1994-03-17 Water Well Sealing Record

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WELL 011 BORIN6LOCATION Minnesota Well and Boring H 4 912 b MINNESOTA DEPARTMENT OF HEALTH Sealing No County Name WELL AND BORING SEALING RECORD Minnesota unique No — — Minnesota Statutes. Chapter 1031 or Wsenes No. Township Name Township No Range No Secl.in N) Fracl.on Ism • lit Date Sealed Appm—ate Data Wee I a Boring Constructed 141 Street Addle ss or Fire Number and City of Well or Boring Location Sts �I y� � SS391 C Depth Before Se.pmy h Original — Depth —� tl Shoal esad kLalron of wes or bong Sketch map of well c boring Static Water Level ccurate in section gntl wdh X hor, showng proper Ines N roads and Id.ngs LL Appos.male r r � 1 �i�� Sngb Aquifer ❑ Mulbaqer / er Mn�,w ,dmv.•lmd Wi tr _� sace CASING TYPE f W r r r r r r r r � � • ^ ❑Steel ❑ PIASIK XTdw ❑Other S. i Screen from -- to --- _._ fl Open Hole hum In -_�� h -- f reA1 --•-- OBSTRUCTKMYDEBRIS/FILL iruchon ❑ Debns ❑ FII P/^ROOPE�RTY OWNER'S NAME \KaiVl _amarfe_ _ -- __ ----- Type of debris obstruction M,, Lnq Agd....... .1 rLbeg int Ihnr. p, o(M•,+y ntkfres•. nuU..Ned ntnwe Obstruct* Debns FUI removed1 �Xe•. ❑ Nu PUMP L*4emoved ❑ Not Present ❑ 011ie, ��•�� CASINO GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO _ FORMATION D.amole, Depth Set .n oversee hule� Annular space nAlally groubW --/L,-:,n from r" _ to V.? N ❑ Yes 01(o ❑ Yes ❑ No ❑ Unknowlift _L __ 11 not krgwn r"Wale estimated lormatrurr log from nearby well or boring 142 drift 0 infrom _- to h ❑ yes ❑ No Ci Yes ❑ No ❑unknown It ❑ Yes ❑ No ❑ Yes ❑ Nn, ❑ Unflurew — — ---`— -- — — METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, 0" CAMO AM SORE "OLE: CKo Annular Space E.usls ❑ Annular space grouted with Iremw pt.` ❑ Casing PerforatronFTerrroval n Irom to --- If ❑ Perforated ❑ Film" .led .n Irom to 4 ❑ Perforated ❑ Reeklved Type of perforator — --- ❑ cher O _ OROUTWO MATERIAL --_-- - - Gmuhny malarial N� AT L f /�%L fVI Irom �_ to h yards from to If yards _ REMARKS. SOURCE OF DATA. DIFFICULTIES IN SEALING to h yards .- from to _ h yards UNSEALED WELLS AND IORMS Olhor unsealed well or bonny oe p.,. •edy" ❑ Yes LICENSED 00 REGISTERED CON7NACT011 CERTIFICATION Ths well or bnru,q was seakd n t I-11, . a wdh Mnnesola Rules Chapter 4725 The informaloe rananed n the report is I1.y. ro the best of my kn�owled.le ]� /�� T� �s _ � Stodola k*U Dril11%' Co�� ii<--. __- Z 72 Bnti.ness Nan.. Ln'en a Rf`grsfraf..+ No 1 • �'t°"�°�' ( OCAS COPY M 49125J�^ N.e .• U Pf•rsrr, Sealing wen m k. ,.ny HE 0143401