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Home My WebLink Aboutwell info , � WELL OR BORING LOCATtON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I County Name WELL AND BORING SEALING RECORD Minne ota Unique Well No. Minnesota Statutes,Chapter 1031 or W-series No. Henc�e in (leeve Olenk rf rql known) Township Name Township No. Range No. Section No. Fraction(sm-�Ig) Date Sealed Date Well or Boring Constructed OCona 117 3 1 4 4 ,. �,. ,� ��>� C}� GPS Lalitude degrees minutes seconds � LOCATION: Depih Before Sealing �� ft. Original Depth ft. Longitude degrees minutes seconds ppU1FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and Ciry of Well or Boring Location �Single Aquifer ❑Multiaquifer WELLBORING J�Measured ❑Estlmated ❑Water Suppty Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring in section grid wdh"X" location,showing property ❑Env.Bore Hole ❑Other �,� ft. �(�elow ❑above land surface lines,roads, d buildings. N CASING TYPE(S) _ _;��..,5._ �.�.�-•--,'--- / � ! �teel ❑Plastic ❑Tile ❑Other T + `i W --�- - - - -- -- — E �!� � WELLHEAD COMPI.ETION �(� �� `� Outside: ❑Well House Inside: �Basement OHset _Y_ _i__ _l__ _i__ E.._ �^� � � , � ❑Pitless Adapter/Unit ❑Well Pit -- - -f— -�-- -�-- I �AJtl� , S , 11� 3�1"7a � ❑We��P� ❑8�� _�'"a—a�' �/�C' ❑Buried � PROPERTY OWNER'S NAME/COMPAnNY NA_ME` p CASING(S) �P .S(,`�t t 7 S�"'Y7�1 C�� Diameter � Depth � Set in oversize hole? Annular space initially grauted? Proparty owner's mailing address if ditterent than well location address indicated above /f. �_ In.ffOm� t0�ft. ❑Yes [�o ❑Yes ❑No ❑Unknown 2S0?3 .R�3rtC88 Pr3i[!t LBt� -�" ��p,� CC M1 in.f�om to ft. ❑Yes ❑Na ❑Yes ❑No ❑Unknown JlJ7i � �� in.from t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELLOWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE r + Well owner's mailing address if ditterent than property owner's address indicated above Screen from�t0�ft. Open Hole from t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill l,�No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑ No Describe FORMATION If not known,indicate estimated formafion log from nearby well or boring PUMP Type ❑ Removed C�rNot Present ❑Other T METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing PerforatioNRemoval in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) `�� r� i Grouting Material � C-��+�/vTfrom�to�ft. yards � bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The infortnation contained in this report is true to the best of my knowledge. Pon Stodol.a Well Dri2ling Co, Inc. 2T172 Contractor Business Name _....... License or Registration No. /. 11�1 7�� pre entative Sign,�fUie� Date Tirn SLertt�C LOCAL COPY H 2 d 31 g 0 Name o/Person Sealing Well or Boring . 'yvELL OR BORING LOCAT1oN MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I � County Name WELL AND BORING SEALING RECORD MinnlesoNa Unique Well No. " - ��e��n Minnesota Statutes,Chapter 1031 or�W-�s�eri�es No_ Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed : Or0[t0 117 23 17 43�-t}t�94 ��. . GPS Lafilude degrees minutes seconds � LOCATION: Depth Before Sealing I� I ft. Original Depth ft. Langitude degrees minutes seconds ppUIFER(S) STATiC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Mul�aquiter �� C��.J� � Or� WELUBORING Measured ❑Estimated 1 Water Supply Well ❑Moni[.Well � Show exact location of well or boring Sketch map of well or boring in section grid with"X" location,showing property ❑Env.Bore Hole ❑Otlier �ft. �below ❑above land surface es;roads, buildings. N ��,�.� 1�..,,.�.�. '�,,. CASING TYPE(S) - - - - - -- - -- u ,,,� Steel ❑Plastic ❑Tile ❑Other � � � � :� � _ W -�- -;-- -;-- --;— E }{ WELLHEAD COMPLETION � � � � j „ �,/ : Outside: ❑Well House Inside:g Basement Offset -'r- ---- -i-- --i-- � • e''�� 1C� / � � � � y� ❑Pitless AdapterNnit ❑Well Pit --�- -�— -i-- --�— i � �. � S �� ❑Well Pit . ❑Buried �-��»��, ,3��o ❑8�� PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameter � Depth � Set in oversize hole? Annular space initialy grouted? Pro ner s� il ddress'rf different than well location address indicated above '2 �� /'� in.ffOm�t0�ft. ❑Yes �No ❑Yes ❑No ❑Unknown ZSl7t7 [�n=�$ �`V1�� i.�IX in.ffOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown �tirn7@Cdttka, 1� 55391 � in.ffom t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL NER'S NAME/COMPANY NAME SCREEWOPEN HOLE ///y v r Well owner's mailing address if different than properry owner's address indicated above Screen from�,[LS�t0�_ft. Open Hole from t0 ft. OBSTRUCTIONS �Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) �f!�� /=7 p� } C��2 GEOLOGICAL MATERIAL COLOR HAHDNESS OR FROM TO Obstructions removed? Yes ❑No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP Type r"�(%(�JC� ��J f'y+}�,,^S Removed ❑ Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: (�No Annular Space ExisGs ❑ Annular space grouted with tremie pipe ❑ Casing Pertoration/Removal in.from to ft. ❑ Perforated � Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag o}cement=941bs.,one bag of bentonite=50 Ibs.) r �/�� r Grouting Material ��T�'�O�L�from � to J�ft. yards L— bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in acxordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the besi of my knowledge. ik�n Stodola f?ell I?rillin_: Co, Iric. 27172 Contractor Business Name License or Regishation No. �_ _ _ � �.1-��)'� A es ntative SignaNre Date Tim Sterner ��A��PY H �4 3181 Name of Person Sealing Well or Boring � �Q(ELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„� County Name WELL AND BORING SEALING RECORD Minne oNa Unique Well No. '��a�g�j,� Minnesota Statutes,Chapter 1031 o�r W-�enes�No. Township Name Township No. Range No. Section No. Fractian(sm-->Ig) Date Sealed Date Well or Boring Constructed ` Oro� 217 3 17 4 . �i ,. ,. � GPS Lalitude degrees minutes seconds � LOCATION: Depth Before Sealing �� ft. Original DepM ft. Longftude degrees minutes seconds ppUIFER(S) STAl1C WATER LEVEL Numerical SVeet Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer 71�, WELUBORING easured ❑Estimated $�Shareline vL� Or�IQ ry�(Nater Suppty Well ❑Monit.Well � � Show exact location of well or boring Sketch map ot well or boring �� in section gnd with"X" location,showing property ❑Env.Bore Hole ❑Other �%� ft. �low ❑above land surface N ��. li s,roads,anQG mgs. ,....`� ::,...:;k„�,:..,__x. .r� CASING TYPE(S) �1,� teel ❑Plastic ❑Tile ❑Other �� W "f- 'Y' 'l" "1-' E � { �..� WELLHEADCOMPLETION � � ��j/��y } Outside: ❑Well House Inside: �asement Offset _Y_ ____ _l__ _�__ i � � � i i � �^"b �1 � . ❑Pitless Adapter/Unit ❑Well Pit --�- -i-- -i-- -�— I �__, ;r .1 J�7 a � +� ❑Well Pft ❑Buried S �rr--�'"+'-�4 �y'ci0 ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameter + Depth � Set in oversize hole? Annular space initially grouted? Pr rty owner's mailing address if different than well location address indicated above �/. _� In.ffOm�t0�ft. ❑Yes �o ❑Yes ❑No ❑Unknown �� n�� vl�t �`� in.ffOm to ft. ❑Yes ❑No ❑Yes ❑Na ❑Unknown ' 4iinr�tnka, MN 553.91 in.ffOm to ft. ❑Yes ❑No ❑Yes ❑Na ❑Unknown WE L OWNER'S NAMFJCOMPANY NAME SCREEWOPEN HOLE Well owner's mailing address'rf di8erent than properry owner's address indicated above Screen from�t0�_ft. Open Hole from t0 ft. � � OBSTRUCTIONS � C�(Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe)�ybzhLt��"�L 1- �L�"� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? 8S ❑ NO D2SCfib2 FORMATION If not known,indicate estimated formation log from nearby well or bonng PUMP dCtft TYPe J«` 1'��urnl� �iRemoved ❑ Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: f9ifJo Annular Space Exists ❑ 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) (One bag of cement=941bs.,one bag of bentonite=50 Ibs.) .1t� / / Grouting Material,/U'Gp�'/ ��'+�'�'A fT from�t„�_to�ft. yards � bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICUITtES IN SEALING Other unsealed and unused weil or boring on propeAy? ❑ Yes o How many? 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. Dan Staddla t!eZ1 t?ri.l.Ifn�; Co,. Inc. 27172 Conhactor Business Name License or Registration No. 11-i7-05 r' d re tative Signatu e Date LOCALCOPY H 2��q p� Tim Stecner . •L�} Name o/Person Sealing Well or Boring