Laserfiche WebLink
, _ _ _ . - -_ . _______ _ . .T.� <br />� <br /> MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring ������ � <br /> WELL OR BORING LOCATION Sealin NO. I H <br /> Gounry Name — WELL AND BORING SEALING RECORD 9 -- --� <br /> Minnesota Unique Well No. I� --— � <br /> ������� Minnesota Statutes,Chapter 1031 o�W-�sMe„as No. <br /> Township Name Township No Range No. Section No. Fracuon(sm.-�Ig.) Dale Sealed Date Well or Bonng Constructetl <br /> �rnao 11? 23 7 . ,. �"_ .�% ;'- s'�"c.' <br /> Numerical Sireet Address or Fire Number and Ciry of Well or Bon�g Locauon <br /> l�f!$ H4�th A13 DY j 41't73� $��� Depth 8etore Sealing_� �� 8 Original Oepth ___h <br /> Show exact bcation of N-ell or boring Sketch map ol well or bonng AOUIFER(S) STATIC WATER LEVEL <br /> In section gnd with"X". location, showing property Sngle Aywfer ❑ Mulhaquifer <br /> � lines,roads,and buildings <br /> N ' WELUBORING �Measured ❑ Estimated <br /> s',. <br /> - -- -- -- - -- ,� • �later Supply Well ❑Monit.Well <br /> :" ❑ Em.Bore Hole ❑Other _ ___�7_�ft [�below ❑ above land surtace <br /> i <br /> . W __f_ _,__ _l__ __l__ E : . �::. <br /> �. CASING TYPE(S) <br /> -;-- -;-- , --i- � ' f�Steel � Plastic �Tile �Other <br /> � � � � �mile �....._.�- r <br /> —�- -�- -�— --�— � F/` CASING�S) <br /> t <br /> Diameter Depih Set in oversize hole7 Annular space initially grouted? <br /> 5 4 <br /> ��m,ia� '� m trom � to� n. ❑ �es ❑No ❑ ves ❑No �Unknown <br /> PFOPERTY OWNER'S NAME in.irom_ to ft. ❑ Yes ❑ No ❑ �es ❑ No ❑ Unknown <br /> • Joht� iTalker <br /> Pioperty owner's maihng address if different than well location address indicated above. in.from_ to .ft. ❑ Yes ❑ No ❑ �es ❑ No ❑ Unknown <br /> 1'�1{i �J'��LEGw� �l��C� SCREEWOPENHOLE <br /> ► �� ..� <br /> �1"�O� i� 5536� Screen from�-��✓to�� ft. Open Hole from ro k. <br /> OBSTRUCTIONS <br /> WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �No Obstruction <br /> JOhn WSI.�te� <br /> Well owner's mailing address if diHerent than property owner's atltlress indicated above. Type of ObStrodions(DOSCfibe) <br /> - s�� Obstructions removed? ❑ Yes ❑ No Describe <br /> PUMP <br /> 7ype �\.J��, �e"'���{jl � �. <br /> GEOL061CAL MATERIAL COLOR MARDNESS OF FROM TO y�Removed ❑ Not Present ❑ Other <br /> FORMATION <br /> - If not known,irWicate estimated tortnatbn log from nearby well o�bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: <br /> `�.No Annular Space Euists <br /> r � <br /> ❑Annular space grouted with tremie pipe <br /> ❑Casing Perforation/Removal <br /> � in.from to tt. ❑ PeAorated ❑ Removed <br />�' <br /> • in.from to fl. ❑ Perforated ❑ Removed <br /> Type of perforator <br /> ❑ omer <br />�� GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) <br /> Grouting Matenal ���'-� t ����f�om � to�.�. yartls bags <br /> from to R. yards bags <br /> _ from to .ft. yards bags <br /> from to_ ft. yards begs <br /> REMAIiKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS <br />�,� <br /> Other unsealed and unused well or boring on property? ❑Yes .�No How many? <br /> LICENSED OR REGISTEHED CONTRACTOR CERTIFICATION <br /> This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information coniained in this repoA is <br /> true to Ihe best of my knowleclge. <br /> Stevens I?rillinQ � Eav_ ServiceR g(�65�. <br /> Contractor Business Name.. License a Regisfretion 170. <br /> . � -. ��: ..—'_ <br /> a , � . �'`'-�'� __� � _', /,? <br /> S � - <br /> AuMorized Representative Signature Date <br /> ..� �.: ��• + � k'`;� C�....,;", �1, <br /> . n 16 3 4 7 7 Name ol Persoo 3epling Well or Boring . <br />