HomeMy WebLinkAbout1994-03-17 Water Well Sealing RecordWELL 011 BORIN6LOCATION
Minnesota Well and Boring H 4 912 b
MINNESOTA DEPARTMENT OF HEALTH Sealing No
County Name
WELL AND BORING SEALING RECORD Minnesota unique No — —
Minnesota Statutes. Chapter 1031 or Wsenes No.
Township Name Township No Range No
Secl.in N) Fracl.on Ism • lit
Date Sealed Appm—ate Data Wee
I
a Boring Constructed
141 Street Addle ss or Fire Number and City of Well or Boring Location
Sts �I
y�
� SS391
C
Depth Before Se.pmy h Original
— Depth —� tl
Shoal esad kLalron of wes or bong
Sketch map of well c boring
Static Water Level ccurate
in section gntl wdh X
hor, showng proper Ines
N
roads and Id.ngs
LL Appos.male
r r
� 1
�i���
Sngb Aquifer ❑ Mulbaqer
/
er
Mn�,w ,dmv.•lmd Wi
tr _� sace
CASING TYPE
f
W r r r r
r r r r � � •
^
❑Steel ❑ PIASIK XTdw ❑Other
S.
i
Screen from -- to --- _._ fl Open Hole hum In -_�� h
-- f reA1
--•--
OBSTRUCTKMYDEBRIS/FILL
iruchon ❑ Debns ❑ FII
P/^ROOPE�RTY OWNER'S NAME
\KaiVl
_amarfe_ _
-- __ -----
Type of debris obstruction
M,, Lnq Agd....... .1 rLbeg int Ihnr. p, o(M•,+y ntkfres•. nuU..Ned
ntnwe
Obstruct* Debns FUI removed1 �Xe•. ❑ Nu
PUMP
L*4emoved ❑ Not Present ❑ 011ie, ��•��� ��
CASINO
GEOLOGICAL MATERIAL
COLOR
HARDNESS OF
FROM
TO
_
FORMATION
D.amole, Depth Set .n oversee hule� Annular space nAlally groubW
--/L,-:,n from r" _ to V.? N ❑ Yes 01(o ❑ Yes ❑ No ❑ Unknowlift
_L __
11 not krgwn r"Wale estimated lormatrurr log from nearby well or boring
142
drift
0
infrom _- to h ❑ yes ❑ No Ci Yes ❑ No ❑unknown
It ❑ Yes ❑ No ❑ Yes ❑ Nn, ❑ Unflurew
— — ---`—
--
—
—
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, 0" CAMO AM SORE "OLE:
CKo Annular Space E.usls
❑ Annular space grouted with Iremw pt.`
❑ Casing PerforatronFTerrroval
n Irom to --- If ❑ Perforated ❑ Film" .led
.n Irom to 4 ❑ Perforated ❑ Reeklved
Type of perforator
—
---
❑ cher
O
_
OROUTWO MATERIAL
--_-- -
-
Gmuhny malarial N� AT L f /�%L fVI Irom �_ to h
yards
from to If yards _
REMARKS. SOURCE OF DATA. DIFFICULTIES IN SEALING
to h yards
.- from to _ h yards
UNSEALED WELLS AND IORMS
Olhor unsealed well or bonny oe p.,. •edy" ❑ Yes
LICENSED 00 REGISTERED CON7NACT011 CERTIFICATION
Ths well or bnru,q was seakd n t I-11, . a wdh Mnnesola Rules Chapter 4725 The informaloe rananed n the report is
I1.y. ro the best of my kn�owled.le
]� /�� T� �s
_ � Stodola k*U Dril11%' Co�� �ii<--. __- Z 72
Bnti.ness Nan.. Ln'en a Rf`grsfraf..+ No
1 •
�'t°"�°�'
( OCAS COPY
M 49125J�^
N.e .• U Pf•rsrr, Sealing wen m k. ,.ny
HE 0143401