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Home My WebLink Aboutwell info , ,�. :- r :� MINNESOTA DEPARTMENT OF HEALTH M�nnesota Well and Bormg � �4 6�7�� WELL AND BORING SEALING RECORD Sea�ing No H �ry�^� Mmnesota Urnque No. — -- � Hennepin Minnesota Statutes,Chapfer 1031 or W-series rvo. ILeave b�ank il n��known) Townsftip Name Townshlp No. Range No. Section No. Fraction�sm.-s Ig.) Date Sealed Date Well or Boring Constructea arano 117 23 OS LZ-a02� � p{/ ^ Nurtiencal Stree1 Address a Fire Number and Ciry o(Well o�Boring LocaGon � ! 60 S a7t�Ib� �8� L�,d y 4rons S 5359 Depth Before Sealing �� H O��ginal Depth ��> 8 Sbow e�cact location ot`rell a boring Sketch mae of well or bormg qpUIFER(S) . STATIC WATER LEVEL n section grid wNh'X'. locatio�owing property ��Single Aywfer � Multiaquifer lines, an�ab itdin �[ N � rZ� �� WELUBORING �LI Measured ❑ Estimated S:,v 1��j Water Suppiy Well ❑Monit.Well �r� � ` �^�--� ^ 1 ❑ Env.Bore Hole ❑Olher _ _w� R. �below ❑above Wnd wAace W 'Y- 'Y- 'T- -T- E '� CASING TVPE(S) -ir- -r- -�-- -�- ��, :.$ Steel ❑ Plas6c �Tile � Other �� um�.: -...___�.._ -�- -�- -i-- -j-- � - CASING 1 Diameter Depth � Set in oversize hole? Arwwalar space inhially grouted? S J� - /fi �4 �t mis� . �_ in.from ✓ to �� ft. ❑ Yes �No ❑Yes ❑No ❑Unknown � r. PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑Y�s ❑No ❑ �^k^oN'^ � � Prape�ry owr�s maiy address if dilferem than well locaaon a ress indiwted above. in.from to fl. ❑ Yes ❑No ❑res ❑No ❑Unknown � SCREEWOPEN HOLE Screen from�to "=��j � ft Open Hole from to k. OBSTRUCTIONS �LL��"� Rods/Oro Pi ❑ p pe ❑ Check Valve(s) �'Debris ❑ Fill ❑ No Obstrudion WM ow�efs m�ip addrees N dilhrent Man properry ownefs aCtlress indicated above. Type ot Obstructions(Describe) �\;�4�:,��T�' Obstructionsremoved? �Yes ❑ No Describe PUMP 7ype (�EOLOQICAL YATEitlAL COLOR HARDNESS OF FROM TO � Removed �Not Present ❑ Other FORMATION q�b��o�� METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: , No Annular Space Exits r: � -. ` ❑ Annula�space grouted with tremie pipe �.� ❑ Casing PeAoration/Removal in.from to fl. ❑ Peibrated ❑ Hemwed in.from ro R. ❑ Perloralsd ❑ Rertwved Type of perforator ❑ Omer GROUTING MATERIAL(S) Ai,�s'.`�'�;;��M,�'r��— �� Grouting Material om to ft. yards�,,,,_ bags trom to fl. yards bags from to ft. yards bags from to__ fL yaids begs REYARI(8,SqIRCE OF DATA,DIFFICULTES IN SEALING OTHER WELLS AND BORINGS C�ther unsealed and unused well or boring on property? ❑Yes�No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring wes sealed in accordance with Minnesota Rules,Chapter 4725. The iriortna�qn oaRained'n tfrs report is true to the best of my knowledge. Don Stodola t�ell D C I Confredor Business Name � ; i L.iosw w Reps6atlm 170. --� . � ' .��3 .: .�� , � � �� ,�.r �,i 3 1��.� - _ uth ed epresentative Signatuie Or�s t z �• . . .. . . . ..... ... •/" ..J" 4\1��,..�.�iV'�'.... H ��^� ` Name ol Person t ling Well or Bonng LOCAL COPY �� * i HE-01�.3�00 ?J97 R .. ,,, ;�;,� �. MINNESOTA DEPARTMENT OF HEALTH Mmnesota Well and Bor�ng � /F11 —� WELL OH BORING LOCATION Sealing No. I H �„4 6 V y�� Counry Name WELL AND BORING SEALING RECORD Minneso!a Unique No. — � IIenne �L1 Minnesota Stafutes,Chapter 1031 or W-series No � (Leave blank il not known) Township Name Township No. Range No. Section No. FracUon�sm.�Ig.) Date Sealed Date Well or Bonng Constructea �' t}rono II? 23 05 1�-0822� C I�'� "i`��' Numencal Sireet Adtlress or Fire Number and City ot Well or Boring Location �� A � V� CJ J��b«� �a Rd� Or0�0 � DepthBeforeSealing -�� ft. OnginalDepih �� h. Show exact locatlon of�•ell or bonng 5 l�590 Sketch map.plyvell nng A�UIFER(S) STATIC WATER LEVEL in sectbn gnd with'X'. � loca6on, s7l�iing operty gingle Ayurfer � Mul6aqwfer e lines,road and uil ing5�" ry �'1 � � WELUBORING �Measured ❑ EsUmated � � � � .� ' �__ � Water Supply Well ❑MoNt.Well � � � .: .___�..__....�.. ` � � �( `,g'� �`� � ❑ Ern.Bore Hole ❑Other _ (L?�' h. �}pelow ❑epwe land wAace � 1 � � � � W --'"- "�-- '�'- --�-- E CASING TYPE(S) -�-- —�- -i— --I-- � � -' " Steel � Plastic �Tile �Other --`- -�— -j-- --j-- �� CASING Diameter Depih r Set m overs�ze hole7 Mnualar space fnitially grouted9 l /,/�,, ��,,��SS �r,-�,m�e� � m.from�_ to �`� R. ❑ Yes �No ❑Yes Q No ❑Unknown I PR PERTV OWNER'S NA E m.from b ft. ❑ Yes ❑No ❑�'es ❑�'1� ❑U�k�'� �l.em Rrol� �i73-2£i33 Property ownei s mailirg adAress B AiHerent t�an well locahon address indlwted above. m.from to R. ❑Yes ❑No ❑Y� ❑� ❑Unknown Z O1 +G SCREEWOPEN MOLE Screen from �'� ' to �� , ft. Open Hole irom lo fl. OBSTRUCTIONS WELL OWNER'S NAME Rods/Dro Pi ❑ p pe ❑ Check Valve(s) ❑Debris ❑ Fill No Obstruction WeN owne�s msiNng atldress if tliMerent t�an property owner's adtlress indicated above. Type ot Obslructions(DesCribe) Obstructions removed? ❑Yes ❑No Describe PUMP Type (iEOLOfi1CAL MATERIAL COLOR HARDNESS OF FHOM TO � Removed �Not Present ❑ Other FORMATION If not krawn,indicate estimeted lormation log from near�y well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE MOLE: dr i f t Q �^ No Annular Space Exits t� ❑ Annular space grouted with tremie pipe ❑ Casing PeAoratioNRemoval in.irom to tl. ❑ PeAoraled ❑ Hertaved in.from to ft. ❑ Perbrated ❑ Flenwred Type of perforetor ❑ omer GROUTING MATERIAL(S) . ,/��`,t�'"c?'.��!� /, Grouting Matenal rom � ro ` `�" R yards � bags from to ft. ysrds baps trom to ft yards baqs from to__ tl. Yards bps REYARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes ❑No Fbw man�/? LICENSED OR REGISTERED CONTRACTOR CEHTIFICATION This well or bonng was sealed in accordance with Minnesota Rules,Chapter 1725. The iNormatlon oor�'eied in Uvs repat ia true to[he best of my knowledge. IIon Stodola hte11 Driiling Co. , Inc. 27172 Contractor Business Name .-^� Licerns or Rs�6a0an�io. r' ��; _-j .'�,-�,, - , j l-Ej-98 � � ��„�e��-��,�.� o� Hia Antonson LOCAL GOPY H 14 6 0 9? Name o/Person SeeNnp WeN a Boring HE-01434-03 2/97 R