Laserfiche WebLink
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring i 3 <br /> H �!� <br /> WELL AND BORING SEALING RECORD Sealing to <br /> Count'Name Minnesota Unique Well No. — — � <br /> 487 <br /> HenneHennepin Minnesota Statutes,Chapter 1031 or W-series No. <br /> pin ILaeve Hank tl not known) —J <br /> Township Name Township No. Range No Section No. Fraction(sm.y Ig.) Date Seated Date Well or Boring Constructed <br /> Orono 118 23 31 Ski NE SSI 8/7/00 <br /> Numerical Street Address or Fire Number and City of Well or Boring Location l <br /> 340 Turnham Road, {Trona Depth Before Sealing 147 -_ft Original Depth _ __ft <br /> Show exact location of well or boring ki Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL <br /> in section grid with"X'. location, showing property *Single Aquifer ❑ Mult aquifer <br /> lines,roads,and buildings. <br /> N WELL/BORING `,Measured ❑ Estimated <br /> Water Supply Well ❑Monit.Well <br /> 133 <br /> Env.Bore Hole ❑Other tt. below ❑ above land surface <br /> W --I- -�-- -i-- --i-- E <br /> i CASING TYPE(S) <br /> f <br /> r LL` I <br /> --�- -�-- --�-- --�-- � � T4 Steel ❑ Plastic ❑Tile ❑ Other <br /> }rl mile I <br /> = CASING(S) <br /> DiamLeter n Depth 1 L Set in oversize hole? Annular space initially grouted? <br /> S +i 0 i42 Yes r No ❑ ❑ <br /> r mile in.from to ft. ❑ '�"^ Yes No /7 Unknown <br /> PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown <br /> Erie Menge <br /> Property owner's mailing addressitdifferent than well location address indicated above. in.from — to ft. E] Yes E] No E] Yes ❑ No ❑ Unknown <br /> 34th Turnh:gym Road SCREEN/OPEN HOLE <br /> Orono, IMN 55323 Screen from 142 to 147 ft. Open Hole from to ft. <br /> OBSTRUCTIONS <br /> WELL OWNER'S NAMEE] Rods/Drop Pipe p El Check Valves) E] Debris E] Fill *No Obstruction <br /> Well owner's mailing address if different than property owner's address indicated above Type of Obstructions(Describe) <br /> Obstructions removed? ❑ Yes ❑ No Describe <br /> PUMP <br /> Type <br /> GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO Removed ❑ Not Present ❑ Other <br /> FORMATION <br /> 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: <br /> �No Annular Space Exists <br /> ❑Annular space grouted with tremie pipe <br /> ❑Casing Perforation/Removal <br /> in.from to ft. ❑ Perforated ❑ Removed <br /> in.from to ft. ❑ Perforated ❑ Removed <br /> Type of perforator <br /> ❑ Other <br /> GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) y g <br /> Grouting Material NecIt Ce*. from U to 147 ft. yards _13 bags <br /> from to ftyards bags <br /> from to ft. yards bags <br /> from to_ ft. yards bags <br /> REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS <br /> Other unsealed and unused well or boring on property? ❑Yes No How many? <br /> LICENSED OR REGISTERED CONTRACTOR CERTIFICATION <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 /> Stevens Drilling & Env. Services, Inc. 86654 <br /> Contractor Business Name License or Registration Aii <br /> 8/7/00 <br /> Authorized Representative Signature Date <br /> Randy Johnson <br /> =J�,AL COPd JH <br /> 163487 <br /> 634O Name of Person Sealing Well or Boring <br />