WELL AND BORING SEALING RECORD ,
MINNESOTA DEPARTMENT OF HEALTH M(nnescta We+'ane'Bnr:no v 3
WeLL 4R BORING LOCATION WELL AND BORING SEALING RECORD Seating3
,Nc
County Nan"2Unique Well No. H
....
Minnesota Statutes,Chapter 1031 or W sexes No '
ANOKA _..
Tow-'s p Narre Torenshro No IRa^ge Nc Sect.cr Nc I F,acircn,sm 4 �Date Saa4ed Cate Wel'.o,Honri Cr<'ccec I
FRIDLEY 30 24 24 SW SE NE Friday,May 24,2013 1940
GPS .at,tude cogrtres rr.rutes_ seCans1s Dept'BeI?e seal:-,g^ 174 _...r O•9tnaDepth CWI no record r
LOCATION- ongitndrt avtgrerrc m'rutes se;3n45 .._... ..-.�. ....._...... ...........
AQUIFER'S) STATIC WATER LEVEL
`iNu^eaneal juts•Aorress er Fra NCmOrr,d City of.VRI'or BO,nit,y;aaer S'j9&Cotter MWt.aoitrte,
•WELL/BORING x Mea..'.+n Estr'nalwf Da,r Measures OSR42013
1508 GARDENA AVENUE NE,FRIDLEY,55432x Water Soddy we _ MCnr1 r,e'.
';Snow erect ICCa:oh or well or boring Sketch,lap Or we Cr baring .._ __
rn sector'Ono wtlt'1(' ocanon snow rQ proper•, I. Eno Ba'c Npr: Gam'_ .....___ 71 ,i X.tea. awvn lard sunar.a
nes 'oads,and buteirgs. CASING TYPE'S)�..
I I _
1SOD gardens were
X Steel P,asci_ T=r Oche-' Galvanized T&C
i
...: XI�y J11WELLHEAD COMPLETION
tti, _P lI _s
l house Outside: ),V).1 House At Grace Inside: X Basement Oise!.
.
1J.v B_r,eC _.Welt P,.t
�... ,_P e's5 Attapfe'Una _.
I
Buried
1 '_ r1'e F.
t 5
well o, k.
I PRCPE CITY OWNER S NAME COMPANY NAME CASINGIS)
FQICKSON,CHARLES 'Damete' C'n Set in overs_ee hale'' Ann....or space InrpaEy grouted',
Prppnr•,Y owns^f r•s.ep aec'es;n CNtrer:liar we I n:alic'..add-e5;.no..rarx Y1.w 6
2 to "Crt0 174 I. Yes X Na Yes No UnKrwwn
1508 GARDENA AVENUE NE to ^,err :a I: Yes No Yes tic Unenown
� I
FRIDLEY,MN 55432
in #roc,. to r. —Yes ..No ,_Yes Nc lio nown
_
WELL OWNER S NAME COMPANY NAME SCREEWOPEN HOLE
SAME
Wal ow'M"s rat.rp a nrrc r de.e'4n'I•ar p'.'vR r,acre^ axret,i"0.-n-I lSCvS SC'Ce'^'rpt 174 'Gr ^.'+ate from IC Y
t OBSTRUCTIONS
1SAME x Rods,Drop Pipe C''.ea Va^vea DOb,s Fil NoObstrudo'
'tee Cr OGsti u:,ors:Descr..bet Removed 144•Wood Rods And%war_
GEOLOGICAL MATERIAL s COLOR HPOAMATION FROM TO Oust,;Ci=.ons re-Fa.'eC' x Yes Nc Des.r:be____.
PUMP
'II not hnewn.=rSK.ate es aced Kx'nat:e:'log Inert nearby*,el or bcr,ne
Type Stroke Pump
:GEOLOGY FROM: 151M GARDENA AVENUE N X Removes NCI"son= Ogre
[
Clay 1--8rowe_ ._o_ 10 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASHIGS,OR CASING AND BORE HOLE:
X Na Ann.:a.Space Erisls Anru"ar, Sarwr Grouted weft Treme Pipe ._ Casrg Peroration Remove'....
i Free send Wit '14--_.'28'_ ,n 'ton' ''0 _.. . ..._._.____'t. __ Perforated Removed
`Geeise'Sand _ , i l 78 =185 ,,, Iron. ;a tt Perforated nein eed
arl
466--44-7sH
i , Type JI y'r'1Cr;71C'.._._..�.�
i Sandy Cly Brown :175 1185
Other
.._cater, grown ._
�_ 1al �._._ 185 1 186
GROUTING MATERIAL'S) (One by of scowl!.W lbs.,oro beg of benlonite s SO lbs.)
FlfleilifiNi SAM Usk 186._214_ a.
Grcut'rg Ma:e'ta Neat Cemec from 6
_....__. .._ tc 6.5 n 0.0815 plow __ bags
Clay 'clue 214 296
St Pen S+ Brows 226 247
Enyiroplug Ironpan 6.5 to 174 n 27.3025 9bags
,
OTHER WELLS AND BORINGS � � �� h0 n —
1 c 1 ___,_Al OWL, bags
Shatopee olomite _ __ _ _247 j 267
a_
REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING €0"e^c^seaeo a''o -uses Ail w rias r:g an a'oae'ty, vee x Nc How PAoy'_____
'LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
Ins weir C,borng was seairO'n»rco'oacce*re M•rnesota R.,,:ei Cnaote'4725 the thb•m...artnn roma.neo in Intl report
Wel Located In Pump Room On South Side Of Basement ,,c hue to::^e test at my 0,npwlay4,
Wel Depth Measured From Grade Level
Myron L. Malenke I Malenke Water (763)493.3650 1426: A
hrpecbr Was Not On Site i___._
M,D.H, Dung Wel Sealing 1,shun Bus esa Mare, cre++se a gerrsrranw No t
Received Well Sealing NolHication From M.D.H / G M.L.Malenke-347: A May 24,2013
PID 24 30 24 14 0007 Cegibec A ora%..a S'p,.ar Cerldrr:Ray No Dare
H `) _, r 1 Jesse Malenke Sr Jesse Malenke Jr
, WO, .=EP' =,F HEA,7,.,,i„s=5
Name.'Pr's..-S.n.,ng W.^^i a•tic"np
_
HE 01434 13 ICC 140-0423 -.—.-w ____�_ 512.=