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I WELL OR BORING LOCATION I
Coun~ Name I WELL AND BORING SEALING RECORD
Scott Minnesota Statutes. Chapter 1031
T;;;;~~.rJ~-";~ I~NoI'S;:No IF;~'~+~..~se""11_6-OO
NurMncaI ~rHt ActOr.... or Fire Number and CIy of ~. or Bonng LocatIOn
15280 Eaole Creek Blvd.Pi-ior Lake... MIl. Oopth.........,'"9 15
Show ...aloclllon ol wel or bomg N ~ Sketch map at.ell or bOnng AQUIFER(S)
tnS8ChOngridWlll'l"X. Ir:leabon. 'oOWII'lg property .SlngleAqullet 0 MuItIaqudef
3/ ......-....-
f_+_...+.N'_+_'_'__1~~ r t~ :==_o......w..
L_~_...~___~_._L. lV~ ~ ~....I=:~:l 00''-
wf: . . . E 1l f-- I ~ ~
Lt---+-.+.+ T ,... !~ ";t os..., 0....."" .T" 0""'"
f. ..._ ".,
L-i-. ..+- ..<-- --<-- L \ CASlNl1lSl
L' , . I ' . . ~ Diameter Depth
1-----':"-+ ')..811-';- ~+f-I.I<-"~.'""" 0 10-15.
p~~'S_ .. . ~"""
nuugwn rlIII11Y Trust -
~ owner's lNIIng..... ~...,.. '*'... roc..on addNuirldlcaled 1lboW. _ in. trom
. MINNESOTA QEPARTMENT OF HEALTH
~ -J;l/.f (JJfI{)("'/OOO
~~:v"'and_ng 'H 165232--
MiMesota Unique Wall No,
or W-series No.
..--.--
.... .,.
. .
Oa.e Wen or Bonn; ConsI'\.IC~
II Ongonal Depltl 15
.
STATIC WATER LEVEL
. MeIl$Urecl 0 ESlIIT'lIecI
8 . .__
o above land surtec.
'0
.
Set lnoYefSltenoIe'? Am.AIr spc, nMIIy pUd7
o v.. .No o v.. DNa o Unknown
o v.. DNa o v.. DNa Du_
D v.. DNa o v.. DNa 0_
10
..
Mary Cole
5057 ~4llIl!.as Ave. So.
Mpls.,~55410
I weu. OWNEA'S_
welI__.lMilIng....ildIhIwnIlNnplapefty-.r'......inclcaMdu-.
I_HOlE
""'- '''''''
0IISTRUC110Hll
.-..""'" Oo.oVaIvo(.) 000llria 0". 0...".....,
"""al~("""",,,) 14 ft_ of drQp pipl!l. P'1IllP rod .. <:yl irWir
~"""""'" ..,.. DNa _ all +h.. aMVI!
....
10
tl. OpenHolltrom
to
15
..
I GeOl.OGICAl.IIATERIAL 1 COLOfI 1-==-.:1-1
I "naf knawn. ..... .........Iarmdon log Il'am ,.., well fit bomg.
T,.. band n..
TO e-> 0__ 0"",",
- ~ USED TO SEAL. aNNtIl.AA SPACE KTWEEN 2 CASINGS, OR CAIMQ AND.... HOLE:
I sand
.J;ljv
..sanrt
D 11.
H 'i3..
5:i. 192..
.Na_Soco Eldata
OAtnMl~~wIt1...plpe
Oc.tngJ\".....4Il.~
in.-Irorn
10
ft.
0_
0_
in. ham
lD
..
0_ 0_
"""..--
I
I
I
I
_ I
REJIMKS, SOURCE OF DATA. DIFFICUL 11ES IN ~
0"",",
GROU11HG IlATEIIAL(S) toM... of oemMl_...... ...... 01......... . mil&)
Hiab Solids
GI'OUIing~ -8ento"ite horn
Clay
10 11;.
..
.-
.,
-
,....
o
lD 15
ft.
2.-
-
;>-
'''''''
lD
..
,....
-
-
lD
..
.-
-
Geology taken from a well a short
Sill fT'Oll this above sealed well.
3756 - 154th St. NW, Prior Lake, MH.,
unique well number 522693
OTHER WELLS AND 80MrIGS
way' """'........................"'_an_ o v.. eNa -many?
UCENSEDOR ',~.",,- ;;',.J. CONTRAClOIlICER1W'ICA11OtI
This.....orbcWIng.........In' .... . wtIh~AlM.o.ptef472S. The,
W.1D"bellafrny~.
". CIlll"Uinedin..,.....
Hart'........ Wfilll Co_
eo..ctot..... "".".
~JU74
L.lctet.-arf. .,
,,....
~.~J
Aufhorized. . _, I SIgnnn
11-6-00
Dele
,
,
Kevin Hartmann
'~
.'
~.
au OR IIORINQ LOCATION
Coun~ ......
MINNESOTA DEPARTM~T OF HEALTH
WELL AND BORING SEALING RECORD
Minnesota Statutes, Chaptei1031
~~n~t .
;:;;-rTJ::-~~ I";NoI;-NoI:;c;;':;~ D"::~_{)1
~ S1rW AddreSS or Fire Number and City of Well or Bonng Location
08pCh Before Sealing ::!.;!..
15280 F"lgl'" Cre",k Blv<'l,Prior lAVO ~
Show --=t IOCMiOn of .... or boring Skek:h IMP 01 wed' or bonng
inMCtiangridwiCt'l"X". 1oc:aIion. ~ propetly
1lnes,~..ndbuildingS.
N
._+..-._+-t-+- -1--
; ; t. .
.-+...-+. ...;..- - -
W:m'+:ET
..+.. ._+-. -+~. .-+-
+:: :.".
.-+-. ..+- -+-. .-+- 1
I , , ,
~
s
f--'---+
PROPERTY OWNER'S NAME
tJ..n.,..~... .Hom<>fi
.......,,--. iMIng-....-il..... __ _Iocdon..... inlIcMId--..
1895 Plaza Drive Suite 200
Eagan, MN 55122
WELL OWNER'S NAME
WeI OWMI"I ,...,. ....11 dlftMnl: twn popeRy 0WI'IlIl". eddI.- inCIcMId KlcMI.
GaOl ftnWOAI IlATUIAL I COLOR 1::::1 FROM I" TO
......IIrlclM\~.........,farmIIionIogIrWnMMly...orboririg.
sand
...cl 'w
sand
I 1
1 I
I 1
1--4/.- I I.?_
J 093- 1-26-
is onl
1
I
1
I
J't><:
This sealed we~l
lot 7 or 8. 1
I
I
I
o
COPY ~ 180430
AOUIFEA(S)
.5ingIe Aquifer 0 MulRquile,
WEUJIIOfllHG
.__\VeI O......w..
o Env. Bore Ha18 0 OeMr
c:..- TYPE(S)
.S....O_OfiIoO""*
Minnesota - - Boring I H
Sealing No.
Minnesota Urique Wall No. I
or W-series No.
.-..........
Dale Well or Boring Constructecl
180430
fl. Or9ne10epttl....2~
STATIC WATER LEVEL
.
. Musured 0 Estimated
173
ft. ._ 0___
""""""'"
""'...... llep4h Sttt in oversize hole? -----
~in.lrom 5 10 229 ft. o Y.. .No o Y.. 0'" 0"""'-
_in.trom 10 . o Y.. 0'" o Yes ONo 0"""'-
_in.fl'Ql'II 10 ft. o Yes 0'" o Yes ONo 0"""'-
I SCREDlIOPEN ttClU!
__ 229 10 234 ft. Ooen__ .. .
OIISTRUCTlONS
. """""""'Pfoa 0 ",-_.) 0 Dobris 0 FlI 0 NoObsltuclion
rlP"..OI>oINcticlNlOescrtlo)21fLft: of drop pipo. pllrrq> wir.. {I, P'''''r
0bstNdl0n............ .Yes 0... _.all the above
.......
rIP" Su1::mersible
._ 0..._ 0","",
IIIETHOO USED TO SEAL.f.MrNL,.AII SPACE
11 ....-.....-
O.........~groutedwflh.......pipI
DCeslng' .__
~.-
in. from
..~ .... 2 CASINGS, OR CASING AND 110III HDLI:
..
.
0_0_
0_0_
11 ';~
531192
I I
I 1 I r....._
1-41- -N-l 0 0Iw
31 W _1IA1IIIAL(S)
I
10
.
tono bo8 .._........... bo8"-. 1011Io.I
GroutinQ~nlO~r r-'2:IDeIl.t...fram C)
Hartmann Well Co.
,.,~Netr>>
1O~'
...... --20...- _
-
-
-
-.-.IOUIICI OF DATA" DlFFlCUL11ES IN IEAUfQ OTHER WEU.8 AHD 8OfING8
Geology taken from a well a short way ""'*-.......-.....-"'- Dv. e...-_
sw from this above sealed well. Uee-OR_RlDCOHlllACTlllI.,. . .~1lON
3756 - 154th St. NW, Prior Lake, MN., _.....___~ .... . ..._......~.725. lbo,
unique well number 522693 -....-..... . .
We also sealed a 2nd well 11-6-00.
Unique well number 165232. The
house was destroyed, the land is
now set up for homes with city
water and sewer.
10
ft.
......
......
.-
10
.
....
---
10
..
,1.~InMrtrpClIt"
4017"-
u... or .
I. ' No.
~~
-... -
Kevin Hartmann
I ,.",. Q/ ~ SMIrV MWorBDt*W
-