SiouGauze Length: ____ -Ff'-bt~,-Ser Beiween , ____ ....:h. and ______ __ .It.
FITIINGS: 0 K-Pocker O Bremer Check
0 Blank Above Screen fr . Other
9. STATIC WATER LEVEL:
_____ fr. Below Land Surface 0 Flowing
..i 1 0 . PUMPING LEVEL: Below Lana Surface
_____ ft. Arter ____ hrs. Pumping at--==---G.P.M.
0 Plunger O Bailer O Air O Test Pump
l •SCREEMS* 11 . WELL HEAIJ CUMPLETION:
0 Pitless Adaoter
D BasemP.nl Olfser
0 12" Above Grade
0 Well House
.., 90 ET TOTAi LENGTH DE
0
USE A 2ND SHEET IF NEEDED
I : 5. ABANDONED WELL PLUGGED? D Yes U No
! I
I . !
Casing Diameter _____ in. Depth _____ r1.
PLUGGING MATERIAL: 0 Near Cemen[
0 CemenuBentonite Slurry O Concrete Grout
No.of Bags__________ Casing Removed?
16 . REMARKS: iElevauon. Source of Dora. etc.)
.·,PAGE Tl-JO OF FORMATIONS
%-1 t-0.325
170 180
0 Bentonire Siurry
0 B11ntonite Chips
0 Yes O No
1 2 . WELL GROUTED?
D Neat Cement
No. of Sags
0No ~Yes •
0 Bentonite
Addinves
to ft.
Type _____ _ Disrar.ce ____ ft. Direction ___ _
Type __ -·--- Distance ___ It. Direction __ _
1 4 . PUMP: 0 Nor Installed O Pump Installation Only Manufacturer's Name ____ ___________ _
Model Number ______ _ HP ___ Volts __ _
Length of Drop Pipe _____ fr. Capacity ____ G.P. M.
TYPE: 0 Submersible O Jet D Oit;er _____ _
PRESSU~E TANK:
Manufact;.;rer's Name ___________ ___ ·--. ·--------
Model Numoer -------·-Capaci;y . Gallons
1 B . WATER WELL CONTRACTOR'S CERTIFICATION:
'----------------- -------; This well was drilled under my jurisd,c,;on and this report :s :;l.e to the best or my . ~nowledge and belief. ,
! 1 7. DRILLING MACHINE OPERATOR:
~ Employee O Subc~ntraccor
Name __.!EEE At I SHOI ISF
\ F1eo,sr:AE6".lc,;li,.iMME We. l l f) t i l ii II g · f II c •
AUTHO~IZED REPRESENTATIVE
.~· .. ~. , ,- . , ..... .... . -. '' EQP 2017 (12/96)
l
J
GEOLOGICAL SURVEY NO D MICHIGAN DEPARTMENT OF PUBLIC HEALTH
WATER WELL AND PUMP RECORD 111 IDJI 111 1 PERMIT NUMBER
1 LOCATION OF WELL PA RT 127 ACT 368 . PA 1978
County Townsh:p Name j Frac11on 'Section Number 'Town Number IAange Number
~ .:; ,,,,.._ g_,r7 / .4 h 1 /.. ;_~ / /9- W£ •1.~ tfit./li&I• cJ Cf / $ N! sl ~ Fl!w
Stree1 Addre,, & Cit'/ of Well Lo.:at,on
Loca1g w1~h ··x~ 111 Ser:''"" Oelow H
I I t I I I J(
Address
E 1.- /1 /f' 0 /1/7 /? J-., Address Same As Well Location' ~ D No
~ WELL DEPTH 1compleledl 1 Date of Completion
? 7 ft : //7 -~3-'$7 .._ _ J __ I_ -:- - 5 D Cable tool [21;..,tarv D Driven O Dug
: : I $" - ,hh /'/ # D Hollow t•)d O Aug~< 0 1.-.11,.,1 0 w ._ - ~ - - t - -:- - ~~
1;:======~=1=========----fe5""iu~S3EE~~~D;:=s~t1~c-rOlc1~y~p~e ~I ;Pu~b:l:1c--'=--r=o~T~y:pe~lll~P~u:b~lic:=1
I I I .X D lmgat1on O Type Ila Public D Heat pump
- - -,- - T - -,- - 1 "'1 · D Test Well O Type lib Publ ic 0
I I I j_ I t ) ;, (? 'T'- ,4 ~ -"~ 7 CASING r., - 1 r., .c.. I
L....--'--- ''----'----' .v · .r/ · ,._... o,omeidr ~,ee u..;-rreaded I Height Above/a..i..--
1 1 Ml5LE D Plast1c O Welded· _J_ _..- ') I Surface ft
_p..- 1n 10 ..:;2-5 fl dAplh I 2
- ,
FORMATION DF.SCAIPTION
/
p_ J ~
I
?~rc:.·1vF'"' I I ... . v. ~ I I
---UC l 4 l~H/
, __ :v ;:;diJ o t Env ,ru11rnental ,mo -·,·:c.:uo,,tion:-11 :-11:1:iltt, · GWCS
use A ZNO SHEET IF NEEOED
15 Remarks. e1evat 1on. ,.s_oi,rce of dara. ere .
067d 1Rev t0-80 1
·Wt.LL
THICKNESS OF
STRATUM
~ I
!CZ I , -. I ·1 ,~ , . :SO I
J.:J..
I I
DEPTH TO BOTTOM OF
STRATUM
~/
~_; I
...-., r I _::, _.,,,,
t, ~ I
77/
__ 1n, lo __ II depth
Grouted Drill Hole Diameter __ ,n to __ fl depth
h depth
8 SCREEN
1we1ght~./h
I I Drive Shoe ~ I 0 No I
D Not lns1alled
/ I//
Type Ll,'J,'<7'UL.e. G~eter ---''---.--.:;~<--- - ---
~au,e ----,$e-..;.4...L-- Length ------cif-..c../ ____ _ Se1 t"ietwi,en / § FtTTiNGS @_.!sjacker
r7l ~above screen 9 STA TIC WA TEA LEVEL
It end 7 / h 0 Lead PJcke: ~er Check
I ft . Other
Ln It below land surface 0 Flow
10 PUMPING LEVEL below land surface
2 /) :1 ~ftP.r _)__ hrs pumping at -1. .. 1 G.P.M.
---- ft after __ hrs. pumping at ___ G.P.M
11 WELL HEAD C9MPLET10N
12 WELL GAOUiED'
D Neat cement
0 P1tless adapter
0 Basement offset
Q~bove gradP.
trApproved D•I
0 No ~ From ___ to ___ ft
~n1te O Other-------
No of baas ol cement Additives
13 Nearest source of poc;s1ble contam1nat1on
? 9' ft Direction /
Well d151nlected upon comolet,on' ~ 0 No
14 PUMP D Pump Installation Only
ManufacturP, ( 5 name--------- --- -----
Model number _______ HP ____ Volts -----
Length of rJroo P1oe ----- It r.aoac-ty - - ---- G P M
TYPE O Suhmer s• ble D Jet ----- ----
PRESSURE TANK
Manufacturer·5 name -------- ---------
Model numbe• Capac,tv Gallons
16. WATER WELL CONTnAcron·s CERTIFICATION: This w~II was drilled under my 1unsd1ct1011 and th,s report ,s truf! to the bes1 of mv knowledge and belief.
11Ectsrrnoius1NESSNA~= Aedtii"RA rroN NO. ,
Address. /( .,t:;( / -=" .-&?f !J;;i ,1'.J,4LC« h
Signed tf3.7-6£i, {/,:;v,?1.., .-rt,:;{41 Date/,() -..$.? -$ .? U HORIZED REPRESENTATIVE
lb ~ z.,
GEOLOGICAL SURVEY NO. D MICHIGAN DEPARTMENT OF PUBLIC HEAL TH
WATER WELL AND PUMP RECORD I I I !DJ ! I 1 1 1 PERMIT NUMBER
1 LOCATION OF WELL County I F:rt,~4 I Section Number
U/tu ,. .d)1. h ) 14 ,;.' q D1 s1 a nc e A nd 0 1rec 11 on From Ro ad In ter sect ion 3 OWNER OF WELL :
1 1) 89 7 C) ' J C:. oacl
Addr ess
3ill Wein'.)ar9 10397 - 3 '.-1ile ~r::. Evart, Mi. 49631
S1ree1 Addr ess b C, ry of W ell Lo~a r,on Addr ess Sa me As W ell Locar ,on l ,.Q Yes O No Locar e w 11h -~ ,n Sec r1on 8elow~~~~~~~~~~~S~-k~;~/ -ch~ M~a- p- .~~~~~~ ~ 4~~~E~l l~D~EP=T=H~:~~;~u~!7~--~~~o-~-~~~~t~~d~w,-. -k~;~~~-N~epw~W-e-"~~~~~~ ~
x : : : f- 9 I FT. : :/" : ;.. r ; qt: o Re placement Well
~ - J.1
- - 1
1- -
1
1- - /.' //'./
5 °'table 1001 otary O Driven O Dug V ..:~;i )' / \!::'.l '-
1 I I ~---.~-i / 0 Hol low rod,. 0 Au ger O Jetted 0 w.,_ _ _J _ __ -1---1-- -"T - -( ," , /- 6USE
I I I I I I
om es uc O Type I Public O Type ·,, Public
0 lmga11on O Type Ila Public O Hea r c um p ~ - ~- -T - -1- - i Ml. 0 Tes l W ell _ 0 Tvpe_.!lb Public 0
I I I J_ I I I
'----!---'-----'
~I Ml5LE
7 5~~~~' Steel Th rea ded : Height · Above/~
2
' 0 Plas11c O Welded I / Surface ----r-- It
,n 10 ?' ~:r fl . doprh I FORMATION DESCRIPTION
TMICKN!SS ' Of
STRATUM
O!nH TO eonoM Of
STRATUM ___ ,n. to ___ tt . depth
G,o,ed Drill H~ Diameter
/ ) f / I / /-. ,n . to ..5{:..(J ft. depth ( / /i.1 ,_/ <+-" ( / / A. V '£" / !) , ) __ ,n ro ___ f1. depth
1 We,gh1 --,LI.- lbs :ft .
: Drive Shoe ~ I [J No
..... ;I 8 SCREEN : . hi D N I~ 11-"' A . ...,,, , , ,. o~,.:/ ...,,, I-___ _____ ,.__(_·· · _,__c_· - •'f-.1-- ----------;-- ~/ --'~/·_i -t-=,:7'_·(_'./ __ -; T·1pe f/, /..I A i.::.C } .-'111. • 1ame1er f of?;,? ' ~~~_,-~~-~~~
- / I / J .. , / • Slol/~ / U Length---"~-"------'· j / 1 Jd '.> f...f V A :) - .~// Y (_) 'l( Ci Set between . ,p It and r I tt.
I ~~ r:, ~ker [] Lead Pac ker O Bremer Sheck < t :"'/ V C- J ;/ 3 · 0"'01ank ab:-:::: n ~ ft Other
/ / 9 STATIC w/EVEL
(- } .d ti 4- { 1" ,./ A '.) __: 7 J 'O 4 J ft . below land surface [] Flow
/ 'J ;,- "" 10 PUMPING LEVEL: below land surtace .- /.., I /" ~1- ''./f}..., ~~-6 ,J . J/// ,J 10 -..., / .,J ,JC C: \ ~ I )J •..) ;_
1'1 11~r,. 00/., _':;-;(, f · L , f t. after .....6.. hrs. pumping al ....La=.. GP M :..1 ... 1, tt:. ,. ;!.~ ~ : ~;-
_ _ __ ft , alter __ firs. µumµ,ny ol ___ G P.M.
_/"'
.._, L.. f '- '. j !S'.:J~ 1 1 WELL HEAD ri..(,tless adapter [] 1 2" above grade COMPLETION l..!'.J "'"
-31ii'.?i= r 1 ,, , 0 Basement ollset .......0 Approved 0,1 - -,--,---j
I ~, u,\J;\ j Hf,.:'-::,, .. ' .-., L · - s From_LJ__to.~ ft . oclr; ·p- .:-TI ~-1
:!\f nu,~i\;1.:. ::r:- 12.W\IE..LL GR OUTED ) ~ / 1 / 1 )
I ,'11_; :·1-~ '11/IJ" f.-~~~-~~~~~~~~~-~~~~~~~~~-t~~~~-t-~~-~-, CJ Nealcemenr _J H~n~ 0 Other
No o f baas o f cemen1 ~ Add111ves
USE A 2ND SMEET IF NEEOEO
15. RP.marks . elevation. source of data . etc.
17 . Rig Operator ·s Name:;
.067d 2/89 , I .,
/"' I ·U.,' (-t') ,l .-·,/ 0 ./ "-"""·' -'
13 Nearest ~urce of ~ ss,ble con1am1natro"2,., . J Type .J ·~ ,,! -J1 C Distance~ Oirecuon .....,,;V _ _ _ _
Well disinfeeteiupon complerlon1 ~ 0 No
Was old well plugged? D Yes D No
14 PUMP [] Nol lns! alled [] Pump lnstallat•on Only
Manufacturer's name __ A__;·=--·-· _ ,.-'\....L,-.;.......af~.""";----'/ ___ ___ _
Model number ,4 - ,' '2 HP Y:h Volts ;),? !_} Length of D~ P~ It capacity _ _ _ _ __ G.P.M.
TYPE l.]'"submers,ble [] Jet ---- - - - - - -
PRESSURE TANK: y _ -1 .· ,) } Manufacturer's name _ _.. _ _._ __ ..;....-"--- ----- ---
Model number i ::, .' " J ,,J ;1. Capacity
16. WATER WELL CONTRACTOR 'S CERTIFICATION:·
,,....~,...11'"""\1""1.- \'
This well was drilled under my jurisd1c!ion and this report is true to the best of my knowledge and belief.
Kit Waldren Well Drillina 090 7 REGtSTEREO BUSINESS NAME REGISTRATION NO.
Address -~10._7,._..L->7f'q,;..ll1_-_.,,c·"''--'~"-''U;,;':::'·l:;i.2,::....._:Ra.:.a::::'1c.:•:...__-_~::::·...:.v...:a:::;r::....:t:c...,..,_...:.t-.;;..U~ • .....,.-
1., / F I I FI' I / "/,1';/ fr?f Signed .( , // I I / a/ d -t,t...-'}<'-._/ Date j I ,;;' ·,·/ ·, ..
AUTHORIZEO REPRESENTATIVE
Authority: Completion: Pene lty:
c-1 i!'' l =v ~- -.::v
Act 388 PA 1978 Required Conviction of a violation of 1nv provision is a
W WLJ! I I I IWl...-L....I _,___.I I EOLOGICAL SURVEY SAMPLE Ne.
_• 1?; ~: ·: 196S WATER WELL RECORD MICHIGAN DEPARTMENT OF ACT 294 PA 1965
1 LOCATION OF WELL I PUBLIC HEAL TH
:ounty I Twp . Fraction !Section No. 'Ta;~
I Rang" I /)_~,, ,:::;.,../a c::. , A rCl_c~p 0 /,ri ,c !-.;\/ (' v. ;110~ c,,( ~ NI~. ? YIW .
''Distance And Direction From Rood Intersections .JOWNER No. I 3 OWNER OF WELL :
-C11-m1 .$;pr I fff H ,· II /3,'b/e
I ;w;,y {!,/ee-t(- I< cljs I: YI?-/' T /J'J c i, Address
ch 'f ~~ L L:MAV . -- '· 1 1= VH,f ( /)7 I ';Street ~dress & t'.ity o~~ Location 1,:. ,,A.) \ I>- \l ") E<-\ i U /V
THICKNESS DEPTH TO 4 WELL DEPTH: (completed) Doto of Completion 2 FORMATION OF' BOTTOM or J./S /~ //'7 /t,x-STRATUM STRATUM Ft.
5 0 Coble tool 0 Rotary 0 Drive~ D Dug
I , ~ ,4 1,.,/ J. ,- ,, . , · r/ do .3 () D!!i_Hollow rod 0 Jetted 0 Bored D 6 USE : ~ Domestic: D Public: Supply 0 Industry
(! /,4 u 7 37 0 Irrigation D Air Conditioning 0 Commercial
I w~r,.r: 0 Test Well D /,; ).h:;:. c- ,,,~ J. f' 1/S- 7 C ASING •
Tf,reo~ We lded D ! Height: .a..-./ Belaw _ ,·i I' # ;" <' - ,1..-.,..,, -- Diam .
I --2-in . to fr.Depth :surface I/_ fr. 1 I Weight ::, 7 S lbs / ft.
-in.to ___Jf, Deoth (D, iv" Shoe? Ye_s.PqN~
8 SCREEN :
~..,1 2 Type: Dia .: L 'Ii ~/Gau,e - tz. 0 Length
48' ,,,,
Set between ¥-L ft. and .v..__< ft. '
Fittings:
9 STATIC WATER LEVEL
~L ft. below land surface
10 PUMPING LEVEL below land surface
h f'o ft . ofter-L_hrs . pumping /0 g.p .m.
ft. oftor--hrs. pumpin; g.p.m.
11 WATER QUALITY in Parts Per Million :
Iron (Fe) Chlorides (Cl) . .. Hardness
12 WELL HEAD CDMPU!TJON: D In Approved r;i 15<!' Pitless Adaptor D 12" Above Grade
13 GROUTING :
Well Grouted? D Yes~ Na
Material: D Neat Cement D Depth: Fram___lt. ta __ ft.
14 SANITARY:
Nearest Source of possible contamination ___ feel --Direction Type
Woll disinfected upon com pletion l'SiJ' Yes D Na
15 PUMP :
Manufacturer's Name
Model Number HP.
Length of Drop Pipe ___ ft. copocity ___ G.P .M.
Type: 0 Submersible D D J.,t 0 Rec:iarocotino .
16 Remark,, elevation, sourr.1t nit data ', etc. 17 WATER WCLL CONTRACTOR'S 'CERTIFICJ\TION,
This well was drilled under my jurisdiction and this report is true
ADDED INFO. , ;( r;.,L£~. ITEM :,O. to tho best of my knowledge and bel ief. ,
..7b.,~~L~ ~ /?9~.S-tCeRRE~;iC.!,. Wi' REGISTRATION NO.
I Address ti:::± ~~ • (£f'i3/
$~OOITION BY. Signed ? A-:; )/. . Dote .1-2. - L.Z - t,. /:..
AUTHORIZ£.O REPIIIIESENTATIVE
0670 100M 6-66 \,J(u_ ID-= Z-~ ~ ) ~yr;
w
. I _ . .I- " MICHIGAN DEPARTMENT OF PUBLIC HEAL TH
GEOLOG :.i.L SURV~Y~:~-=--. i·_;.:. -~it ~. WATER WELL AND PUMP RECORD 11 11[011111 PERMIT NUMBER
LOCATION OF WELL PART 127 ACT 368 . PA 1978
~v~
/ _,,, ,L
c ~#4"7 ,/"14/~d:, Address Same .i.s Well Locat ,on > 0 Yes
4 WELL DEPTH 1comole1edl
a3 11
------------J!--t------1..0- 0 Cable tool
0 Hollow rod
~Rotary
0 "ug~r
0 Or,ven
0 Jetted
No
Doug 0
__ on to ___ h depth
~Yes
r[j No
8 SCREEN 0 Not Installed
Type j"phA(:?c9d Diameter /-j; // Slot!'-- - --L~--- Leng1h .¥. (7f. /,/
Se, netween ,2 tj' fl and S?":3 h
FITTINGS ~ K·Packe• 0 Lead Paclter fe 8remer Check
Other
w
--c:~-_;..~~~...L.'-I.~',L..-..,L.....;.:::z:;.::'.:,,:.,_~c..t.~~::_----1-~:!___-- J.:=::::.,,,t__~+--:-'..,..-,:a::l!:::!!a::====~'~t ~b~e~lo~w~ l;and surtace below land surface
0 Flow
1---------- ---------
USE A ~NO SHEET ! f NEEDED
15 Remarks ~levat,on. source ot ';l.t1!iE(jlfNFO IH r.RILLER, ITEM M~
"CORilES7:D BY -
'. ADCITIQN BY.·- T ELEVATION OfPTH T-0 ROCX
067'1
ft atrer __j_ hrs pump,ng at~ GP M
---- ft after __ hrs pumpong at ___ GP M
11 WELL HEAD COMPLETION
la( "11le.ss adapter O 12 · above grade
.... 0 8.J~emnnt off&et • 0 Aooroved 011
12 WELL GAOU iED' ~ No O Yes From ___ to ___ ft .
0 ~eat cernenr 0 Benton11e 0 o,h~, ______ _
I\Jo of na " of cement ___ At1t1,r,vps.
i 3 Nearest ':iource of pO'iS1ble conram11,at1on
Tvoe S 4 ,,A ,P~•stance ~4'ft Otrec1,on U,/
Well d1s,nfec1ed upon comple11on l Yes 0 No
1 d PUMP O '\Jot Installed , 0 Pump lnstallat,on Only
Mar·ular.!urer s name .c' &'¢,£;"~1!.C/~ Model numoe•C 4~ 4HP ~ Volts :Z;Jp Length of Dr00 P,pe i5 ft cao~ ·, ~ - G PM
TYPE O Submers,ole ~ Jet ----------
PRESSURE TANK C ,,/1 / Manufacturer~s name 4-- ,T~tJ? Model nurrioer
16 WATER WELL CONTRACT rn ,s well was dr!lled un(ler my 1ur,sd1c11on ano this report ,s t rue to :he hest of mv knowledge and belief
~
Gallons
w~u.. rLPt 1 )555'
i GEOLOGICAL SURVEY SAMPLE No.
.. ?J~- i. ~Bs-1,~ tt ,.,., :- 1976 - MICHIGAN DEPARTMENT
[0[001 I I I 1[01 I I I WATER WELL RECORD
ACT 294 PA 1965 OF
I 1 LOCATION OF w_E~_L '-~"'"."'."".~~~~-------~~"""'."'------,~------""'l'!!'-P_u_sL_1~c-H_E_A""'!L"!!T_H ____ ""
C<.>u11tv rTuwnshiu N,1me ' ~J~ - 1Secti;_7mber ITo~, ;·m:::i. I R~ng; Nu:t:.
J -0-5 e- ~.a. I 4 ··-· C?. *' r-~ t'/../A... . _ .. __ -~~·.IY~1;;,-·~_1i_v t,o,{_ • .....,.._ ........ ___ ....., __ ......, ____ ----11 01~Ft111' " Ami Dl,,..ct,un from Ro,1d 1,11.irscn t lons - , ,,. . 1 .., ,. 3 OWNER OF WELL: " ...... . ,( .. • -'·. _l) .I A ,,,y ~- / ,,, . I f .A...,~ "f , .,, 7 ,._,,..,.,..,..,.,,,. · , .. , .. , ~., ~- C-- ~J .f'{' f A . 7 .4 1 <!:, .. - .(.. - i A . .,r,·,,, /,.,.. j . ~ ,:.-< ..... / ~ ·'·".J</ ~
• I r: , A'-'(~ , .. ;; r (r, • .... -
l(/' _,£,. .•/ ~ ~_,,..,...,..,,:Z-(. ""'--<- ti-:: /"i~ -~ ' I
J S:rtiul u.lclrt!'.;~ &. City of Well Loc;,llion , . ",
---- ~...-1
· - eo, ·"F''':;·""<"T SCi;7,C1",iOW - -;; ·-· s~P.t; ::~~<l h" / ··· 4· W~L~ D;T:: ~comp11::en1 / D;~: Co7~llo: : .
I --· 1 - - 1 - -,- - - - ---t-'r------- ---------to; 0 Cable tool ~tarv O Driven 0
Addroass
: - ····· ,/ ··
.i.. (~ \ - . ;.:.-I I . , ... - :· .· .
7,-"":' I cf
Duo
, 1 I I - 7'. 0 HOiiow rod O Jcttc<.I O Bo,ad 0 N - - ~I- -ti - -:,- -->:T ~ t-6-u_s_e:--=[Q,oo=--o-m_e_s_t_1c----"o=--P-u_h_l_ic_S_up_p_l~y=-- -0--1-nd_u_s_t=,.=, c.c;::==-1
n lrrigntion D Air Conditioning D Commercial
>- - -r-: --:- - 1_' Ml . ~t-; ft;/. 7
nTest Well rE. 0
I
I , 1 CASING: Threadedo Welded I Height: Above/aei...w
I---, M151.e Diam. I Surface, / ft.
THICKNESS DEPTH TO . 1 2,-, en: IJF BOTTOM or -"'-,n. to __ ft. Depth I Weigh! ~1os./ft.
STRATUM STRATUM in. to Ki ft. Depth I Drive Shoe? Yes~ n 2 FORMATION
8 SCREEN:
IC I .. Type: :) bT Dia. :
~ # /1/_; A A/--1 ~ ~~ ,,,.,..I 4 Y" /' ..e.-f / ,,& 1 Length t iGauze ~ .J:-~ z,
et between~ ft, and ,j7 1 ft.
'
(
/ //I ... · /-;,. /:7 - / /
') ,-v-.,.,. -, I
I
r- _, /
../ I
Fittings: .,t:' 1--:;" //·.,./~ LA,~ /~ I..... L- ~.v-
9 STATIC WATER LEVEL 1
J c;i;' ft. below land surface
10 PljMPING LEVEL below l~nd surface
~ ft, after ./-hrs. pumping _ _./-.sfl,.,.·-- g.p.m.
ft. after hrs. pumping g,p.m.
11 WATER QUALITY in Parts Per Million:
Iron (Fe) ______ Chlorides (Cl)----------
Hnrdnc~~ Qthtir
12 WELL HEAD COMPLETION : O In Approved Pit
n Pitless Adapter ("il _u:,:. Above Grnde
13 w,,11 Grouted? 0 Yes ~
0 Neat Cement O ~entonite O ----------Depth: From ft. to ft.
14 Nearest Source of possible contamination I------~·~·----- - -----------+-----+-----~ ~feet F, Direction, ~>: ,~ TA:?9"4"."Tvpe
Well disinfected upon completion ~ 0 No
15 PUMP: ~t installed
Manufacturer's Name--- -------------
Modei' Number _______ HP __ Volts
Length of Drop Pipe ___ ft, capacitv __ G.P.M.
Typo;: 0 Submersible
o Jet 0 Reciprocating
;JSE A. 2ND SHEET IF NEE.DEC i----------------·- ---,--------.....L-----+----........1---------------------------; t6 nemorl<:;, elevation, source o f dnta . etc . 17 WATfR WELL CONTRACTOR'S CERTIFICATION: 1 # 11 ./J ?J/~ Th1:3 well wcls drilled under rny jurisdic.;ti4..111 and thi~ r~port i:J truu I / .·-, ."7 _,- ,-, C/ / • / /I, /Y . ..-:;:. (.../ '.;... ....c;..., -. v' r ,t. • 10 thfl bteSI o)',m',I knowle<.lge and belief , ,. &· / ~-_ _,,_,.,,, ,, ./.-- ',, / .,/7 L-/ A .. , } ·~ 7 ,-P ? ;- / _ , . -J<LGIST'~A.£0 BUS°INE°SS NAME' : REGISHATION fo/0 ,
/ <I, .· ', C·/' l " U · /. l Address // . _-t:,/ ./ / . / .-/7 Ar.:. "' .,., ., ' •.,
( .' I , - • t • I ' ' /
Si!Jn"d ~.,.k (2 Llc/<>1?/,,. Date /.- /,,.. -~it.£En1P'lhs E:,THl'IE ' - / '
ii,.) .
jGEOLOt: 1cAL SUHVEY SAMPLE No. [0[00 1 I I I :mi I I I
I.," V'; //,,f
St I :~I] ( 1drln.~~~ & CI ty ,Jf W1:II Loc,Jlion --- -- .
l_c)• d1' w1lh ·•x•• 111 :.;t'CIIOfl ht~hJW
" --1>-~·s- ~-~-t-c-h~.lil-!IP-:~~~----j,~ ,~-----1,-4,....WEL-~~D._E_P_T_H_:~i~--o-m_p_l_P.--,u-·d-)~-~-.,-l_e_D_f_C_o_m_p_l_e_t _ .. ; __ -_ --~~~~~ .....
Ut>__,.,<.,,, A•fA
2
I r I I
I I
~ _J_ ll __ 11 __ r -..ac:r-1 I I .., ~ -: ~--~t- -;--· T
~ - -1- - T - -1- - i Ml .
I l I J_ I ' I
FORMATION
.:::::; ,tJ /V ..1 V--4Z-h~
SA,-yd ?- c.-/ Av_ /
c/av /~ --I',,
~.///VA (./ .....e- // ..... -. ,
/ I A,/ / _ _;
/ .. ..,. /J A/ _/ l/_.P,;// -· ,, ,I • ·- .. -- 7 / '
,. /
. ' '1;' .,
','FR-;111c.1rk:,, elevetion. source otnd.itc1. etc,
. ... '• f" • .
• -~-.., t.f 7 ft. l..?J ..!5 ~~ - 7 7"
THICKNESS OEPTH TO OF BOTTOM OF
STRATUM STRATUM
I '"11 / l....,/
/ ,
I ~
/ ,...J_
//') / I
/~
,.:, _]
, Ii'~
I
J U'J.A I .,
7 / L 7 I / ,r
5 0 C,1bl e' tool
0 llullow flJCI
0 Dr , ,.;,~
D 3or~~
0 Dug
D 6 USE : [Jer67,,ust 1c lnduslry D Public Supply
0 lrr1g.J1ion O Ai, Conditi·on1ng
n r~,st Wi,11 D u Commercial
7 CASING : Thri,JdHd l.Jwelded D I H"ighc : A:, ,)v~/ Bel ow 01um. I -..--
J Surfac~ j It.
~n.to
in~ to
"/-!/-11. Depth
ft. Depth
I Weight ~J.e6./ft.
I Orive Shoe? Yes ~ n 8 SCREEN:
TV P e; -:::f'". ,= ~ -7.~ - D ia.:~~--,,...._~~--~~~~~ . ~
//
I ~lo~ou~e :i:>(j?
sdl' between !::/-l- ft. and
Fittings :
Length
'I ( ft.
, :::- .,,"' "' .. ., J
9STATlC WA~R (.l:VEL ~--::. , ~ · ·°' ft. below land surface
IO PUMPING LEVEL I.lei ow land surface
,
!./,/_,./ ::z...c It. after ~hrs. pumping __ 7.,t:;....,, .. '..--- g.p.m.
ft. after hrs. pumping g.p.m.
11 WATER QUALITY in Parts Per Million:
Iron 1Fel ------ Chlorides (Cl)----------
HardnP.ss Other ••
12 WELL HEAD COMPLETtON: 0 In Approved p, t
n Pitless Adapter n 12" Above Grade
13 Wei I Grouted? D Yes O N'z...--.'-'"
0 Neat Cement O Bentonite O ----------Depth: From ft. to ft.
14 Nearest Source of possible contamination
feet Direction .1'/C)//L- · Type
Well disinfected upon completion ~ 0 No
15 PUMP: Not installed
Manufacturer's Name ---------- -------
Model Number------- HP __ Volts
Length of Drop Pipe ___ ft. capacity __ G.P.M •
Type; 0 Submersible
0 Jet D Reciproc3ting
17 WATl:R WFI I C-:ONTRACTOR'S CERTIFICATION :
I µ ~",/ ('' /:_..~/e. This well was drrlled under (l'ly jurlsdlctlt'n and this ,eoort is true to the.J>est of_;nv knowledge and -be I ief. / ./'? LJ'~-;;> ~ C? /'i -e-.., ..5 ,...£?"1 '.S / r.-,, 7 ,-
/ I ,/.}/ ,,.... ' .. · ,' / - ·
J '---~~~~~~~~~~~~-#---~~~~~~~~~~~~~~
1 OOM (Rev. 12-661 /f .. 067d fl) -
REGIS TEREO BUSINESS N .. ME REGISTRATION 110.
Addr-.ss ~ .:zY / ...; ~ # =- ....-"v'I / <-4
Signi,d /,~:/ g C:,--'-4~_, Date/ /-.SJ¥· ?y ..;ijT~Rl~RESENT~ T tV E
GEOLOGICAL SURVEY SAMPLE No.
DJDJDI I I I IDJI I I I. ~FEB :2 :: 1976 WATER WELL RECORD MICHIGAN DEPARTMENT
r . ACT 294 PA 1965 OF
I 1 LOCATION OF WELL.-·~-"""!"--------------------------P_u_s_L_ic_H_E_A.,.L ... TH ____ _ c~ l·l;HV ...... . -----·- - - 1Towr1s ln1J N.ime .JFr:u;:df::.t1un ! Section Number IT own ~;unbt:H I Rongt? .. Numbt!r
l
·~ ) ,:? ~ ~ )A L..1.;. ,.. I ' /lit-=, ~ / / ~ s( ;x 'ft? ,/ / ~ ?· d .,.-:-' / __ ,,,, · c- ~ --- h -- -• i-::-~·-·· ~~-·~~---...__..__,,_N_l __ , ......... _·,, ___ rw;,;,;.""' o ,' si~,11 ,, And Dir,n:ll(HI Ir on, Ro ,ld lnltir s ection~ .,: • . • 3 OWNER OF WELL:
" • ~ -~ j ~ -"-..; _.:. • .. ~ .1/ -,, C ,,_ ,;1 r ; :-:-5" ./ /1/.,...,,,. / .,",/ )f ~.. ~ ~ .r.:;.< .r 7 ,7.,.., ,:/ ~ i · ,4".
~ , ..-"->~· -~~ .. -: ~//- .{.~~·'/ Add,es s v · --':./ / .,,,.7 ,· c · / .. · ' :..1 ja.
Slrc e t .idrirt!s~ & City t>f Wv ll Loc ,llion - --.-----·-" _,...,, ____ , ____ _ _ _. _____ , ,,,. .s,/ , . ·7 .;:< J / 7 _ __, / ,,. ·- · L.Oc. 11\·~· ·,.\.-~ri~r·x·~ ~ t i~\ 11 J. al ...._____ I Sk.t:t t~I\ M:.lp· 4 WEL!.. D EPTH : IL:UlllPIC:lt.:d J D d lr= of c ,>rt1ol~t16n
I I 1 /' / ~./ c.../ I I 1·--r--._,. ______ ;.....:-----
1,y-.2,,,:1· '> 14 , ·, .- ' i /' ft. / ..t - -··,,.d. ., c: - -
. - _1 - - i _ 11 _ - ' • • , . -·.1 1-=s-0----...,.------'--..... - -~----------....; __ I ___ I___ '. ,f_;, C ,1b le1 oo l 0 .. Elotilry Oori v on Doug
I I I f ( 0 Ho lt.1w r,,d [J Jet1t1rl O B0r1'l cl 0 "' '- - ...JI_ - .!..I - - 1
1- :I,. ~T ' /! 6 USE: '71 E>-cimest,c O Put,1,c Supply
I I I ·x' j 01rriyation D Air Conditionrng
D D
Industr y
Commerc ial
2
, I . '- --1--T--1-- , Ml . · ; .,-, ; nTestWell 0
1 I I J_ I ·7 I! , / / ,-, ' 171
I 1 I I ( r; v/1 .{ ( . 7 CASING : Thrt!ildedW"'WeldedO I H,a1ght : Abcve/ Below
I Surfa~e / ft. '-1----~,-M-,"''-~-E _ _.__~ L,;· Diam.
FORMATION
/
THICKNESS OF
STRATUM
~/.,, -· I
: z:;-
.
-- /
-;~ ,.
/,/'} -~
/
t ~
OEPTH TO BOTTOM OF
STRATIJM
~./.
.,.
I z::. /
~/ ,I
~- . . vi/ V ·'
{ }''& /
/ ,, -
~ i n.ro
in. to
~i.Oepth
ft. Depth
-I Weight ~s./1!.
I Drive Shoe? Yes~.Jl
8 SCREEN: J ~-
/ •·-;;. . __.-·~r Type: __ ->~---/....,.. ____ Dia.:
SlotlG.:iuzc -~7'/~~2:~·-·) ____ Length - z ?d'. ., /
Set between~ft. .ind ,pj,· ft •
Fittings: -'1 /:; ./4,11 _,, ,.,,,,:J v · b'?
9 STATIC 'WATER L EVE L I
-, /1 It. below I.ind surface
10 f>GMPI NG LEVEL below land surface
'JO It. after .l..hrs. pumping __ ..;.7-· ~-- g.p.m.
ft. after hrs. pumping g.p,m.
11 WATER QUALITY in Parts Per Million:
Iron 1FeJ ------ Chlorides (CII ----------
Hilrdncss "" Other
12 WELL HEAD COMPLETION : O In Appr oved Pit
n Pitless Ad.:ipter rJl i.;z.:.:.Above Grade
13 Wtil I Grouted? 0 Yes ~ 0 Neat Cement O Be nton,te O -----------Oer,th : From ft. to 'ft.
14 Nearest Jource of possible contami nati on
1------ - -------------------t------1----- --t c;:z___;;_ feet I!( Direct i on h ~ .,. ,~ r ~e
£etl .d i sinfecte~ ~pen complet i o;=-~ (] No > > f
IJ Sf. A 2.NO SM(ET ,F' N££DE0
1Gne111ttrk!!, elevation. e;o11rr.A of narn. ate.
'· cit.I L · ~ c •r ,1 '' •• , ~iC,',
r ''- ' • : ' . • • .,<;-"l) tLF. !~i!Ull
~f..r TH flJ f<ur.:i<.
067d 100\.J •R•1v. 12-'381
NO.
15 PUMP : 0 Not ins ta I led
Manufacturer's Name ,,. ,.-1 ; .f'' ,-::: 4,,,,_, .,f '' (' , ,/1 , , I . • . • ' / -·
Model Number ;iC · / .:z:· HP;'";, Volts "" - .:·
Langth of Orop .Pipe 2 0,.,., ft. capacity __ . _G.P.M.
Ty pe : 0 Submarsihle -
0 Reciprocating
17 WATFR WFLL C:ONTRACTOR'S CERTIFICATION: Tliis w ~I! wos drill~d under mv JUri s r1ictiori c..1rH.J lliis !'~port i3 lrlllJ 10 th1:, tJust of m v kno"~tiug e Jnd belief.
h /'J...,'!f . ~ ~ .~,AA ~ R'EofSTRAT I 011 NO .
J
GEOLOGICAL SURVEY NO I j MICHIGAN DEPARTMENT OF PUBLIC HEAL TH
WATER WELL AND PUMP RECORD I I l IITJI I I I PERMIT NUMBER
5:ree• Addre% & C.1y ol Well LO <: Jt,on
E
T ~ JloA I •
~_____....____. l_ s
Mllf:
;~EC.tlVED f.:'.i:~r: [:~,;~:! r;~ O:·!·-:··. :·::~~!::~
.:; : :r·, ,:
use A 2NO SHEET IF ."4 EEOEO
1 5 Remarks. elevation. source of da!a . e£c
D67a 1Rev 10·80'
\J £LL ·1D :: rs
PART I 27 A CT 368. P.A . 1978
THICKNESS OF
STRATUM
-
DEPTH TO BOTTOM OF
STRATUM
w 3 OWNER OF WELL
G-v,y i G' l I di(< s
E ti '4v1° ) I\ I ,J ArJ<1ress Sdme As Well Loca11onl ~es
Address '-19 t .31 ......, U No
4 WELL DEPTH {completed)
JO
7 CASING I D,ameier SIP.el Threaded I Height ~~Below
J O Plast•c O Welded I Surface _£.._ 11 --+- ,n . 10 _j_f}5,1 depth I I J 1 we,ght -I-'-- lbs 111.
_. __ ,n 10 ___ It deplh oi<::' Grouted Droll Hole Diameter I
,n to --- It depth I Drove Shoe . Yes
I O No ___ ,n ro ___ 11 deprh
8 SCREEN
Tvpe ()ob fJ ; Q vJ Stor/G-. J :l.. Sd1 h~rween io :f'" ~T,:.Gs Ol,<PackP.r
~Blank above screen
Length ------------
11 and I JO Ir
0 Lead i>acker O Bremer Check
ft Or her 9 STA TIC WA TEA LEVEL
It below land surface 0 Flow
IO PUMPING LEVEL below land surface
____ Ir airer .. __ hrs oumo,ng ar ___ GP M
---- 11 alter ___ hrs pump,ng at ___ GP~
; r WELL HEAD COMPLETION
CJ P,rles~ adaorer
1 ollser
Q 1 ~bove grade
~ .nrnvP.rtr,11 12 WELL GROUTED' 0 YP.s From ___ 10 ___ IL
0 Orher ------ -
Nn nl nags ol cement _ __ Ado,1,ves
~ 3 Nearest ~ource of po~s,ble conram•nar•on
Type --J--..C_p,.,._k,-....1-(- Dostdnce _:5Jj It D,rect,on Na l f b Well dos,nlected upon complet,on' 0 Yes 0 No
14 PUMP O No1 rnst311eO · - , 0 Pump 'nstallat,on Only
Man,,fac1,,,e• s name _ __ A_., Jt~ M=._.o ..... kl,-'v-~C------~-Model numbP.r ,SI If O 9 HP , ~ Valls 2 3() Lengrh ol D•oo P,pe 9 1 I! :acac,tv .2 tJ GP M
TYPE ~bmers,ole 0 Jer - ----- -----PRESSURE TANK
Manufacturers ~ame --------------- ---
Mode! r.Llmbf!' Gallons
1 6. WA TEA WELL CONTRACTOR 'S CEH 1 IHCA I ION. Th,s well wa~ drilled under mv 1unsd1ct1on and this report ,s t 'ue :o :he cest ol my knowledge and bel!el
J""'\,.-..1,.-.. \ I .-1 1-\ Ir-°'.'-,-..;""":, .. .'
WWLJI I I I IWI I I I JEOLOGICAL SURVEY SAMPLE No .
WATER WELL RECORD MICHIGAN DEPARTMENT OF ACT 294 PA 1965
11 LOCA TJON O F WELL l PUBLIC HEAL TH
..:aun ty I Twp. Fraction ISectii'N/.? I Tow/~
I Range
J 05ePo /4 17. '5 C. f) { ) /,4 .,/[', .) r;- I~ .VE'~ N/ 1. !( r;w. >) istonce And Direction from Rood Intersections
loWNER No. I 3 OWNER OF WEL L: LJ ,: ,.. ' -t!;;,e/ 11~1/~t<( l Ll-'.~-,q~· ' ~ - f VA~ T
. m ,cli Address /{. ~,;
_> ltoe t address 8. City of Well Location f:YrtRT !7') '~ I. THICKNESS DEPTH TO 4 WELL DEPTH : (completed) Dote of Co7
1
letion I 12 FORMATION OF BOTTOM OF ;t.),f Ii. ij //.s· t1 STRATUM STRATUM
'1 j I! I It/ 5 0 CobJ., tool 0 Rotary / D Driv9n 0 Dug
I <;IJ IY G - ~Ho ll ow rod 0 Jetted 0 Bored o_
0,111,~1 - .s. A 11cl- e I /1- u 1. r,/ 9Z/ 6 USE ·..g:Domutic 0 Public: Supply 0 Industry
d:(. Irrigation D Air Condi tioning 0 Commerc ial
f/Y~' - h /- /} LI ) /'/ -...5 /J d j_ /,tfi J,, J- L. I JL/01
0 Test Well 0 . 5?) 7 C ASING :
Threade d O Welded O iHeight~/ Below I Dij>,m.
I 'l!Lrt. Depth : surfoco £ ft. 6 / H/ p/ I
\. ~#/'/ d· kJ/Jir b,PAriJt/-i fl ;ft/ ~in . to
~ IW,:igh t3 7~ ~~ft.
I I I '
I in . to __J1. Depth 1Driv0Shoe?Y.,, nO
8 SCREEN :
Lc21(j . .s . 1 ia ., 1/t_ J Type : L I go 4%/ Slot/Gouze Length
Set betwi,i,n /'f «/ '
ft . and /t/k Ft .
Fittings :
9 STAllC WATER LEVEL
· _ t) ft . below lond surfoce
10 PU7G 1:, EVEL below lond surface
t} ft. after..Lhrs. pumping //) g.p.m.
ft . olti,r--hrs . pumpin . g. p.m .
11 WATER QUALITY in Ports Per Million:
Iron (Fa) Chlorides (Cl )
Hardneoo '•
_·;_ :, .. ~ ·12 WELl HEAD COMPLETION: Q~l'nAppro·ved Pit :.- .. , . ,. Q{" PitleH Adapter LJ'-12" Above Grade
13 GROUTING : . Well Grouted? 0 Yes~ No
Material: 0 Neot Cement D Depth : From ___ ft. to __ ft.
14 SANITARY:
Nearest Source .of po ss ible eon tom~tlon •
~feet ..._S.aDirection e,E?fi C T ype
Well dis infected upon completion C8J' Yes 0 No
15 PUMP : - ,I Manufacturer's Name I-: . UI. Model Num be r H P. JL'-L
' Length of Drop Pipe ___ ft. copocity ___ G.P .M.
Type: 0 Submersible 0 uJ....:t;", 0 Reci procotlna
16 Remarks, elevation , sourc:e of data, etc. 17 WATER WELL CONTRACTOR'S CERTIFICATION:
Th is well was drilled under my jurisdiction ond this report is true
;..._i!;-c .) , .• ii,:, .... : ., ' r ,.-~ , ... 4 ••
to th e best of my kna;;lge andA f.
/.t& ... n u , '..I/# ///:· ,,,. ;:]9..J..5 Addre• sAE~~::-:;<SS &> _.1 /
REGISTRATION NO .
~(j~~c; ::c . ,, . . J
~~.!! '~ !ii.{':,. "!'• Signe/}) C. ·· · J J.,,. //£( .A-71 J Doto ~-<~/f AUTl10AIZ.£0 PIIE.PA£S£NTATIVE
0670 IOOM 6-66 WJ\ID~3 , ''' "' ,..~"• ,....,...,,,... • • t'"11n,1r.v rr,..nv
GEOLOGICAL SURVEY SAMPLE No. DJ[JJDI I I I l[JJI I I I 1 ______ _ WATER WELL RECORD MICHIGAN DEPARTMENT
l 1 LOCA Tl ON OF WELL I 1,.---.. · - · . County
If c; , ... ,:, o I;:;.
~ i" \. I .,
(j'i staoce And Direction tram Road Intersections
ACT 294
r} /JO f T /v o rt Ill Of /).rt N 115 lr Ir d, Stretlt c>dclress & Citv of We ll Loc~t1on / )7 i/ 11,,f . .,l ,I?,,-,
Loc ~, t~ with ·x·· ,n St!Ct1on bt::luw
" I I I I I I
'- _ J __ I_ I I I - i--
1 I I
w ~ - :--1-~i---T ~ - --i - - T - -,- - ; MI.
I I I ) l_ I I I
2 f'ORMAflON
I') u 11 ~l C' e '519~/ ,
, ),,9,,vr/ of (~~/f I+ J, ~- j
-
Sketch Map:
THICKNESS Of"
STRATUM
I
J
ii
7tJ
PA 1965 OF PUBLIC HEAL TH
l~~:n5~;. lu/% 1Sec11on;,u~ber r ow;~:~~ I Rangyu;e:.
DEPTH TO BOTTOM OF
STRATUM
I
.2
r
J;?
3 OWNER OF Wf.LL)/,
5. J.o,~t.vood
Address
Ir. If- 3 f v/?li' ./ l"'-J. C 7'. 4 WELL DEPTH: tcompleted) Date of Completion'
7 2/ 5 0 Cable tool
J29 Hollow rod
tt .
0 Rotary
0 Jetted
:'I · - / ~ 0 Driven
0 Bored
6 USE:_Qg Domestic 0 Puhl ic Supply
0 Irrigation O Air Conditioning
nTest Well 0
D D
. .., . / '-
0 Dug
D Industry
Commercial
7 CASING : Threaded O Welded O I Height: Above/Below Di~m. . I Q L,,,,, I Surface ft .
;) in. to ~ft. Deoth I Weiriht~s.lft.
1n. to ft. Depth J Drive Shoe? Yes~ No n
8 SCREEN : I • I
Type: OtiY(., Dia.: ./- 'j Slot/Gauze _..,.&;._()_' ____ Length ~ - f ,e I!
Set between~ ft. and J J ft.
Fittings:
9 STATIC W'}Tpl/LEVEL
~(p""ft. below land surface
1 0 PUMPING LEVEL below I and surface
) 3'.: rt. afterJ.. hrs. pumoing ----- g.o.m.
ft. after hrs. pumping g,p,m.
11 WATER QUALITY in Parts Per Million:
Iron (Fe)----- Chlorides (Cl)----------
H~1dness Other
12 WELL HEAQ COMPLETION: 0 In Approved Pit
n Pi tless Adapter ~ 12" Above Grade
1 3 Wei I Grouted? D Yes .c!SI No
D Neat Cen,ent O Oentonite O ----------Denth : From ft. to fi.
14 Nearest Source of possible contamination
~-----------------------t----- t-----j fl_teet Direction __________ Type
Well disinfected upon completion n Yes n No
15 PUMP: ~ Not installed
Manufacturer's Name --------------- -
Model Number _______ HP __ Volts ----- -
Length of Drop Pipe ___ ft. capacity __ G.P,M.
Type: 0 Submersible
D Jet 0 Reciprocating
USE A 2ND SM[.tT IF" N[EOEO
16 Remarks, elevation, source of data, etc. 17 WATER WELL CONTRACTOR'~ CE::Hlll-lCAIION: This well was drilled under my jurisdiction and this report is true
to ?'-?a l/,r t~vvtl/d t>'!t//,:), h o 'ti , 6
' ' , ,.;;i,.ON BY) ·. ;t,.:
D67d 1 OOM (Rev. 12·69)
