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Home My WebLink Aboutwell info Minnesota Well and Boring WELL OR BORiNG LOCA7iON MINNESOTA DEPARTMENT OF HEALTH Sealing No. H �o��Y Name� WELL AND BORING SEALING RECORD^^��eso�a u��Q�e No , I��p�� Mmnesota Statutes.Chap�er 103/ or W-senes No. ;` ILeave blank il noi knownl Township Name Township No Range No Section No Fraction�sm. •Ig) Da�e Sealed Approxima�e Date Well �O�> 1,�_l L� l,J �i�t,f(;�� or Bonng Cons�ruc�ed �' la Numencal Street Address or Rre Number and Gty ol Well or Bormg Location 1(`'� � / ' � %!% ��K �3.�i� �� l. :�7 ih�„ Depth Bebre Sealing ""'`U ft. Ongmal Depth �� ft. Show exact locatan of well or bonng Sketch map of well or¢onng Static Water Level Accurale m secuon gnd wdh��X�� IocaUon.show�ng prop�rly�ines. � � io�d�ap�l I�LJdings ❑Approximate N i _�_ /t �( � / � � � { � S�ngle Aqulfer ❑Multiaqwfer �v fl. '` below above land suAace � i � i t _i- -�- -�- � CASING TYPE W E � � � � -r -�- -r- -r i i i i � leel ❑Plashc ❑Tde ❑Other mi�e -�- -i- -�- -i- � ..1i... - � �U� / � 7 //`� S Screen from � lo ��G` ft. Open Hole from to ft. �""'k� .�L�.I � vL � OBSTRUCTION/DEBRIS/FILL Obsiruc�ion ❑Debris ❑Fill PROPERTV OWNEH'S NAME D1CJ� & ��y Hc�l�(:�I J� /� Type of debns/obslrucUon �-�`,-A-.J��—��.T/"�f �` G.=tr1T` MaJ�ng Address d ddterent Ihan propeAy address�ndicated above. �� Obsiruction/Debns/Fill removed7 Yes ❑No �2�3�) Halca� Bricige P�UMP �Itha�ett.�, ceorgia 5�l�—p�11�3l� 1tf'�—q��—�i g� 3G'1.02 Removed ❑Not Present ❑ Other CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Set in oversrze hole? Annula�space mitially grouted? II not known.�ndicate es�imated formation log irom nearby well or bonng. 4- �/� /`, / in.from �to�(1� fL ❑Yes �lo ❑Yes ❑No ❑Unknown in.trom to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �!o Annular Space Exisis ❑Annular space grouted with Iremie pipe ❑Casing Perforation/Removal m.from to tt. ❑Perforated ❑Removed m.irom lo R. ❑Perforated ❑Removed Type of perforator ❑Other GROUTING MATERIAL ...., �` � Grouting materialA,��,1 ��j7�js� (rom y,�to ��_ft. yards �bags ,r— from to ft. yards bags REMARKS,SOURCE OF DATA,DIfFICULTIES IN SEALING from to fl. yards bags from lo ft. yards bags UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑Yes o LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The iMorma6on contained m this report is �rue to ihe best of my knowledge. Dii�; ti'i+ODtsLA i�i� UR11..LTNG CG., IH�. �11 i� Conhacfor Business Name License or Registrahon No. i � "` -''` -��'.��-.T�� .-� f I - !'i -,�/ h e � pFesentat�e Signatura Date --i ` ..�� _ . H � � �' ' '� l , � �, , � �,�'„�j„�;�"Y( •• � Name ol Person Seahng Well or Bonng HE-01434-01 Minnesota Well and Bonng WELL OR BORING LOCAT�ON MINNESOTA DEPARTMENT OF HEALTH Sealing No. H CountyName WELL AND BORING SEALING RECORD M��eso�a u��Q�e No. �'^��'�-� Minnesota Sfatutes.Chapter 1031 or W-series No ILeave blank il noi known� Township Name Township No Fange No Seclion No Fraclion(sm. •Ig.) Date Sealed Approximate Date Well / j ,-�.�, j,+�/ or Bonng Cons�ructed c�r� i t7 z3 0� ��14��;��,a � f Numencal Slreet Address or Fve Number and City of Well or Bonng Localion ,-�� f j.�!5 t'ark Dr_ive Ur�C.7� �11. �5��f�� Depth Before Sealing ��",'-� It. Onginal Depth h. Show exact localwn of well or bonng Sketch map of well or boring Static Water Level �Accurate �n section gnd wdh��X�� sy lo�ca�ion.sTi wmg propeAy hnes. t �oads.and buildings. ❑Approximate -- -�-N--- -- C � ) i �y Smgle Aqwter ❑Multiaquder fl below above land surtace i i � _�_ -i_ ,,� CASING TVPE W ' ' E J�u. � � i � o _�_ '�_ _r_ ❑Other i i i m.� " S�eel ❑Plas�ic ❑Tile , � ,_ 1��;,t � �,�. c_ -;- - ,- --- -, ��T�� f � - S MMC.1.� � Of �$ Sueen Irom � ��I�� lo � "� '� f� Open Hole from lo fl. � �'"'k� OBSTRUCTION/DEBRIS/FILL ❑Obs�ruclion ❑Debris ❑Fill PROPERTV OWNER'S NAME Dicis & Peggy Hatch ,�,,! , , Type of debris/obstruction Maihng Address d dAferent ihan p�operty address indicated above. Obstruc��oNDebns/RII removed� ❑Yes ❑No C7L.'�!U HQ�L:LitiJ BiI1C� PUMP R1tF�Z'E?t�� Cx3. 3!;:c(;2 t��J4�-�i7�—jt t7� ❑Removed NotPresent ❑ Other CASING GEOLOGICAL MATERIAL COLOH MARDNESS OF FROM TO . FORMATION Diameter Depih Se�in oversize hole? Annular space irnhally grouted7 If not known.indicale esUmated IormaUon log from nearby well or bonng. � � � in.from ` '� to ��J fl. ❑Yes �No ❑Yes ❑No ❑Unknown t i '� �'�.:1 in.from to fl. ❑Yes ❑No ❑Yes ❑No ❑Unknown �, m.from to tt. ❑Yes ❑No ❑Yes ❑No ❑Unknown � � METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casmg Perforation/Removal in.from to fL ❑Pertorated ❑Removed m.irom �o ft ❑Perforated ❑Removed Type o(perforator ❑O�her GROUTING MATERIAL (% Groutingmaterial �=�'� `' � `��"`�l+drtl� '�-� to �'-1�� it. yards -��-, bags from to ft. yards baqs � REMARKS.SOURCE OF DATA,DIFFICULTIES IN SEALING from to ft. yards bags from to ft yards bags UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑Ves No LICENSED OR HEGISTERED CONTHACTOR CERTIFICATION �" This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained m ihis report is � irue to the best of my knowledge. DU[3 :'IC7DC�I.T+ WEI�., D�II.i,ING C�,, INC. 2717� Confractor Busrness me 3 �;. License or Reg�sfra6on No. � �_,r,..�- _.. �, .,� �/- i' i% � uf nz epresenfativeSignature� Date _r u �..,� . /s,, �;'l. �c� i 1.::C.J�i i��7� n ��7 Name o!Person Sea6ng Well or 8onng �� HE-01434-01 Minnesota Well and Boring WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEAITH Sealing No. H CounlyName WELL AND BORING SEALING RECORD M��eso�a u^�Q�e No. .;� �Zj��l,j} Mmnesofa Statutes.Chapfer 103/ or W-senes No. /'� ILeave biank�I noi knownl Township Name Townsh�p No Range No SecUon No Fraclwn(sm. •Ig) Date Sealed Approximate Date Well q � or Bonng Consirucled t��)n� ! �7 .4✓ �f ��--5%l�a/U'ia � Numencal Slreet Address or Fve Number and Gly ol Well or Bonng Locahon �/� � y/.'��'�� i 1375 P�rk Driv+E: vlflnf:� ��• �J✓`6'i Deplh Be�ore Seahng �,L� fl Ongmal Depth `-�' f� SFaw ezact bcatan ol wefl or bonng Sketch map of well or bormg Slatic Water Level Acwrate m secLon gnd wdh�'X-. ' IocaUon s wmg propehy hnes. � �oads.and bwldmgs. ❑Approwmate -- -;-N-r- -- f � � i ` � ��i o �/� � '' Single Aquifer ❑Multiaqwfer yl1—fl. � below above land suAace i i i i --��- � -i- -�- -i- CASING TVPE w i i i i E - -�- -r- -r i i i ,� y ` � �"�^.,f � Sleel ❑Plashc ❑Tile ❑Olher , LJ -- - i_ � � i- --- -� / �f,l I S ��I ? (;.�. 3 Screen trom —�— b —L� fl. Open Nole from to it �""'k� OBSTRUCTION/DEBRIS/F�LL ObslrucUon ❑Debris ❑Fill PROPERTV OWNER'S NAME Dic.'� & P r�attct; 1,�s�. PrP� 9-- Ji� Type of debns/obstruction Maihng Address d different ihan property address�ndicaled above. Obsiruction/Debns/Fill removed� �es ❑No 8�48 Holaxnb Sriciqe R� e1�MP 4G�-993-�]92 ��lthare�'�, C�. 3C;L(;� --- emoved ❑Not Present ❑ Other�� CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Sel in oversize hole7 Annular space iNtially grouted? - II not known.indicale estimated torma�ion log irom nearby well or boring. � // � in.from � lo � ft. ❑Ves �'No ❑Yes ❑No ❑Unknown - " �c �- i._� _>/) m.trom to fl. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unk�own METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �o Annular Space Exists ❑Annular space grou�ed with tremie pipe ❑Casng PeAoration/Removal in.irom to fl. ❑Perforated ❑Removed in.from to tt. ❑Perforated ❑Removed Type o(perforator ❑Other GROUTING MATERIAL - / �� i Groutingmaterial�/Uj�_�TI ��I�1�Irom _�_to fl yards bags from to ft. yards bags REMARKS.SOURCE OF DATA,D�FFICULTIES IN SEALING (rom to ft. yards bags irom to ft. yards bags UNSEALEO WELLS AND BORINGS Other unsealed well or boring on property7 ❑Yes ❑ LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or bormg was sealed in accordance with Mmnesota Rules,Chapter 4725.The information contamed in ihis report is true to the best of my knowledge. DC�A1 S`�:tiJt)C:L� 't�..I. IJ�1.itL�I:1tiG CG., Ihit:. G!1%�: Conhactor Busrness Name L�cense or Reg�strahon No. � r'� , �, /`�' �j f._, ;� t .�f?epr2senta6ve Signature` �� Da�e _.� �J ( . f:-ti ,/-1 ��-� �r= �:�J�'l �,Q�.�i,�;;f1)Ff�''(( � Name ol Person Sealrng Well o�8onng HE-Ot434-01