HomeMy WebLinkAbout1993 - Well & Boring Sealing record Minnesota Well and Boring
MINNESOTA DEPARTMENT OF HEALTH Sealing No. H 42991
WELL OR BORING LOCATION - _
County Name WELL AND BORING SEALING RECORD Minnesota Unique No.
Minnesota Statutes.Chapter 1031 or W-series No.
Hennepin
Keave blank d not known)
Township Name Township No. Range No. Section No. Fraction(sm. •1g.) Date Sealed Approximate Date Well
or Boring Constructed
40 .V.10 117 23 5 33-(1934414 /2 Ca-- q3
Numerical Street Address or Fire Number and City of Well or Boring Location 94 / .7/ /
332 II Lake St, I,cnT4ake, M Depth Before Sealing It. Original Depth9 ft.
Show exact location of well or boring Sketch map of well or boring Static Water Level S4ccurate
in section grid with"X". location.showing property lines.
roads.and buildings. ❑Approximate
N \\
' "
_
J /
.
f.
i 1 Single Aquifer ❑Multiaquifer below above land surface
A ,_ CASING TYPE
W E Y
r +
, r T
� i Steel 0 Plastic 0 Tile 0 Other
i :smile f
I.
S 3 Screen from `0 to / ft. Open Hole from to ft.
He —t mile—'1 OBSTRUCTION/DEBRIS/FILL
0 Obstruction 0 Debris 0 Fill
PROPERTY OWNER'S NAME
Waters & Assoc. �( )ems
Type of debris/obstruction
Mailing Address if different than property address indicated above.
Obstruction/Debris/Fill removed? 0 Yes ❑No
10340 Viking Dr, Suite 110 PUMP
Eden Prairie,yeMN 55344
Attn: Blake ❑Removed plot Present 0 Other
CASING
GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO
FORMATION
Diameter Depth Set in oversize hole? Annular space initially grouted?
If not known,indicate estimated formation log from nearby well or boring" r
c94 0 . in.from to. ft. 0 Yes , No 0 Yes 0 No ❑Unknown
Drift in.from to ft. 0 Yes 0 No 0 Yes ❑No 0 Unknown
in.from to ft. 0 Yes 0 No ❑Yes 0 No 0 Unknown
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE:
No Annular Space Exists
0 Annular space grouted with tremie pipe
❑Casing Perforation/Removal
in.from to ft. 0 Perforated 0 Removed
in.from to ft. 0 Perforated 0 Removed
DEC �i "T":;;-93
Type of perforator
►+ ❑Other
GROUTING MATERIAL
/
(El'1Krv�yv, QC/
Grouting material A„fill / from Q to / 7 ft. yards /)_. bags
from to ft. yards bags
REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING
a,�,,
from to ft. yards bags
Grouted 2” well 94' deep from to ft. yards bags
2 bags cement UNSEALED WELLS AND BORINGS
4lbs bentonite
& Other unsealed well or boring on property? 0 Yes {]�(Jo
2men labor, rig cement grout pump LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is
true to the best of my knowledge.
Don Stoddla Well Drilling Co., Inc. 27272
Contractor Business Nar•e License or Registration No.
f 1!0-13-93
� _ - �
t 'e•-'-.rASSnt five Signatu!firre Date
Jim Antonson
LOCAL COPY H 42991
Name of Person Sealing Well or Boring
_ ,kEoi454-m