HomeMy WebLinkAbout1994-08-11 Abandon Well RecordMinni
Well and Boring
OR BORING LOCATION Sealing
57009 7 O O
MINNESOTA DEPARTMENT OF HEALTH ea6 NN o f7 u 1J,7
County Name _-----------� - WELL AND BORING SEALING RECORD MlnnesolaUniqueNo -
HttL.�... Minnesota Starules Chapter 1031 or Wsenes No
e Y• •i r•,�.r I'.InY ,1rpt YrHMri�-_ - ____ d
Township Name Township No Range No Section No t r•rctlon Ism • lg 1 Date Sealed Approximate Date Wen
Or_cx+n 118 23 36 4 WO 1,5 or Boring Constructed
_
N. �i-if Sheol
Address or Fire Number aannd.�Cay of Well or Boring Location p , l �04
119 \ A. VY � D • Orc W 55391 Depth Belore Seahny---���_ __ _ it ong"I Depth - II
Snow eaact location of well or boring Sketch map of well or bonny Static Water Level curate
—lion grid with K location showing property lines
j it ds and qtr rigs El Approximate
IN S • .. J Il . }]t
ogle A,Iwfer ❑ Muthaquder _ it _— A below above land surlace
i r r i fI —
W -- E V
I i reel ❑ Plastu: ❑ Tile ❑ Other
S Screen Irom — ----- to ---- 11 Open Hole hom — Io__ It
Imo— .* —moi OOBSTRUCTIOPWiSPISiFILL
/
PROPERTY OWNER'S NAME oostruction ❑ Debris ❑ f dl
Jetj w0ek 47b-[931,
- ----- - -- — - — Type of debnvolosin chon _ L1Lf le
Meil,nq A&Y1•• d ddlemnt than property address rndica•ed above
ObsfructioNDebns'Fill rcHnovcd"' Ale, ❑ No
PUMP
Removed ClNot Present ElOther 54AP PCrmP
CASING
GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO
FORMATION
It riot known, indicale estimated formation log from nearby well or boring Diameter Depth Set in oversize holel' Annular space indralty, grouted'
drift_ in from Io.. It ❑ Yr a VN. ❑ Yes ❑ No ❑ Unknown
_ io birth to 11 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
in from _._ to 1t ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
-- - ------— METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS. OR CASING AND BORE HOLE:
No Annular Space Exists
❑ Annular space growled with berme pipe
— --- -- — ❑ Casing PadoratiorvRemoval
-- in from to -- it ❑ Podorated ❑ Removed
in from to it ❑ Pedoraled ❑ Removed
-- Type of pedorator
—___..._.. ❑ Other
GROUTING MATERIAL
Grouting malenal 04'e 0o 7 !/hf N/ born— to til it yards , bags
from __— to ti yards bags
REMARKS. SOURCE OF DATA. OIFFICULTtES IN SEALING
from _ to —_— ti —_ yards nags
from — to _ _ it yards Sags
22 UNSEALED WELLS AND BORW6S
AUGj Uf �' (Mhei unsealed well of boring on propertyl ❑ Yea 361.
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed in accordance with Minnesota Hubs. Chapbv, C . M.,mation contained in Mrs report,s
true to the best of my knowledge
Dan 5t .1ola well Drilling 1w. 27172
Conlra[Yor %sirress Name License iv Neorstrahon No --
•
r t ne'f"r,' mrzd" Sgnaaue Daly
x 7 0 0 9 Jim An`ons'
x �L t tv H -- --
,,, ,INoaaHrxrny