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Home My WebLink Aboutwell info .;{_.a ,.,: �- . � �" � � � �� / MtNNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring +� ��f'�� WELL OR BOFING LOCATION �yELL AND BORING SEALING RECORD Seaiing No. H 1 L _ � co�nry Name Minnesota Unique Well No. � Minneso�a Statutes.Chapter 1031 or W-series No. Hsnne in n..,.d,��.�� -- -- -- � Township Name Township No. Range No Section No. Fracuon Ism �Ig) Date Sealed Date Well or Bormg Consiructetl Orcuio 117 23 2A 'SE �FT `� � 01/25/02 � � Numencal Sireet Adtlress or Fire Number and Ciry of Well o�Bonng Locahon � � �7� SY�Or2�.1T� DriV� Depth Before Sealing 1� n Original Depih h w ex loca i of H• Sketch map of well o�boring ApU1FER(S� STATIC WATER LEVEL in section grid with"X". location, showing property Q Single A�wfer ❑ Multiaquiler �� lines,roads.and bwldings. N WELUBORING �Measuretl ❑ Eshmated , � � � �Water Supply Well ❑Monit.Well -'r- -i-- --i-- --� , �e i, ❑ Env.Bore Hole ❑O�her _ � tt. �below ❑ above land surface :-s. W -- - -- -i-- --i-- E ^�- CASING TYPE(S) � � � OASP MPq� � —i-- -i-- -i-- --�-- � U �Steel � Plastic �Tile �Other Yimile —`- -j-- -�-- --�-- � CASING(S) Dlameter Depth Set in oversize hole9 Annular space initially grouted7 L� S "�� ^ 1s �I(�—t mi�e� ` in.from 0 b 1V3 ft. ❑ Yes p No ❑ �es ❑No � Unknown I PROPERTV OWNER'S NAME in.from to it. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Property owner's mailing address il diHereM t�an well loca6on address indicated above. in.�rom to ft. ❑ Yes ❑No ❑ �05 ❑NO ❑ UnknOwn � � � SCREEWOPEN MOLE Crystal Bay I� 55323 ' S�,ee�,,om 163 ,o I68 n . . Open Hole irom to fl. OBSTRUCTIONS WELL OWNER'S NAME �� Rods/Dro Pi e O ❑ Debris ❑ Fill ❑ No Obstruction � p p ❑ Check Valve s Well owner mailing address if diNerent than properry owner's atltlress indicated above. Type ot ObStruCtionS(Describe) Obstructions removed? .Yes ❑ No Describe PUMP .. TYPQ S�SO� HARONESS OF � Removed ❑ Not P�esent ❑ Other GEOLOOICAL MATERIAL COLOR FORMATION FROM TO If rat krawn,irWicate eatimeted formeuon log from nearDy weli or bonng. 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 Perforation/Removal in.irom to R. ❑ Pertorated ❑ Rertroved in.from to h. ❑ PeAorated ❑ Removed Type of perforator ❑ otner GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Matenal ��i� from � ro 26$ ft. yards � bags , .. from to ft. yards bags from to ft. yards begs from to__ ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEAUNG OTHER WELLS AND BORINGS �� /� Other unsealed and unused weli or boring on property? ❑Yes �No How many? PD- j�� LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or bonng was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. T.L. Stevens Well Co�ar�y 27194 Contracror Business Name License or Regisfreb'on l�io. Authonzed Representative Signature Da e �ff iTa�-nn 1 FOFR7AN o �L�''�'d � �i�Jr�.�-:! + H ��/1/�/�� Name ol Person Sealing Well a Bonng f� PERS-Vlr� �'vti;�iEF a„'' ' V L V � . r . r MINNESOTA DEPARTMENT OF HEALTH - WELL MANAGEMENT SECTION -- SEALING VERIFICATION This is to verify that this office has received notification thac a well (Minnesota Unique Well Number H0180713) is to be sealed by BERGERSON-CASWELL, INC. at: County: HENNEPIN Township Name: ORONO Received: 06/14/2001 Township No. : 117 Range: 23 Section: 17 I,� SE;f SW3,( SFri,� Street Address: 3770 SHORELINE DRIVE, ORONO 55391 This well must be sealed in accordance with the Minnesota Rules on Wells and Borings. NIDx staff may be on site to inspect the well sealing. ORONO, CITY OF -. � P.O. BOX 66 CRYSTAL BAY, 1�IIJ 55323 . . , . . r MINNESOTA DEPARTMENT OF HEALTH - WELL MANAGEMENT SECTION -- SEALING VERIFICATION This is to verify that this office has received notification that a well � (Minnesota Unique Well Number H0190975) is to be sealed by WATER PLUS at: County: HENNEPIN Township Name: ORONO Received: O1/03/2002 Township No. : 000 Range: 00 Section: 00 1,{ 3f ;� � Street Address: 37� SHORELINE DRIVE, ORONO � This well must be sealed in accordance with the Minnesota Rules on wells and Borings. NIDH staff may be on site to inspect the well sealing. ORONO, CITY OF 2750 KELLEY PARKWAY ORONO, NIN 55356