Laserfiche WebLink
WELL OR BORIRO lO(.• TION <br />Courtly Name — - - _ <br />Henaepil�i <br />i •� I••;. Name t't•wcrfihip No J Range No <br />Waysata 117 123 <br />MINNtbUTA Utt'AHIMENT Of HEAL] H Minnesota Well and t3onng 139709 <br />WELL AND BORING SEALING RECORD SeaMinnesota Na Unique No H <br />Minnesota Statutes. Chapter 7031 or Wsenes No J <br />risers byre I ntd rnowni <br />- - <br />Section Nu 1 Fraction tsm -0 n) r <br />04 2-Ml <br />Date Sealed <br />I f <br />Date Well or Owing Conslructed <br />Numeracy Sheet Address or Fue Number and City of Well or Boring Location <br />2660 Fox St E Wayzata 55391 <br />Depin Before Sealing,M <br />AOUIFER(S) <br />S,ngle Aquifer ❑ Multiaquder <br />WELLADORING <br />SupWY Welt ❑ Mond Wert <br />❑ En% Bore Hole LU Omer —. <br />0,,g�nal Depth4�0_� <br />Show enact location of well or boring _ -- ---Sketch map of rig <br />on Section god vnth'X• location sh 9 Or nY <br />lives roads a DudO.n <br />N __ <br />- _— <br />W "{" E . `. <br />• —+ - <br />1r row <br />--`- -t- •{-- --{-• <br />S . <br />Ila— r y _ <br />STATIC WATER LEVEL <br />_ <br />Mea•.wwf ,) EstimatedWater <br />�/. <br />i n Z. r+ec- ❑ above land surface <br />CASING TYPEJS1 <br />�K%IeM U. PlasN,... Lie " "1 Oise, <br />CASINO <br />Diameter Depth Sol to overwe note? Annuals; space inNapy, groufW7 <br />��/ 2 Yes XNo ❑ Yes ❑ No ❑ Unknown <br />m from ❑ <br />_ to h <br />n from to h ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown <br />in from to If ❑Yes ❑ No ❑Yes ❑ No ❑ Ureutown <br />PROPERTY OWNER'S NAME <br />r <br />Pmpery 'a madutg address d *%fem was wlocation address indicated above <br />SCREEIYOPEN MOLE <br />r � <br />Screen from _0_ to h Open NOW frown to If. <br />OBSTRUCTIONS <br />❑ RodsfDrop Pipe ❑ Check Vahre(s) ❑ Debris ❑ Fill 'G7 No Oostrudron <br />Type of Obstructions (Describe) - -- --- /� <br />Obstructions removed? ❑ Yes ❑ No Describe <br />WELL OWNER'S NAME <br />WON+ers mWq ss addred dmwem fnan Propertyo vnei S aodress mdcals0 above <br />PLOP <br />Type <br />❑ Removed Not Present ❑ Omer -- <br />GEOLOGICAL MATE;; COLOR F � DF FROM TO <br />e nol loom. esternstsd loins w from nearby wM or boring <br />METHOD USED TO VEAL ANNULAR SPACE BETWEEN 2 CASNK3S. OR CAWM AM IDLE: <br />No Annular Space Exits <br />❑ Annular space grotded wdh from* pipe <br />❑ Casing PMora"OnfRemoval <br />in from to It ❑ Perforated ❑ RentO..d <br />in from to h ❑ PNlorekW ❑ Rsntov.d <br />Type of pedoralof _ <br />❑ Otter <br />I <br />GROUTING MATINAL(V) <br />Grouting Mateo from _�— to1rL h yards <br />from to h yards bw <br />from to n yards brows <br />from _. to -- It Yards bw <br />REiI•AM& BOUNCE Of DATA, DIRFICULTfEV 0 WALING <br />OTHER WELLS AND BORINGS <br />Other unsealed and unused was or boring on property? ❑ Yes wo-low many? <br />LICENWO OR IIEl1MTE11ED CONTRACTOR CERTWICAT10N <br />This wee or bong was sealed in accordance won Minnesota Rules, Chapter 472S The udormabon oonterrfed n Vea mplift le <br />true to the best of my knowledge. <br />Don Stodola Well Dcilling Co., Inca 27172 <br />Conrrww Business Name Gdee.e a RplebVbf Iflo. <br />Dow <br />LOCALCOPV <br />JH 139709 <br />dPerson Switai"'g'WaSwing <br />14-01434-W "J, n <br />