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Well Sealing Doc • NIIflNE80TA AaTMt~krtT DF f16A1b.Tt1 t't ft�ihnesota Wetl artd Boring----"-77'-"".305-465:-..•-'-., -, - " ` 04 VilELL tiR BOFUNf3 LOCATlOC�! Yt! �.L � �Q � �1 �� r# Ci1J�h f 5ea1(rig No H a busty Nvitq Wf rMlnlle�Qto Ulk�Ctu�a W9il fV u ` yy 3 Series t-lrt °' P a t r 'ATl>aK� MltinesotiiSEafut�S,G AC 'tO3l •-t e+eDat}iWtaaPt Tgwr a Nana Township Nos Range No.Section No Fracd`on Csrn -*Ig} Date Sealed` Datta Welt or kl Constructed . Fridley, , 30 23 14y : S� ,SE 9/25/12 n'criown aPs t.afltusi45 degree .,__,I.:_;•,..,:•,,..-„.: 4,7,7:47,54.7,70‘i- ii , minutes saoonds Deptheefore seatirtri'° 20 fL Original Depth ft 1::;•': ; LOCATION, ttrt.!.":-..--7-77'..0i2ere maul n -' es] esS �i- i . • 6!� .r srpTlq WATER LEVEL 9125/12 Numerical Street Addross or Fire Number'and City of Well orSon rg C•or don rtgla Nqultar Q Mu i3�4i(er y u ? tmatl Date Measured 631'0 Able Street F idle X5432 � • aifn`-SitpplY,WBfI[�MoniL Well 1 hoff+qxaet loeation of well or boring Sketch map ptws tlr bor g fore Hole , 'e In ser l' gild oath"X • loaatlon showfid ._OOre? ft I;1 tow [► Glama sutfaae ii= • N • � Imes roads tiding CASING'•=r0. {S) • r' eef QPlastic j Titd-9 Other h WELLHEAD COMPLETION t ,, w 1 .. ,„.:1. < t g.{ + Onside.::;(JWOilallBa { itf-grads lnatdo Sasemenftit,�t)sat ! ' ";lhMwme jEurldd QttVi3llWt t t � PitfesB. dapterlUnit s� ;Q Well pit • Buried `l s r • ( Other }• t • i M1,.........,.I I lrar - i y y„ cf -j ,3 • PROPERTYOWNEIS-NAME/GOM!PMV 511U - .'..:.•;..•••,•••:,•.:4491,40(4i„:.,-;::4„.,.._!.,,,,,,,,•. j Ruth 011ila Estate 'aiamete1Depth `' Set In oversize hole? An ulWrspaceihltianygrguted? Pro•perty sonar s maillngeddresa it dwensit than wail 1005500 address Indli�ted•above 1 frortr p 1 7` e 4tc, 87 Yes Q Yas q �(Uhknown 44421tice Creek Blvd Fridley;7V T 55432 �-- -ln '� tt yap c�Ntl • Cr,r [.'No .Q Unkrrown to from to ft •• G Yse DVNi O yes. ❑No [�•Unknown ` WEL4,OWNE,F S NAME/OI tMPANI'NAME r i aCREEN/OPaN HOLE tntelt owner's ma H address tf dHlereirt $creep from tau 20 -i! Opeft hole from to g, n9 !hen PmPmM owrlaYS at3d1'eas Fndicl8bava P Reds/prop Pipl: ( fahocck VaI e(s t patois + Q F 1I Q ilt Obstruction } 4.n Type of Obstructions(Describe) i GEOLOGICAL MATERIAL , CALOR ptPATtD►i FROM TO y'AI tructtons tentbved? ©Yes Q Na Describe t r :I€tett known.(ndtcat5•estimated fOrgratlon log from nbarbt.well or boringNO ; E sena 19 ' Ai Removed Present [D Other -,-;;'':••-'''r.'''rl E Clay F D ,1 '''''":1'.;'•:: '5 „ .,bw.tJsEb TO SEAI.ANNU4A$aPAO. B4(EEM 2 CA�4lf'�Q3r OI t+1„l�S`!NG�lND EDRF•HOLEq q AnnNlar Space Eicists = E AnnularSpaoe arduted witfi Tremla Prpe) tj•�asing Perfar n/Rempvot L. Stones 5° G0 -• ;, Sand Heaved • -lr from • to it Q Perforates Q Rertioved 6e 63 ce rented Sand 6 0 tri frorRt tp it „ CJ Peifotated Ramovad Clay&Stones 6° 92 T„pe'''''',..'•''''''''.'Y'':••-•.'",•.,,PaAorator Dry sand • 9 94�other • fi Mud '.9' 1r04raaouTtNa l t t ` .00Il--af tt 9a tba na ua �t ;twufea5!tits.) 'Neat.:CrrouC '0 X20 • 1/z Sand 10' 114 ° Material from to it yards; bags it� .--,-,r.. �, - r .r { H.••;..',. n ny.,�� i•,Y.�s�,(r '��;� -='•'-1:-.'"'"'-'..'.•"1.',','-'1.': t� .v ��t � i • r�� �OmV." r J � x� ° from t!').!,..:,... ft yards,�,bags� { ?etrI�•r ii E's ,,:iia St `� , p l r ��¢¢a+n 1 '7•,',;';1•17;,`''.."••,.-,«:/-',:;••,,,...., -.s�yy y�� Ayr w1 /gyp j I • 39f�a t•�.-I�YMd� ��^N7a� �814� N .'Y ,FER1BOMNiW1 ; �1 t 'I Nf y �� REMARKS($OU'0007F4"4411 :pFptOu*TI .-; :.f the unse artd utrusediwdul orboi9rfg-anprdparty?. t Yes Hour many? 't LICENS•ED"OEC REGISTERED CONTRACTOR C•ERTIP•i•CAYiON 9 This we•lt•or ging was seated In•'C'• Mklneso"ta-Rules chapter 4726 The Infommtion contained in this report Geology From; 63117 'Street is true fo me bast ofiny imovtledge ' W .ter Level din";Abov�e'WelL��37 R tH Renner;&Sri 143`1 late Water Level Taken. 08/05/1964 ` iisensee N. E � - Llcelrse�fl�7lstrarlon No Well near°by 9/25%12 Un ue 206668 • , q carr sew 9dpisSarrtadve Slghalrrle Rep No bate Kevin Scheiterlein Y . ., Name dr.��on searing v�eu ar,�at+� _ � , `� HE�Oid34 12� IC 14Q 0423. > y