Laserfiche WebLink
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring <br /> Sling No. <br /> County Name <br /> WELL AND BORING SEALING RECORD Mmneso a Unique No. H 154410 <br /> Hennepin Minnesota Statutes,Chapter 1031 or W-series No. <br /> (Leave blank it not known) <br /> Township Name Township No. Range No. Section No. Fraction(sm.i Ig.) Date Sealed - Date Well or Boring Constructed <br /> Orono 117 23 02 324-O(101h /? A 4)6 <99 <br /> Numerical Street Address or Fire Number and City of Well or Boring Location ! 'ry <br /> J55 <br /> 485 Orono Orchard Rd, Orono Depth Before Sealing n. Original Depth "' ft. <br /> Show exact location of well or boring Sketch map of well or Sax g IFER(S) STATIC WATER LEVEL <br /> in section grid with X. i ror.anon, trig put + ASingle Aquifer 0 Multiaquifer <br /> lines,roads,and builkli s. <br /> N WELUBORING Measured 0 Estimated <br /> i ;i/ Z Water Supply Well 0 Monit.Well <br /> --T---1-----'--`-1--- I <br /> [ !al-- ..i ❑ Env.Bore Hole ❑Other ft. low 0 above land surface <br /> --Y- -Y- -l-_-__l__• J d <br /> W E f1 `�,; I <br /> CASING TYPE(S) <br /> -T---%--`-4 i--. T 1 hfi 8 Steel 0 Plastic ❑Tile ❑Other <br /> 4 I I I u mxa I `1---',"--4.----4.----4,--- I _-.�L ,: CASING <br /> 1 _. Diametgre Depth / Set in oversize hole? Annualar space initially grouted? <br /> S �,�"" <br /> 1.---r mile-4 ;' '1, in.from to ft. 0 Yes No 0 Yes ❑No 0 Unknown <br /> PROPERTY OWNERS NAME I in.from to ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown <br /> Yerigan Construction <br /> Property owner's mailing address if different than well location address indicated above. in.from to ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown <br /> 27741 University Ave !YE SCREEN/OPEN HOLE r <br /> I"`f an t i, 5 5440 Screen from to ft. Open Hole from 'j� to 355 pit. <br /> 612-429-6229 id fi.° <br /> H OBSTRUCTIONS <br /> WELL OWNER'S NAME <br /> ❑ Rods/Drop Pipe 0 Check Valve(s) ❑Debris ❑ Fill Xo Obstruction <br /> Well owner's mailing address if different than property owners address indicated above. Type of Obstructions(Describe) <br /> Obstructions removed? 0 Yes 0 No Describe <br /> PUMP <br /> Type y( <br /> GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO El Removed , Not Present 0 Other <br /> FORMATION <br /> If not known,indicate estimated formation log from nearby well or boring. P4 IOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: <br /> �"'.,t p No Annular Space Exists <br /> 1,...) `� .,1 L ..)'I ❑Annular space grouted with tremie pipe <br /> ,,,_ ,)-rtr,3. a4 r--4.,.. . �'i cs:,:. ,❑Casing Perforation/Removal <br /> in.from to ft. 0 Perforated 0 Removed <br /> in.from to ft. 0 Perforated 0 Removed <br /> Type of perforator <br /> 0 Other <br /> GROUTING MATERIAL(S) <br /> Grouting Material , '`" `^�"' '` Vf an 0 to S75ft. yards bags <br /> from to ft. yards bags <br /> from to ft. yards bags <br /> from to_ ft. yards bags <br /> REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEAUNG OTHER WELLS AND BORINGS <br /> Other unsealed and unused well or boring on property? 0 Yes ,4No 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 /> Don Stodola Well Drilling Co.* Inc. 27172 <br /> Contractor Business Name ,..--7 License or Registration No. <br /> " j. . - .,... <br /> - ;, .$- <br /> Au.., . Wive Signature Date <br /> S.‘,..\ <br />