My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
09-02-2021 Well & Boring Sealing Record
Orono
>
Property Files
>
Street Address
>
R
>
Rest Point Road
>
1390 Rest Point Road - 07-117-23-33-0005
>
Land Use
>
09-02-2021 Well & Boring Sealing Record
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/22/2023 5:36:21 PM
Creation date
10/12/2021 3:22:15 PM
Metadata
Fields
Template:
x Address Old
House Number
1390
Street Name
Rest Point
Street Type
Road
Address
1390 Rest Point Rd
Document Type
Land Use
PIN
0711723330005
Supplemental fields
ProcessedPID
Updated
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
Page 1 of 1
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
HE -01434-17 ID# 53159 i I/19H <br />Minneso <br />MINNESOTA DEPARTMENT OF HEALTH Sealing to Well and Boring <br />WELL AND BORING SEALING RECORD Minnesota Unique Well No. <br />Minnesota Statutes, chapter 103/ �r W .*9-1 ori <br />I I 4� Q (l <br />(? 1 1 �1 <br />WELL OR BORING LOCATION <br />County Name <br />ITnn n- <br />Township Name <br />Township No. <br />Range No. <br />Section No. <br />Fraction (sm. - Ig.) <br />Date Sealed <br />Date Well or Boring Constructed <br />Orono <br />117 <br />I 23 <br />07 <br />1 SF SW 'uS <br />9/2/21 <br />GPS LOCATION — decimal degrees (to four decimal places) <br />n L <br />Depth at Time of Sealing C] � ft. <br />Original Depth ft. <br />Latitude Longitude <br />AQUIFER(S) <br />KI Single Aquifer ❑ Multiaquifer <br />STATIC WATER LEVEL <br />Measured Date Measured) 2 21 E] Estimated <br />3 2 t1. RJ below ❑ above land surface <br />Numerical Street Address or Fire Number and City of Well or Boring Location <br />1390 Rest Point Rdo Orono <br />WELUBORING <br />® Water -Supply Well ❑ Env. Well <br />❑ Temp. Boring ❑ Other <br />Show exact location of well or boring Sketch map of well or borirr��gg <br />in section grid with "X." location, showing props riy <br />CASINGTYPE(S) <br />Steel ❑ Plastic ❑ Tile ❑ Other <br />N 5361 lines, roads,Idbyfldngs. <br />-1--] <br />WELLHEAD COMPLETION <br />Outside: ❑ Pitless Adapter/Unit ❑ At Grade Inside: ❑ Basement Offset <br />❑ Well Pit ❑B uried Well House <br />❑ Well Pit <br />< <br />W i E <br />f , T <br />vz Mile <br />—% I <br />T <br />L <br />s <br />❑ Other <br />❑ Buried <br />—t Mile y <br />jo Other f- CAW PACE <br />CASING(S)-- <br />For temporary borings, provide additional location <br />information, a site sketch, and geology on a separate page. <br />Diameter 4 Depth n Set in oversize hole? Annular space initially grouted? <br />3 in. from 1 to Q O ft. ❑ Yes ❑ No ❑ Yes ❑ No Xj Unknown <br />in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown <br />PROPERTY OWNER'S NAME/COMPANY NAME <br />Property owner's mailing address if different than well location address Indicated above <br />in, from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown <br />SCREEN/OPEN HOLE <br />WELL OWNER'S NAME/COMPANY NAME <br />�' <br />Screen from to ---91-4-11. Open Hole from to ft. <br />OBSTRUCTIONS <br />ja Rods/Drop Pipe ❑ Check Valve(s) Debris ❑ Fill ❑ No Obstruction <br />Well owner's mailing address if different than property owners address indicated above <br />1,❑ <br />Type of Obstructions (Describe) drop )tfte <br />Obstructions removed? W Yes ❑ No Describe <br />PUMP <br />Not Pt, Roved Prior to Sealing El Other <br />Present, em <br />❑ resent Pg <br />Type e t pump <br />GEOLOGICAL MATERIAL <br />COLOR <br />Hon <br />FORMATION <br />FORMATION <br />FROM <br />TO <br />If not known, indicate estimated formation log from nearby well or boring. <br />drift <br />O <br />84 <br />METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BOREHOLE <br />® No Annular Space Exists ❑ Annular Space Grouted with Tremie Pipe ❑ Casing Perforation/Removal <br />Casing Diameter <br />in. from to ft. ❑ Perforated ❑ Removed <br />in, from to ft. ❑ Perforated ❑ Removed <br />Type of Perforator <br />VARIANCE <br />Was a variance granted from the MDH for this well? ❑ Yes ❑ No TN# <br />GROUTING MATERIAL(S) <br />Grouting Material iiTo A t r Mn n trom--I_ to A4 n. yards_4 bags <br />from to ft_ yards bags <br />from to ft. yards bags <br />OTHER WELLS AND BORINGS <br />Other unsealed and unused well or boring on property? ❑ Yes id 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 <br />is true to the best of my knowledge. <br />REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING <br />Don Stodola Well Drilling Co Inc 1691 <br />Licensee Business Name p License or Registration No. <br />,/r 553 9/2/21 <br />rtified epresentafive Sign tore Certified Rep. No. Date <br />Jerry Barr <br />LOCAL COPY <br />JH g 6 <br />Name of Person Sealing Well or Boring <br />HE -01434-17 ID# 53159 i I/19H <br />
The URL can be used to link to this page
Your browser does not support the video tag.