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WELL OR BORING LOCATION MINNESOTA DEPARTMENT rDF Hf AL TH Minnesota Well and Boring
<br />ty 1 Name
<br />_ WELL AND BORING SEALING RECORD Sealing No H i
<br />CounMinnesota Unique Well No -T00T5
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<br />9� f� bbnnesora Srarure, ,ravre •J 7 or W-senes No J
<br />TownSh!p Ndme ,w. sr,q 1;. , ,,.p. N ,• No .g Date Sea*! ;tn+r lte,—!, Einnng
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<br />Numerical Street AyQre55 0• t .i Num[ra• ann !r '.Y " ,• Bc,nng Inc al,nn
<br />\� eUn Be(.!en I n
<br />7V2340-lax ftre �p Wall.
<br />OUIFERISISnow exact rocal!on of "1' u, trnny STATIC WATER LEVEL
<br />,n section Qnd wen -k' ,
<br />w A! uae• r
<br />,a , .f:,�t,au,..rn•
<br />N WFLVBORING . • I,t,n•aren
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<br />_� Aare, S.vpr We, Momt W,• �.
<br />Env Brve Hobe ,' 0mr,' •+ tNtklw r-' abrrve nark w,racO
<br />W E CASING TYPEISI
<br />--7•- -- -i-- -i- 1 Steel [l Plash[ Sul T!te `. Other
<br />Itrar
<br />•-}- 4. .4. -4.
<br />CASBI
<br />Diameter, Deptl, /
<br />jet in overs.te ride'
<br />Annular space trlttially grouted?
<br />. I-W ---- a
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<br />�,j/_
<br />_ ' m .11 __a__ Ib _7.t 11
<br />❑ Yes )&
<br />❑ Yes j] No
<br />❑ Unknown
<br />_ ^ hrsm _ _ . _ _ lU _ it
<br />Yes [] No
<br />❑ Yes :I No
<br />❑ Unknown
<br />PROPERTY OWNER'S NAME
<br />in from - to ._ If
<br />[] Yes [] No
<br />❑ Ye-s ❑ No
<br />❑ Unknown
<br />Property o.rren s mailing edo ,
<br />SCNEENOMN HOLE
<br />�
<br />///x/� lr
<br />�
<br />$greed from � to + _ it Open
<br />Hole from _ _— to
<br />_ It
<br />OBSTRUCTIONS
<br />WELL OWNER'S NAME
<br />❑ Rods/Drop Pipe ❑ Check VaNe(S) ❑ Debits
<br />❑ F,II 910 obstruction
<br />Wes own e, s maang add,ess ,• e,nerent man property owner s
<br />Type of Obstrutt.onS (Describel
<br />Obstructions removed! ❑ Yes ❑ No Describe
<br />PUMP
<br />Type ----- —
<br />ATEAL
<br />GEOLOGICAL MATERIAL
<br />COLOR
<br />_
<br />NARONESS OF
<br />FROM! TO
<br />n Removal Not Present [] ^Iner
<br />FORMATION
<br />11 not known ,nAnts IsaarMlae formakbm log from nearby.Yea or bong _- --
<br />METN^0 USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINOS, OR CASING AND BORE HOLE:
<br />I �
<br />i
<br />REMARKS. SOURCE OF DATA DIFFICULTIES IN SEALMU
<br />LOCAL (;Of , I H 170075
<br />_— Annular Spate Exists
<br />Annula, Space grouted with trenve prior
<br />Catang P9,10,ation,Removal
<br />_- rn From _ - to--. if ❑ PeAoattw ❑ Rantovad
<br />-- in r.om _----- ra it ❑ PWWSted ❑ Ramoyed
<br />TYPO of D61101ator .- - -- ----------- - ----
<br />Other
<br />GROUTING MATERIALS) (One bag of cement n 94 tbs.• one bag of bentonite . SD tbs.)
<br />„wt,nQ MMena pI Q vx,os _ l bags
<br />i
<br />rams bays
<br />words bags
<br />CTHEP. WELLS AND BORINGS
<br />LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
<br />.. 11 .,e, c,Jn„7 was ,e9�•-' .
<br />.... , ., e".. - �'•e nlormatrcx coritane^ ,r tins •x><vt ,i
<br />true to the DOS, n, mY Rr„!.y ..•
<br />DON MDOU V=
<br />MIZZIM CO. Inc. 27172
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<br />sense w Rotirm amv, ;.0
<br />ese'rrahve S•V, r
<br />„are
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<br />Name wParson eda Bonne
<br />Wetly
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