HomeMy WebLinkAbout09/09/1998 Well & Boring Sealing Record MIEIL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH M�nnesota Well and Bormg rH l 4 4�3 9 �
WELL AND BORING SEALING RECORD Sealing No.
Cou�ry Name Minnesota Unique No — —
Minnesota Stafutes.Chapter 1031 or W-series No. �
Henne in (Leave blank il noi knpwn)
Township Name Townshlp No. Range No. Section No. Fracbon�sm.-s Ig.) Date Sealed Date Well or Bonng Gonstructed
Orono 11 23 20 I�fJO°37�� � cr � �^;�:
Numerical Strcet AdOress or Fire Number and Ciry of Well or Bonng Locauon � � -
24�i1 C8.9C� Point Ad� Q=�Q� 5539 epthBetoreSea6ng ��tt OriginalDepth �[� h
Show exad bcation of N�ell or boring '_ Sketch map of well or boring AOUIFER(S) STATIC WATER LEVEL.
in section gnd with'X'. cat�e�, showing property �Sm le A uifer .
� es!��?7ds,and buildings. 9 Q ❑Multiaquifer
ry � WELUBORING (�Measured ❑ Estimated
- - - - - -- - -- '��-s* wa�er s�,cpy we�i ❑r�«�a-weu � r
'�^�f r` ❑ Em.Bore Hde ❑Other .�� R. �pelpw ❑aDove land suAace
W _Y_ _Y_ _l__ __l__ E ��j \ CASING TYPE�S)
� I i
�
-r- -�-- -�-- -i-- � ��� �,Steel ❑Plastic ❑Tile ❑Other ,.
� � � i u mile _._..,.���`�/. �
--�- -�- -�-- -�-- � CASING
Diameter Depth � Set m oversize hde9 Mnualar space irntialy grouted?
S �"�
�~""'�—�' _.._...�.___._�.�.__ ? m-fram � to �U� ft. ❑ Ves �No ❑Ves ❑No ❑ Unkrawn
P OPERTV WNER'S NAME m.irom to ft. ❑ Ves ❑No ❑ �� ❑� ❑ �^k^�'�'^
�ave�*4e 8n CanAastraci
Prop9rty owner's ma�hrg adAress if ditterent than well location address indicated above. in.from to R. ❑ Ves ❑No ❑Y� ❑� ❑V���
C/��1�$�r Finsitat SCREEWOPENHOLE
���iZ: Jee John�on �3CJ'��L.lV �reenfrom ���? / to fr / , ft. OpenHolefrom to h.
3965 �i broadway oBS�„o�
, �,
Roas/Drav Pipe ❑ct,ea�vanre(S) ❑oebris ❑Fiu ❑No otscruaan
Well ownefs meiYg address if different ihan property ownefs atltlress indicated above. Typ6 ot ObStnx.'tions(Oescribe) ��-'��U�1� �e��_j } ,�_/-!y'��G fr f�� �
QbStflIC11011S fQfllOV6d? �85 ❑NO DBSCribB
PUMP
Ty� '`�!<':,e<.� r:,r���iy
CiEOLO(i1CAL YATERIAL COLOR MAFDNESS OF FROM TO Rert�wed ❑ Not Present ❑ Other
FORMATION
If nal Ivawn,irdiceM eatirtated tormatbn log from nearby weli or boring. METfiOD 11SED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE:
i.� , �No/4wr/ar Space ExitS
�`--f"��"r��� �f ❑ Mrx�lar space garted wi�h tremie PiPe
❑ Cesing PeAoraOwNRenaval
�.� to R. ❑ Per(aated ❑ Rertavad
�-� to R. ❑ Perbrared ❑ Renaved
Type of peAorator
❑ Otl�er
GROUTING YA7ERIAL(S)
C,rarting 6,yteriel ^J/.:1/ f�1:�)!-�ho�n � ro L1� ft. yards � bsgs
ham to It. yards bsqs
hom to It. yards bays
hom to_- fl. yards bps
HEMARKS,SOI/RCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BOFi9iGS
Other unsealed and inused well a boring on property? ❑Yes - No How many?
LICENSED OR REGISTERED CONTAACTOR CERTIFICATION
lhis we�a bwig was sealed in acoordence wiTh Minrresofa Rules,Chapter 4�25. The iMortnaOon contaned in Mis repott is
m,a eo me oes�a�y a�ba9e.
Don Stodala We2I Drilling co. , Inc. 27172
co�wac�a�e�esness Name �ioerrss or Hsyisb,ean r•o.
� ,
� yj-'���-•' ��. �� `�LW
�SiBmaNre OWs
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LOCAL COPY H 14 4 4�9 �d Rarsnn Se�alig WeI w Bonng
HE-01�34-03 2/97 R