HomeMy WebLinkAboutwell info WELL DRILLlNQ FOR FOUR QENERATIONS
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15688 J�rvis Street N.W., Elk River, MN 55330
1NCORPORATED (6�2) 417-6100 Fax: (612) 427-0533
Date: OCTOBER 10, 1991 NORTH -
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o�etia
MINNESOTA DEPARTMENT OF HEALTH -�;�- ���.n� �,,
717 SE DELAWARE STREET -W
DIVISION OF ENI�IRONMENTAL HEALTH •
MINNEAPOLIS, MINNESOTA 55440 � � � � U � CJ �o � �
ATTN: Mr J i m Nye ���� # � 19��
(612) 623-5339
SUBJECT: WELL ABANDONMENT
SITE DIAGRAM
RE: NOTIFICATION
Dear Mr Nye ,
This letter is to notify you of a water well in your district that should
be sealed according to the Water Well Construction Code MCAR §4725.2500-2900.
E.H. RENNER � SONS, INC has been notified by the owner of this property or
an interested party and have subsequently submitted to them an estimate for
the sealing of this well under our LICENSE �71015. We have also included
a copy of the current code with our estimate.
In submitting our estimate , the owner may also receive additional estirrt�tes
and hire any number of Minnesota licensed water well contractors in the area
to seal this well . However, there is a possibility that this well may not
be properly sealed and thus jeopardize the ground water and Public Health.
E.H. RENNER & SONS, INC. wishes to provide you this information for future
reference with the abandonment report when submitted.
PROPERTY OWNER: GOOD SHEPAERD EVANGELICAL PHONE # 471-8433
AD�RESc: 3745 SHORELINE DR.
WAYZATA, MN. 55391 DATE
LOCATION: SAME WELL DIA. 6"
NAVARRE DEPTH: 345 '
Sincerely Submitted,
Raymond T. Renner, V-President
E.H. RENNER & SONS, INCORPORATED
STATE LICENSE #71015
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cc: CITY OF ORONO ��
BOX #66 �
CRYSTAL BAY, MN. 55323
q�N; MIRE GAFFRON ' �
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E��ual Opportun�ty Frn;;l���i�� � �` - ,�' '��/�
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WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H �-��315�:'
County Name WELL AND BORING SEALING RECORD Mennle90 aoUnique Well No. �
Minnesota Statutes, Chal1ter 1031 or W-series No.
��� •� Y Leavx blank ii nat known)
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Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed
`' C1CQ!'!O 1 Z� 23 ZO StS !� �1C�F � � .+
GPS LOCATION-decimal degrees(to four decimal places) < <
Depth Before Sealing_��ft. Original Depth�__�_�___fl.
Latitude_._ _ Longitude _ _____
IFER(S) STATIC WATER LEVEL
Numerical Street Address or Fire Number and City of Well or Boring Location . ingle Aquifer '�1 Multiaquifer ,�,�/ }�w
3745 �oreline �r� \7C�Q 55391 ��ORING �leasured ! Estimated DateMeasured�=,At�`r �/I'��
� i Water-Supply Well � 1 Monit.Well � �
: Show exact location of well or boring Sketch map of well or boring ��Ern.Bore Hole '_.;Other �_ft. �below i;��]above land surface
� in section grid with"X" location,showing pro erty �� . - � -.. �.
lines,ro d'�,and b � s. '
, N ��.4; j,,.. ��.... , � CASINGTVPE(S)
, , . _ �. . R ,
�--- ---�- -�-
Steel [ I Plastic [1 Tile ❑Other_ ___ __ __ ____ ____
--- - -- ta. WELLHEAD COMPLETION A/ �
e{ t yo� �o;
W __ _ _ E T / ; Outside: �Well House �.J At Grade Inside ..�;Basement Otfset � °.)
; ; ; � �`� v�
, , , , F Miie e ❑Pitless AdapteuUnit Buried �Well Pit
, � .
.- --�-- --�-----:- ..�t J c�T1- ��5 :
.' , , , , - ` ]Buried O
' ' S ' ' �Well Pit �O 5
�i Other IQ�,. r
�—i M�ie—� �Other_._ ---. ..._____ --.Tv—
----- - tio
PROPERTY O�WLNE,,R'S NAME/C•O�M'PALN.Y,�.NAME nf,,�� �L CASING(S)
�, (^ ,,�it��" Cd iN„�ttic[$1] �,.tiUrLi I Diamet�� �pth ,.+ " Set in oversize hole? Annular space initially grouted? �,
Property owner's mailing address if diflerent than well loca�ion address indlcated above in.from � to J fl. � �'��.Yes No Yes � �
�. _ _.__��_ , � �_� U No ��Unknown
� __in.from_ to___ fl. I_�Yes ;]No [,Yes r No j Unknown
_. in.from to _fl. j Yes [;No []Yes ❑No ❑Unknown
WELL OWNER'S NAMEiCOMPANY NAME SCREEWOPEN HOLE
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��� Well owner's mailing address if different than property owners address indicated above Screen from to ft. Open Hole from��to��. ft 9
OBSTRUCTIONS
'�RodsiDrop Pipe , ,Check Valve(s) L I Debris 'Fill ! No Obstruction
-> Type of Obsiructions(Describe)�/�//lxi�_�._�� ¢��m�
GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? es ' ;No Describe
FORMATtON - --- ----- �--- - --
PUMP
� If not known,indicate estimated formation log from nearby well or boring. Q (� ��
' TYPe--�Uf1__�_��� .
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- — --- --
� , i�� '-`,� �-j Removed �: '�,Not Present �__J Other '
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..�y�--s��--.. � '`� ' .METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE:
� j�No Annular Space Exists ; Annular Space Grouted with Tremie Pipe '�I Casing PeriorationiRemoval
r�
� in.from to fL (-�i Perforated � 'Removed -
j -
., ,___ �__ __in.from_ _ to_________R �, ]Perforated � �Removed �
..- Type of Perforaror----- ._...._. ___.___. ..---- -.
VARIANCE
Was a variance granted from the MDH for this well? .Yes ���No TN#_____,__ __ ;-
GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.)
Grouting Materiai_����_��om��o�='/J 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 information contained in this report
is Irue to the best of my knowledge.
Don St«iola Well Drilli.ng co., Inc. 1691
- - __ -- _ _____ _ -- - -
Licensee ine N e S License or Registration No.
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-- -- - _ __--- -- �.
C ied Re resentative Sig 'Ye Certilied Rep.No. Date
, H ��{1 �-1( � , _, :
{- LOCAL COPY � ol,J ��O ------ --- —�--- .:__.-�{..'l�� _.�r:,�J,,jJ!'Y' `�'' .
Name of Person Sealing Well or Boring � �� �
HE-01434-14 IC#140-0423 ! 5�i3R