well info - Laserfiche WebLink

Home Browse Search

WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL AND BORING SEALING RECORD Sealing No. H 112979 County Name LiF,� E,��Il Minnesota Unique No. Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank if not known) Township Name Township No. Range No. Section No. Fraction(srr,.->Ig.) Date Sealed Date Well or Boring Constructed Oro w 118 G3 s % % �o a!T c�L Numerical Street Address or Fire Number and City Of Well or Boring Location t , 32320 'lUrnhan Rc-,ad Orono,` , No. Depth Before Sealing ft. Original Depth ' ft. Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL in section grid with"X". p,{ location, showing property Ingle Aquifer ❑ Multiaquifer N l lines,roadg _u4 buildings. WELUIBORING E] Measured ❑ Estimated [y(Water Supply Well ElMor it.Well , '� -- ❑ Env.Bore Hole ❑Other �Q ft. [>61ow ❑ above land surface W -- ------ --�-- E ,�} CASING TYPE(S) - -------- --�-- --�-- y E]Steel �lastic E]Tile E] Other 0 w mile t _ CASING Diameter Depth i^ r Set in oversize hole? Annualar space initially grouted? S ""��"" Iw t mile~ 15' x, in.from to ft. ❑Yes JgNo ❑ Yes ❑No ❑ Unknown PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown Butch Zelinsky Property owner's mailing address if different than well location address indicated above, in.from to ft. ❑ Yes ❑ No ❑ Yes ❑No ❑ Unknown SCREEN/OPEN HO��LE Screen from !lei!!// ` to ft. Open Hole from to ft. OBSTRUCTION/DEBRIS/FILL WELL OWNER'S NAME ❑ Obstruction ❑ Debris ❑ Fill >(No Obstruction Well owner's mailing address if different than property owner's address indicated above. Type of Obstruction/Debris/Fill Obstruction/Debris/Fill removed? ❑ Yes ❑ No PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO El Removed XNot Present El Other FORMATION If 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: -.f 5ir No Annular Space Exits ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) Grouting Material ' «�� fr6m to2C ft. yards bags from to ft. yards bags from to ft. yards bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑ Yes No LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. IxN S`X00U, WELL LFZIj�jW, a). INC. 2`/11 Contractor Business Name License or Registration No. 7 A _o4uthoked IWStgnaturel Date H ry Name of Person Sealing)Yell or Boring LOCALCOPY f HE-01434-02 10/95R