HomeMy WebLinkAbout1995-01-06 Well and Boring Sealing RecordMinnesota Well and Boring
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No H
County Name WELL AND BORING SEALING RECORD Minnesota Unique No 61.547
M dnesota Statutes Chapter 1031 or W -series No
Hennepin ---
Towosttrp Name iownslvp No Renge No Sectron Nn F r:¢trnn Ism Iq 1 Daft- Sealed Approumale Dale Well
Orono 117 23 4 1-5-95 or Boring conslrucled
Nunencal Street Address or Fre Number and City of Well or Bor,ng Localwn '
2804 Countryside Dr W Orono 5 5 3 1t1h fielore E..alr,y _._ 148_ 11 Orgnal Depth 152 it
Show exact location d wellor boring 11 Sketch ma nor bonny Stahc Water Level W Accurale
n action qnd with X �: Cf 1 4eeakbA�how A Ir
N roads and thuk,mgs ❑ Approsrmale
Aquifer ❑ 190 II R below above land surface
W _ r _ _ s _ _f_ I _ CASING TYPE
r r ❑ %wo X [ ] T,In ❑ Other
rnrr l..unh� .
i "k •L� 'rex Removed
r S r U„ Screen fromft Open Hole tram to . __— n
I map O1 OBSTRUCTIOWDEBRIS/FILL
MOPERTY OWNER'S NAME [.] Obslrurhun ❑ Deh-, [_� fit
Tony Eiden Co.
TYp' of deboS rN)s(runnone
Ma.inq Address ifd-ft"daalcd atc
4100 Berkshire Lane 0t)%I'Joon Dehns Filll-emaved I L) fes 0 N
Plymouth, MN "446 PUMP
❑ Removed 2 Nut Pa•sr•r:1 ❑ Oth e
VEOLOGICAL MATERIAL
I COLOR
I HARDNET1pNSS OF
I FROM
I TO
iORMA
Uameh•Depth
.
Set in oversize holo? Annular spate initially gfomed'r
M not known formation eslfinelBd Iorfon IOq from nearby well of being
Clay
black
soft
0
---- -
4
—�
4— .n from -_ �_._ to 148 1,
El Yes Zl No ❑ 'as ❑ No ❑ Unknd
in from __ ,o — It
❑ Yes ❑ No Oyes ❑ No ❑ Unkno,
Clayn
Clay
Yello
Grp
sof
sof L
18
88
from to _ h
❑ Yes 11 No ❑ Yes ❑ No ❑ Unllrtol
USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:
Sand/Gravel
Tan
soft
88
148METH
Annular Space Exists
❑ Annular space grouted with tremre pope
_--------- - -
❑CasingPedafabonvRemoval
- - -
m from to
n ❑ PerIo .lid U Hemoved
in Iron to
It [] Pedor,ued f_I Removed
REMARKS. SOURCE OF DATA. DIFFICULTIES IN SEALING
6154
Type of perforator
El ott-o
GROUTING MATERIAL
Grouhrg ----neat ceftiffidlt0 _. ,�, _148 If _—_-- Yards 7
-- from __ to .._-_ it _ __ vara•. -.. gags
UNSEALED WELLS AND BORINGS
Other unsealed well or bonny on propeny? ❑ Yes ® N,,
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed to accordance mth Minnesota Rules Chapter e725 The information contained in trus report is
true to the bell+ of my knowMdpe
Don STodola Well Drilling Co., INc. _27172
Contractor Business Name License or Regrs/r;f n No
1-•25-95
ulliorrfed HepreserNafrve•_Syrwfu,a (late - - -
- "--
Y
Name of Person Seafsg Wee or Soreg