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13/30/19991G:5c E H F'ENNEF: _. SONS• t 0.515 Dn2
<br /> MINNESOTA DEPARTMENT OF HEALTH ta gaol ng No.Well and Bering f 0764
<br /> H 15
<br /> County Name se''' N
<br /> NEIL oft 80RINGLOCATION WELL AND BORING SEALING RECORD
<br /> unique No
<br /> 'il. '>:" EV I N Mimnesofa Statures,Chpplor 703! or W-seriO NO. `
<br /> ouove beint,t n•'known}
<br /> +.t cv�« MSealed ARCH yip ry - Date wdq.or Storing Conatn',Rcyrcya�,v 1998 p
<br /> me Township tip. Range NO S 117 23 2liDn No. na*J IE F+I, Dote
<br /> M ARCD x 2 3, 1999 .7 G J Z 2,1 , F 9 9 8
<br /> —
<br /> Nymerical StreetNumber Address or Firo umber and Orly 01 well or Konno Locallon r�3^op
<br /> IDe BalnSealing Z&.pp _h. 4rigi�al Depth 2416 it
<br /> 200At��H�a L� ROADth re �
<br /> STATIC NrATER LCYEL
<br /> Show egad location of Melt or boring Sketch maO 01 wall or boring AOUIFER(S)
<br /> C.1\' lIooenon, -key.op prop•ny Srn91e Aywtnr ❑ rdulliogwtar
<br /> In section grel WO-)c-• nnoo,roads.and buildings,
<br /> W llJ lu r i 0 M08S Irp¢r ❑ ESLmpted
<br /> --r ---� N ' Water Supply WPII 0 Monil.Well ** t aIBgE' WELL A�
<br /> ,••• Q , r Hole la Other .�II. 0 oelow U above land:unoce
<br /> E+v.Bac
<br /> 1•••1.•-..-4---M------1---e `, C) CASING TYFE(S)
<br /> C' y. \,4,A IL X mee1 p P4.„." ❑Tiio ❑Other
<br /> t 1 I 1 i...4.> „A 1 CASING
<br /> --------------------
<br /> --+-
<br /> -+-- I Sat In OV 1t 2e hole? Ar+ntralar*pAce indi any 9rrerter
<br /> ll
<br /> --S__"••� ,•_ coY' 4 Oliarin�ater Oecan [� .14
<br /> ^� +.y_q/ Unknown
<br /> $ . LL 1ti 1 1`'J in.from L._t 4 LL Vas 0 Na r VID: 0 No ❑
<br /> Ip_ x H
<br /> �g�y M.horn to�� 11. ❑res 0
<br /> No 0 yea. 0 No ❑Unln4rrn
<br /> fErMitrnly CLUB
<br /> in.IrfnH l0 K. ❑ Us ❑No ❑
<br /> P/O9Prly a�►T1er6 '.9 int+it i1iaHM1 Men wee K•coeon seem..�nd:cated eryora. - Yr.* 1=I So U Unloown
<br /> .1
<br /> ?00 10(0(.X/f111JF ROAD 9CRE0M]PEN HOLE
<br /> WAY?A i 1" , MN 55391 $I t000IfOm— ML to II. 0000 HOle from to h. --,
<br /> OBSTRUCTIONS
<br /> i;Vih V"NEas NAME 0 Rods/Drop Pipe ❑ClteCh Valve(8) 0 Oebns 0 Fill XNo Obetructton
<br /> wee e..,.,•magi.o.dm.r..C darerM!tiram wept rt•I pµno,'s addraea mee/t0U aOaeo. Type Cd Ot1atNC000ne(Describe)
<br /> Obauuniona removed? 0 Yea 0 No Deacrice —PuMP
<br /> NONE
<br /> Typo —
<br /> HARDNESS OFFg01A TO ❑ Aempw e NX Not Prewar' 0 Outer
<br /> 4EOLAQIOAL MATERIAL COLOR FORDATION
<br /> _ METHOD USED TO sEAL ANNULAR SPACE BETWEEN 2 cAsiNGS,ON cAO INC,ANEtORE HOLE
<br /> ot
<br /> 11 nlumen.i'Cila estima10ted ,lOW fog fromwary wall Or boring.
<br /> NO Annular Space Euisl5
<br /> .11AY BROWN 0 21 ,XAnnular Space grOu(Od with trob?rie pipe
<br /> .hAY/S D GRAY 2.1 [.0 I D Casing PeriaratloniAemov:tl
<br /> CCC In,from��, to��— n. ❑ PBnoretee ❑ nemvrrd
<br /> �.AY/13UWS Giem 60 '�6
<br /> :;AND/CAVIL iC:1JW CRAY 76 691 In.tram . to n. 0 Ferrotate(' ❑ Removed
<br /> . � ' v----
<br /> CLAY GRAY .91 5.10
<br /> Typo of perforator _ —
<br /> c. i4Y/ NDIGRVI., GRAY 110 124 ❑ ow,r ....
<br /> VLAY/SND/BLDFS GRA' 124 16b GROUTING NATO:DA S)
<br /> p)RTLANt 288 0 1
<br /> {iA{1t7rf3v7/�C LAy �+ BROWN
<br /> �N� . 165� t ,•20r, _ t routing Nalene} from to_ ft. yards WO
<br /> ➢.STN R7/SHALE Cf EEN 209 3 t�Y.SQ troth to _ n. Yprd9 'Mtge
<br /> SHALE GRN/bRN 224 J226
<br /> lv��+��yy ..t.�. v�y,�,� t _ iron} to N. — yerth .._.-. bags
<br /> 1t0CIi/S .:]10ME T,irt'-' j OR1:aEN ;:36 ?1.82` t ro ry yards b9at:
<br /> L (8ZTh }3P N `i`"Af'JGPN/BLit 203 208
<br /> RInuRKe,SOVRCE or DATA,O(FsiCuLTIES IN SEALING IITHER WELLS AND BORINGS
<br /> .:
<br /> U lI..l rY F ROM: 200 W( ODD t 1.l, RD
<br /> Other yrsealed old unused well or Wino on prcoeny7 0 Yea Na How ninny?
<br /> ---
<br /> ORIGINAL WILL LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
<br /> This well er boring was sealed In eccortfartco with Minnarom Rules.Chapter 4725, The inforrnatbncontAiNad in NI report a
<br /> trub to the beat of my knowledge,
<br /> 3�
<br /> SEALED . + SONS s NC:-. 71015
<br /> (,rrr-^-,-rBusinessSeale 7t1,. ...r..,..._,_,_ (.IGOrt}e Cl ilBp15t/$ 1r+feC'•
<br /> L E
<br /> 03/23/99
<br /> According to MN State Regulations AU0ZUR
<br /> lnUrti S! Pte ea
<br /> W
<br /> �.. . NAm-r n1 PcrsG,Sealing WOO OF Donng
<br /> 1 LOCAL -- d1881
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