HomeMy WebLinkAbout1998-06-11 Water Well Sealing RecordWELL OR BORIRO lO(.• TION
Courtly Name — - - _
Henaepil�i
i •� I••;. Name t't•wcrfihip No J Range No
Waysata 117 123
MINNtbUTA Utt'AHIMENT Of HEAL] H Minnesota Well and t3onng 139709
WELL AND BORING SEALING RECORD SeaMinnesota Na Unique No H
Minnesota Statutes. Chapter 7031 or Wsenes No J
risers byre I ntd rnowni
- -
Section Nu 1 Fraction tsm -0 n) r
04 2-Ml
Date Sealed
I f
Date Well or Owing Conslructed
Numeracy Sheet Address or Fue Number and City of Well or Boring Location
2660 Fox St E Wayzata 55391
Depin Before Sealing,M
AOUIFER(S)
S,ngle Aquifer ❑ Multiaquder
WELLADORING
SupWY Welt ❑ Mond Wert
❑ En% Bore Hole LU Omer —.
0,,g�nal Depth4�0_�
Show enact location of well or boring _ -- ---Sketch map of rig
on Section god vnth'X• location sh 9 Or nY
lives roads a DudO.n
N __
- _—
W "{" E . `.
• —+ -
1r row
--`- -t- •{-- --{-•
S .
Ila— r y _
STATIC WATER LEVEL
_
Mea•.wwf ,) EstimatedWater
�/.
i n Z. r+ec- ❑ above land surface
CASING TYPEJS1
�K%IeM U. PlasN,... Lie " "1 Oise,
CASINO
Diameter Depth Sol to overwe note? Annuals; space inNapy, groufW7
��/ 2 Yes XNo ❑ Yes ❑ No ❑ Unknown
m from ❑
_ to h
n from to h ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
in from to If ❑Yes ❑ No ❑Yes ❑ No ❑ Ureutown
PROPERTY OWNER'S NAME
r
Pmpery 'a madutg address d *%fem was wlocation address indicated above
SCREEIYOPEN MOLE
r �
Screen from _0_ to h Open NOW frown to If.
OBSTRUCTIONS
❑ RodsfDrop Pipe ❑ Check Vahre(s) ❑ Debris ❑ Fill 'G7 No Oostrudron
Type of Obstructions (Describe) - -- --- /�
Obstructions removed? ❑ Yes ❑ No Describe
WELL OWNER'S NAME
WON+ers mWq ss addred dmwem fnan Propertyo vnei S aodress mdcals0 above
PLOP
Type
❑ Removed Not Present ❑ Omer --
GEOLOGICAL MATE;; COLOR F � DF FROM TO
e nol loom. esternstsd loins w from nearby wM or boring
METHOD USED TO VEAL ANNULAR SPACE BETWEEN 2 CASNK3S. OR CAWM AM IDLE:
No Annular Space Exits
❑ Annular space grotded wdh from* pipe
❑ Casing PMora"OnfRemoval
in from to It ❑ Perforated ❑ RentO..d
in from to h ❑ PNlorekW ❑ Rsntov.d
Type of pedoralof _
❑ Otter
I
GROUTING MATINAL(V)
Grouting Mateo from _�— to1rL h yards
from to h yards bw
from to n yards brows
from _. to -- It Yards bw
REiI•AM& BOUNCE Of DATA, DIRFICULTfEV 0 WALING
OTHER WELLS AND BORINGS
Other unsealed and unused was or boring on property? ❑ Yes wo-low many?
LICENWO OR IIEl1MTE11ED CONTRACTOR CERTWICAT10N
This wee or bong was sealed in accordance won Minnesota Rules, Chapter 472S The udormabon oonterrfed n Vea mplift le
true to the best of my knowledge.
Don Stodola Well Dcilling Co., Inca 27172
Conrrww Business Name Gdee.e a RplebVbf Iflo.
Dow
LOCALCOPV
JH 139709
dPerson Switai"'g'WaSwing
14-01434-W "J, n