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WEU OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. H 6Aa8 7
County Name WELL AND BORING SEALING RECORD Minnesota UniQue No.
Scott Minnesota Statutes. Chapter 1031 or W-seriesNO.
- tLeave blank " noIknownl
T ownshop Name it'1tt r22 No Sechon No /irachonlsm. '19.1 Dale Sealed . Approxornale Date We. . ..
E~,g, 1 ,ei" ere 35 SE ',. 56,. N~ 10-13-95 or Bonng Constructed
Numencal Street Address or F"" Number and CIty 01 WeU or Borong localoon 90 90
1545 r Breezy Pt. Rd, SE, Prior Lake, M~ pepth Belore Sea~ng It. Original Depth It.
Show exacllocalion 01_ ", bonng tV .If" SkeICh map 01 - or b f""9 Sialic Water level . Aci:ura..
.. sectIOn grid wilh 'X'. Iocatoon. showing property ~. DApproximaIe
N \ )I. ~ roads. and builc:~.
, . I I ~o~X ~ J 49 X
.-,- -.- -;- -,- . Single Aquifer 0 MuItiaquiIw 11. below abow land surface
- -L' .. --' . r:--'-' ~
j , , , - . ,. ... "0
.,- .~ _i. _ _L CASING TYPE "
W . , , +
, , , , 1
-... -,- -r- -... ~Sleel o PlastIC DT... o Other
I , , , '.-
: . '., '. .. . . . ..' . ~
_J_ . , t =
-,- , -r- -,- 85. 90
~
',. .5.'. . I ( Screen 'Rl!" 10. II. Open Hole I,om 10. II.
f4-- ,_--..,. '. . .~ ~ - .
" ~ OBSTRUCTlOHIOEBRlSIFILL
1rn!ffi b~E~'S N'm .' .. . .. ObslructlOll ODebns .Dfil
IC ar . aTsh Type 01 debrislobstructlOri64 ft.
of drop pipe & pump wire
Maotong Address . diIleter1llhan prapetty acldress ~I~ aI!ove. Obslruction/tlebrislFiI removed? .Ves DNo
. . .
PUMP . , , .
. Aemovect o Not p_ O Other submersible
CASING '
GEOLOGICAL MATERIAL COLOR . HARDNESS OF fROM TO
FORMAT1OH
II not known.lndicale estimated fomJaloon 109 lrom nearby _ or boring. Diameter Oeplh Set in """rsize hole? Annular space initially gtOUled'>
3. 0 85 Dves .No Dves DNa o Unknown
Clay 0 80 _...Irom_Io_It.
. - in.lrom _10 _ It. Dyes DNo Dves DNa o Unknown
- in.lrom _ 10 _ It. Dyes DNo Dyes DNO o Unknown
METHOD USED TO SEAL ANNULAR SPACE BETWeEN 2 CASlNGS..OR CASING AND BORE HOLE:
. No Amular Space Exists
o Amular space groul~ with tremie pipe
o Casing PerforalionlRemovat
in. lrom 10 It. o Perforated o Removed
in. from 10 It. o Perforated o Removed
Type 01 perforator
o Other
GROUnNG MATERIAL
Grouting material neat cement 'rom 6 10 90 It. _ yards ~ bags
Irom 10 It. _ yards _ bags
REMARK$. SOURCE OF DATA, DfFFlCUL nES IN SEAUNG
GeOlogy taken from unique well number lrom 10 It. _ yards _ bags
212525 which is Y. mile NW from this
above address. lrom to It. yards _ bags
UNSEALED WELLS AND IIORINGS
'.. , Other unsealed well or boring on property? Dves .No
UCENSED OR REGISTERED CONTRACTOR CERTIFICATION
This - or boring was sealed in acconlance with Minnesota Rules. Chapter 4725. The inlormatoon contained in thIS report IS
lrue 10 the best 01 my knowledge.
Hartmann Well Co. 40174
ConInJctor Business Namtl License or RegIS/ra/ion No.
~/Ne~ 10-19-95
Dale
IIINN.DEPT' OF HEALTH COP~ ~ - 64087 Bob Eckland
Name 01 Person Sea/ing WeN or Borrng
...._ W.' ... """"'j
UC'.'H"'\II.f"