HomeMy WebLinkAbout1999 well & boring sealing record 13/30/19991G:5c E H F'ENNEF: _. SONS• t 0.515 Dn2
MINNESOTA DEPARTMENT OF HEALTH ta gaol ng No.Well and Bering f 0764
H 15
County Name se''' N
NEIL oft 80RINGLOCATION WELL AND BORING SEALING RECORD
unique No
'il. '>:" EV I N Mimnesofa Statures,Chpplor 703! or W-seriO NO. `
ouove beint,t n•'known}
+.t cv�« MSealed ARCH yip ry - Date wdq.or Storing Conatn',Rcyrcya�,v 1998 p
me Township tip. Range NO S 117 23 2liDn No. na*J IE F+I, Dote
M ARCD x 2 3, 1999 .7 G J Z 2,1 , F 9 9 8
—
Nymerical StreetNumber Address or Firo umber and Orly 01 well or Konno Locallon r�3^op
IDe BalnSealing Z&.pp _h. 4rigi�al Depth 2416 it
200At��H�a L� ROADth re �
STATIC NrATER LCYEL
Show egad location of Melt or boring Sketch maO 01 wall or boring AOUIFER(S)
C.1\' lIooenon, -key.op prop•ny Srn91e Aywtnr ❑ rdulliogwtar
In section grel WO-)c-• nnoo,roads.and buildings,
W llJ lu r i 0 M08S Irp¢r ❑ ESLmpted
--r ---� N ' Water Supply WPII 0 Monil.Well ** t aIBgE' WELL A�
,••• Q , r Hole la Other .�II. 0 oelow U above land:unoce
E+v.Bac
1•••1.•-..-4---M------1---e `, C) CASING TYFE(S)
C' y. \,4,A IL X mee1 p P4.„." ❑Tiio ❑Other
t 1 I 1 i...4.> „A 1 CASING
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--+-
-+-- I Sat In OV 1t 2e hole? Ar+ntralar*pAce indi any 9rrerter
ll
--S__"••� ,•_ coY' 4 Oliarin�ater Oecan [� .14
^� +.y_q/ Unknown
$ . LL 1ti 1 1`'J in.from L._t 4 LL Vas 0 Na r VID: 0 No ❑
Ip_ x H
�g�y M.horn to�� 11. ❑res 0
No 0 yea. 0 No ❑Unln4rrn
fErMitrnly CLUB
in.IrfnH l0 K. ❑ Us ❑No ❑
P/O9Prly a�►T1er6 '.9 int+it i1iaHM1 Men wee K•coeon seem..�nd:cated eryora. - Yr.* 1=I So U Unloown
.1
?00 10(0(.X/f111JF ROAD 9CRE0M]PEN HOLE
WAY?A i 1" , MN 55391 $I t000IfOm— ML to II. 0000 HOle from to h. --,
OBSTRUCTIONS
i;Vih V"NEas NAME 0 Rods/Drop Pipe ❑ClteCh Valve(8) 0 Oebns 0 Fill XNo Obetructton
wee e..,.,•magi.o.dm.r..C darerM!tiram wept rt•I pµno,'s addraea mee/t0U aOaeo. Type Cd Ot1atNC000ne(Describe)
Obauuniona removed? 0 Yea 0 No Deacrice —PuMP
NONE
Typo —
HARDNESS OFFg01A TO ❑ Aempw e NX Not Prewar' 0 Outer
4EOLAQIOAL MATERIAL COLOR FORDATION
_ METHOD USED TO sEAL ANNULAR SPACE BETWEEN 2 cAsiNGS,ON cAO INC,ANEtORE HOLE
ot
11 nlumen.i'Cila estima10ted ,lOW fog fromwary wall Or boring.
NO Annular Space Euisl5
.11AY BROWN 0 21 ,XAnnular Space grOu(Od with trob?rie pipe
.hAY/S D GRAY 2.1 [.0 I D Casing PeriaratloniAemov:tl
CCC In,from��, to��— n. ❑ PBnoretee ❑ nemvrrd
�.AY/13UWS Giem 60 '�6
:;AND/CAVIL iC:1JW CRAY 76 691 In.tram . to n. 0 Ferrotate(' ❑ Removed
. � ' v----
CLAY GRAY .91 5.10
Typo of perforator _ —
c. i4Y/ NDIGRVI., GRAY 110 124 ❑ ow,r ....
VLAY/SND/BLDFS GRA' 124 16b GROUTING NATO:DA S)
p)RTLANt 288 0 1
{iA{1t7rf3v7/�C LAy �+ BROWN
�N� . 165� t ,•20r, _ t routing Nalene} from to_ ft. yards WO
➢.STN R7/SHALE Cf EEN 209 3 t�Y.SQ troth to _ n. Yprd9 'Mtge
SHALE GRN/bRN 224 J226
lv��+��yy ..t.�. v�y,�,� t _ iron} to N. — yerth .._.-. bags
1t0CIi/S .:]10ME T,irt'-' j OR1:aEN ;:36 ?1.82` t ro ry yards b9at:
L (8ZTh }3P N `i`"Af'JGPN/BLit 203 208
RInuRKe,SOVRCE or DATA,O(FsiCuLTIES IN SEALING IITHER WELLS AND BORINGS
.:
U lI..l rY F ROM: 200 W( ODD t 1.l, RD
Other yrsealed old unused well or Wino on prcoeny7 0 Yea Na How ninny?
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ORIGINAL WILL LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well er boring was sealed In eccortfartco with Minnarom Rules.Chapter 4725, The inforrnatbncontAiNad in NI report a
trub to the beat of my knowledge,
3�
SEALED . + SONS s NC:-. 71015
(,rrr-^-,-rBusinessSeale 7t1,. ...r..,..._,_,_ (.IGOrt}e Cl ilBp15t/$ 1r+feC'•
L E
03/23/99
According to MN State Regulations AU0ZUR
lnUrti S! Pte ea
W
�.. . NAm-r n1 PcrsG,Sealing WOO OF Donng
1 LOCAL -- d1881