HomeMy WebLinkAboutWell and Boring Sealing Record
WELL OflBORlHG LOCATION
Minnesota Well and Boring I
MINNESOTA DEPARTMENT OF HEALTH Sealing No.
WELL AND BORING SEAUNG RECORD Minnesota Unique No.
Minnesota Statutes. Chapter 1031 or W-series No.
Ileave bIe'* rI noI knOwn)
T~~a~ e IT~~ ~ r~ ~ Sec~~ NOr~~~ (;~. ~~ Oa~ Sead
Numencal Slreet Address 01 FIre Number.t""~ 01 Well 01 Bonng LocallOn
14755 Glendale Ave.. 'Prior lake. MN.
~~:,~_~_-orbomg.N ~ loca::'Ich;;::=,=
N " t.4.~ roads. and buildings.
-:~ -;- -l-- -:- ~ X~ .SingIlI~ D~
~ + + ';P: .. 10' ~. t:0 ......",.
+-~-~--:-lDJ~ Jib
.'. .;. .,. '~'1- l f .
t . . .
.. s
14-'- JUIJ_ 1 ~/- av.e....
County Name
Scott
PflOPtRTY OWNEA"S ~
Doualas Schlt:'if
Maolong Address . dolIerenllhan prope/ly.tddAiss InlIocaled llboVe.
HARDNESS OF
GEOLOGlCALMATEflW; COLOR FORMATION. FROM .TO
If not known. indicale estimaled fClllM1ioft log 110m nelIrby .... or boring.
Clay
Gravel
SalJ~ H .
Sand
brown
brown
.
brown
brown
o 10
10 90
90 120
20 130
REMARKS, SOURCE OF DATA. DlFFICULT1ES IN SEAUNG
Geology taken from this above sealed we 1.
1111I11'"
.I cOPYI H
i64 072
11-2-95
130
Approximale Dale Well
or Bonng Constructed
0epIh Before Sealing
n. 0nginaI 0epIh
SIalic Wale< level
90
11.
. Sleet D P1asloc : D Tile
D 0lI>er
Sc:teen ''''!''
126
10
130
n Open Hole from .
- 08STAUCTIONIDEIIASIFlu.
8ObslrUc:fioi1 . O"Delins. D FiI
..
H 64072
'J-O 708lf
1970
130
n.
. kaInlte
D Approxim8Ie
x
below
above ...... surIac:lI
10
n
TypeoldebrisJobSlruc:ion 105 ft. Of drop pipe & pump wire
ObslnlcIionIOebil.....-d? . Yes 0 No
PUMP
8 Removed D No! p_ D. ohr
CASING
submersible
Diameter 0epIh
4. 0 126
_ ...from _10 _ n.
. Set in oversize hole? Annular space iniIiaIIy grouIecI?
_ in. from _10 _ n.
Dyes D~
D Yes . ~ D Yes D No D Unknown
D yes D No D Unknown
_ in. from "'-----'- 10 _ n. Dyes D ~ Dyes D No D Unknown
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CAsING AND BORE tiOLE," .,
. ~ AnnuIa, Space Exists
D Annular space grouted with lremie pipe
D Casing PerfoiatiorVRemol
in. from
n.
10
in. from
n.
10
Type 01 perforalor
D Other
GROUTING MATERIAL
Grouting malerial
neat cement
2
10
from
1,_
10
from
10
from
10
UNSEALED WELLS AND BORINGS
0lI>er unsealed _ or boring on property? D Yes . ~
LICENSED OR REGISTERED CONTRACTOR CERTlFlCA110N
D PeiIoraJed D Removed
D Pefloraled D Removed
130 n. _ yards ~ bags
n. _ yards _ bags
n. _ yards _ bags
n.
yards
bags
This _ or boring was sealed in accordance with Minnesota Rules. Chapter 4725. The inIorrnalion contained in Ihls repofIos
lrue 10 Ihe best 01 my knowIecIge.
Hartmann Well Co.
Conlrllclor Business Namtt
~.~
Authorized /alive SignaIlHe
Brian Hartmann
Name of Person Seating Well or Boring
40174
License or Registration No.
11-11-95
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