HomeMy WebLinkAboutWell and Boring Sealing Record
WEll OR IIORIHG LOCAnoN
County Name
-Scott
Minnesota Well and Boring I
MINNESOTA DEPARTMENT OF HEALTH SeaHng No. H
WELL AND BORING SEALING RECORD Minnesota Unique No
Minnesota Statutes. Chapter 1031 or W-series No.
lLeave blank . not known)
Appro.male Dale wen
or Bonng Conslructed
64086
Depth Before Sealing
1n-1~_Q~
113
n. Original Depth
113
n.
Stalic Waler Level
.Aa:uraie
o Approximate
32
ft.
x
-
_land """-
-
OOlher
~ Screen '"'!"
108
10.
113
n. Open Hole Irom
10
- It.
PROPERTY OWNER"S NAME .
- .
I" <11. I I II
Matlong Address . diIIerenj.D\an properly address llICIoc:aled above.
OBSTRUCTlONIDEBAISIFlLl.
. Obslrui:Ioon 0 DebI.s
o FiB
Typeol~ion 88ft. of drop pipe & pump wire
.
ObslrudionlDeblislFiI removed? . Yes ..0 No
PUMP
. Removed 0 NoIPresenl 0 Other submersible
CASING
GEOLOGICAL MATEfllAL COLOR HARDNESS OF FROM
FORMATION
" not known. ondicale eslimated formation log lrom nearby well or boring.
TO
o
Diameter DepIh
15{ ~ in. from ~ 10 J..gL n.
Set in oversize hole?
Annular space initially grouled?
Drift
o Yes .No
o yes 0 No 0 Unknown
__ in. from _10 _It.
Dyes ONo
DYes 0 No D Unknown
_ in.lrom _10 _It..
DYes 0 No
D Yes D No D Unknown
METHOD USED TO SEAL ANNUlAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE,
. No AmuJar Space Exists
o Annular space grouted with !remie pipe
o Casing PerforalionlRemoval
in. from
to
n.
D Perforated D Removed
in. from
10
It.
D Perforaled 0 Removed
Type 01 perforator
o Other
GROunNG MATERIAL
Groutingmaterialneat cement
from
6
to
113 It. _ yards ~bags
Irom
10
It. _ yards _ bags
REMARKS. ~E OF DATA. DIFFICULTIES IN SEAUNG
Geology taken from a well near this
above address. Unique well number
207411.
from
10
It. --' yards _ bags
from
to
It.
yards
bags
We sealed a 2nd well which was in this
same well pit on the same day.
H64094
UNSEALED WELLS AND BORINGS
Other unsealed well or boring on properly? 0 Yes . No
UCENSED OR REGISTERED CONTRACTOR CERTIACATION
This well or boring was sealed in accordance with Minnesota Rules. Chapter 4725. The informalion Contained in Ihos report is
lrue to the best 01 my knowledge.
Hartmann Well Co.
40174
Contractor Business Name
A~We~
License or Registration No
10-19-95
Date
_l.-:-!PJ. If 11__..... COpyl H
64086
Bob Eckland
Name of Person Sealing WeI or Boring
WEU OR BORING LOCATION
County Name
Minnesota Well and Boring I
MINNESOTA DEPARTMENT OF HEALTH Sealing No. H
WELL AND BORING SEALING RECORD Minnesota Unique No.
Minnesola Statutes. Chapler 1031 or W-series No.
(Leave bill,. . noI known)
64094
Srnt.t.
T;::=an;roJTO:~; NO.' Ra~ No.
SectIOll No. I Fract,on (sm. . Ig.) Date Sealed
~h IMC',. ,P4 ~" 1n_1~_a~
Numencal Streel Address or Fore Number and City 01 Well or Bonng locallOl\
5428_ ~andy Cove Tra i l, Prior Lake, MN. Depth Before Sealing
~::,~_~__orbomg No l' Ioca=~~~'
N 6 ' ~ roads. and
-'. I I _:_ r ) X ~
.: - 1- - ~ - I . ~ ~o . ~ ~. Single Aquifer 0 MuItiaquifer
_..: -.'-< - ~ - _L .v 0 ~ CASING TYPE
W} :!}: ~ll'Tl - i :~D~4 D'~. D~8
" OBSTRUC11OHIDEBRIS
o 0bSttucti0ri . OOebns 0 F~I
Approximale Date wen
or Bonng Conslructed
48
n. Original DepIh
48
n.
SIalic Waler Level
. .Accurate
o Approximate
32
ft.
x
below
_Iand__
II. Open Hole from
10
n.
PROPERTY OWNER"S NAME
Peter Patchin
"'-.g Address 11 dillerenllhan properly address IllCIocaled abcwe.
Type 01 debrisIobstruct
Obslruclion/Oebil removed? . Yes . 0 it.
none
PUMP
.
o Removed . NoI Presenl 0 OIlIer
CASING .
GEOLOGICAL MATERIAL COLOR. HARDNESS OF FROM
~. FORMATION
" not known.lllCIocale estimated 'ormalion log from Marby well or boring.
,
Drift 0
TO
Diameter 0epIh
156 -L in. from -L 10 ~1.
. Set in oversize hole?
Annular space initially grouted?
o Yes . No
o Yes 0 No 0 Unknown
_in.from_Io_It.
o Yes D No
o Yes D No D Unknown
- in. from _ 10 ~ II. .. 0 Yes 0 No Dyes 0 No D Unknown
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 Perforatiorv'Removal
in. 'rom
to
It.
D Perforaled 0 Removed
in. 'rom
10
ft.
D Perforated 0 Removed
It- .
Type 01 perforalor
o Other
GROunNG MATERIAL
Grouting material neat cement
from
6
to
48
It. _ yards ~ bags
from
10
It. _ yards _ bags
REMARKS, SOURCE OF. DATA, DIFACUL TIES IN SEAUNG
Geology taken from a well near this
above address. Unique well number
207411~
'rom
to
ft. _ yards _ bags
'rom
to
n.
yards
bags
We sealed a _
this same well
H64086
2nd well which was in
pit on the same day.
UNSEALED WELLS AND BORINGS
Other unsealed well or boring on property? 0 Yes . No
LICENSED OR REGISTERED CONTRACTOR CERnACATION
This - or boring was sealed in accordance with Minnesota Rules. Chapter 4725. The information conlained in thIS reporl is
lrue to the basI 01 my knowledge.
Hartmann Well Co.
Contraclor Business Name
A~~~
40174
License or Fleglstration No.
10-19-95
Date
.
p:r
. ..
. a. COpy I H
'64094
Bob Eckland
Name 01 Person Sealing WaR or Boting