HomeMy WebLinkAboutWell and Boring Sealing Record
WELL OR BORING LOCATION
County Name
Scott
TownshIp Name
Glendale
~"OO~ w." .'. =""" I
MINNESOTA DEPARTMENT OF HEALTH Sealing No. H
WELL AND B.ORING SEALING RECORD Minnesota Unique No
Minnesota Statutes. Chapter t03/ or W-senes No.
cleave blank 11 nol knownl
Range No
21
Sechon No Frachon (sm . Ig I
30 SW I,. NW. Ii
Show exact Iocahon of weB or borIng
In Section gnd with ~X
NumerICal Street Address or Fire Number and City 01 Well or Bonng Locahon
14296 Rutgers St., Prior Lake, MN.
N
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~ I mile----.j
PROPERTY OWNER'S NAME.
N l' Sketch map 01 well or bonng
locat,on. ShOWlO!l pt'operty hnes.
roads. and buikjmgs.
01
\- ~ li~~ t
TX~
,mile t.
1 ~
~
...d
Ma~ong Address ~ dIfferent than properly address ,nd,cated above
GEOLOGICAL MATERIAL
II nol known. IndIcate estimated lorma'tOO log from nearby wetl or boring
Clay
Dirty gravel
Gravel-rocky
Gravel
o
15
25
90
REMARKS, SOURCE OF OATA, DIFRCULTIES IN SEAUNG
Geology taken from a well a
NE from this above address.
Number 207079..
few places
Unique wel
_.
IIlJU:~S T lfr.Ill.. IfH cOP H
64053
Dale Sealed
ApprOXimate Date Well
Of Bonng Constructed
8-14-95
Depth Before Sealing
125
It Ortglnal Depth
64053
j
125
It
Static Waler Level .. Accurate
o Approximale
Set in overSize hole? Annular space initially grouted?
DYes _No DYes o No o Unknown
DYes ONo DYes oNo o Unknown
DYes oNo DYes oNo o Unknown
. Single Aquoler 0 Muh13qUtfer
CASING TYPE
77
II
.. Steel
o PlastiC
o Tile
o Other
Screen fro!,"
120
125
II. Open Hole Irom
to
OBSTRUCTIONlDEBRISlRLL
o ObstruCllOn 0 Debros 0 HI
none
Type ot debnslobstructoOO
ObstruchonlDebnslFiH removed? .. Yes
ONe
PUMP
o Removed . Not Present 0 Other
CASING
TO
Diameter
Depth
15
25
90
115
---L in.lrom ~ to ~ II.
_in.from _to _ ft,
_ in. from _ to _ h.
^
below
above land surlace
to
II
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:
. No Annular Space Exists
o Annular space grouted with tremie pipe
o Casing Pert oration/Removal
In. from
to
II.
In. from
10
II
Type of pertoralor
o Other
GROUTING MATERIAL
Groutingmatenal neat cement
2
to
from
from
to
from
to
from
to
UNSEALED WELLS AND BORINGS
Other unsealed weB or boring on pt'operly? 0 Yes. No
UCENSED OR REGISTERED CONTRACTOR CERTIFICATION
o Pertorated 0 Removed
o Pertorated 0 Removed
125 ff _ yards ~ bags
II. _ yards _ bags
II. _ yards _ bags
ff. _ yards _ bags
Hartmann Welleo.
Contractor Business Name
40174
This _n or boring was sealed in accordance with Minnesota Rules. Chapter 4725. The ,nlormation contained '" thIS reporl IS
true to the best of my knowledge.
~~
Authonz epresentatlve Signature
Kevin Hartmann
Name o( Person SealIng Well or BorU1g
lICense or Reglstra/1OfI No
8-20-95
Da/e