HomeMy WebLinkAbout1993-10-11 Water Well Sealing Record #H42960WELL OR BORING LOCATION
County Name
Hasiepln
Toamship Name Triemshkp No Ra»^gr> No
Okono 117 23
Minnesota Well and Bofing
MtNNf SOTA DEPARTMFNT OF HEALTH Seei ng No
WELL AND BORING SEALING RECORD un.qoe no
Minnosotd Sf^itutes Chdpter W3J ^ W-senes No
. l. • r j» •• I
H 42960
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20
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A3r005011
NufT»enr at Sffe*»l ArKJf/»ss ai Fim* Numbof and City of W*»H o» lionivj Locatx.n
3241 Caaco Crl Ocooo
ShOKtu Oiacl location of or bonrx|
tfl MCtKin grid anlh X
SluMch map of larell or bormg
itK.ation sfiotMing property hr>os
roads and build»rvgs
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uuris/tfaneFt Bielte 471-0543
Ma*ng Address *f different Ittan property address mdicafed above
2365 IHanroody Ave
Orono, ^K 55391
GEOLOGICAL MATERIAL COLOR HARDNESS OF
FORMATION FROM TO
N not known irntcate eslimaled formation log from nearby welt or borvtg
drift 0 115
— '>- u• t
'
itc
Date SeaUnJ
Or»pth BrHore Seaftr>g
fej^ngle Aquifer D MuHt.'iquifor
Appioiimale Date Welt
or Boiing ConstruLted
OngiTMt ^)epf^^MSJ----
St.itir Water Level ^^^ccuiato
Cl Approiimafe
S5.1 ^r>elow above land surface
CASING TYPE
l^iilj^tenl Cl Plastic D Tile Q Other
Screert from UL 10 J M Often Hole from
OtSTRUCTK)NA>EBRrS/FILL
]|Xpbslruc1ion G Debus G FUI
Type of debris'obstruction Jajiu^k PjP'. < JfT.
ObstructionOebns Fill removed^ S^es Q No
PUMP
J|li64emoved O Not Present G Other -
CASING
O'lrneter
ir\ from
m from
Deplh
/
Set m overst/e rtola'’Annular space vMiaiy groule<f’
In yj / _ ?l >G□ Yes Gno □ Unknown
_ lo n □ v«Q No G Yes Q No G Unknown
lo n D vot G No D Yes G No G Unknown
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINOS. ON CASINO AND BONE HOLE:
Annular Space Eirsts
G Annular space grouted with Irerme pipe
G Casng PerforatiorVRemoval
M* from it
in from
O Pa rtorMad O Bamovad
O Perforafed G na moead
Type of padoralor
G Other------------------
QNOUT1NG MATERUt
Pifotitmo material ^/ from lo Ji ^
from
REMARKS SOURCE OF DATA OIPPICULTIES IN SEALING
Qrouted 3* wOl 115* deep
5 baga oanent
61be bentonite
2B bi labor, rig & eenent grout pmp
ltX.Al COf>^42960
from
frnUt --------
yards _______bags
h ’S
from yards bags
b^cSEALEO WELLS AND BORINGS
Other ur>vealed well or bonr>g on propefiy'> Q Yes
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
T h»ft well or hiring was seaie «ccordarKa ivith Mir>ne»o a Mulas Chapia 4 72h t he ireormalion conlamad rt 9tf% rapoff is
»nje to the bert* I rny knowteoo'
Don %odola Hell Drlllli^ Co., Inc.27172
( Name Lv^enae or He
lihU-93
Jlai Antonaon
>r »» SeatfT.g \He*f j/ Biv.ng
ME eUJA Oi