Laserfiche WebLink
MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 172552 <br /> WELL NameOR BORING LOCATION _ WELL AND BORING SEALING RECORD Minna No. SIH_ <br /> Sealing <br /> County Name Minnesota Unique Well No. r <br /> HENNEPIN Minnesota Statutes, Chapter 1031 or W-series No. L� <br /> (Leave bank R nor krawn) <br /> Township Name Township No, Range No. Section No I Fraction Ismi lig Date Sealed Date Well or Boring Constructed <br /> ORONO 117 23 05 �'4 SW SW r. Monday,September 25,2000 <br /> Numerical Street Address or Fire Number and City of Well or Boring Location 100 <br /> 684 TONKAWA ROAD Depth Before Sealing h Original Depth it <br /> Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL <br /> in section grid with"X'. location, showing property X Single Aquifer ❑ Mulhaquifer <br /> lines,roads,and buildings. <br /> N WELVBORING IK Measured ❑ Estimated <br /> ]Water Supply Well ❑Monit.Well 40 <br /> 1�,yF�,, <br /> ❑ Env.Bore Hole L-1Other _ h. Cy below ❑ above land surface <br /> W '-�- - -- - -- --i-- E � CASING TYPE(S) <br /> I <br /> ------ Steel ❑ Plastic E]Tile ❑Other Black T&C <br /> }l mie d CASING(S) — <br /> 1 0 Diameter Depth Set in oversize hole? Annular space initially grouted? <br /> tttt S 4,f� <br /> lye—r mde---fie in.from 0 to 1 00 ft ❑ Yes X No ❑ Yes ❑ No ❑ Unknown <br /> PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ unknown <br /> BEUTLER,ROBERT <br /> Property owner's mailing address if different than well location address indicated above. in.from to h. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown <br /> 684 TONKAWA ROAD SCREEN/OPEN HOLE <br /> ORONO,MN 55356 Screen from 100 to h. Open Hole from to ft. <br /> OBSTRUCTIONS <br /> WELL OWNER'S NAME ] Rods/Drop Pipe ❑ Check Valve(s) ❑Debris ❑ Fill ❑ No Obstruction <br /> Well owner's mailing address if different than property owner's address indicated above. Type of Obstructions(Describe) Removed 63'Drop Pipe&Submersible Pump... <br /> Obstructions removed? g1 Yes ❑ No Describe <br /> PUMP <br /> Type 3 Wire Submersible Pump <br /> GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO X Removed ❑ Not Present ❑ Other <br /> FORMATION <br /> It not known,indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: <br /> No Annular Space Exists <br /> ❑Annular space grouted with tremie pipe <br /> ❑Casing Perforation/Removal <br /> in.from to h. ❑ Perforated ❑ Removed <br /> in.from to h. ❑ Perforated ❑ Removed <br /> Type of perforator <br /> ❑ Other <br /> GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) <br /> Neat Cmt 0 .50 0.0016 <br /> Grouting Material from to h __ yards bags <br /> Enviroplug .5 100 0.3184 <br /> from to ft. yards bags <br /> 0 <br /> from to ft. yards bags <br /> from to_ ft. yards bags <br /> -LE <br /> REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS <br /> Pdless Adapter-House Demolished Other unsealed and unused well or boring on property? ❑Yes 17�1 No How many? <br /> LICENSED OR REGISTERED CONTRACTOR CERTIFICATION <br /> Measured From Grade Level... <br /> This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is <br /> true to the best of my knowledge. <br /> Malenke Water 763.493.3650 27600 <br /> Contractor Business Name License or Registration N. <br /> Myron Malenke September 25, 2000 <br /> 5 117 23 33 0011 Authorized Representative Signature f Date <br /> LOCAL COPY —� j F 1 7 2 C C 2 Name of Person Sealing Well or Boring <br />