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HomeMy WebLinkAboutwell info WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 188f WELL AND BORING SEALING RECORD Sealing H o County Name Minnesottao Unique Well No. � -- Hennepin Minnesota Statutes,Chapter 1031 or W-series No. - (L—Nl X-known) L_ Township Name Township No. Range No Section No. Fraction Ism.i Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 17 31-0022 A10 v 15 Numerical Street Address or Fire Number and City of Well or 55391 ggyLoocation r 3760 60 1 ogo Rd. Orono 5 l3T 1 Depth Before Sealing ft Original Depth �� It Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL in section grid with"X" lucallorl, snowingerty Single Aquifer ❑ Multiagwfer hoads,and butldi s. [:] Estimated WELL/BORING Measured Water Supply Well ❑Monit.Well ❑ Env.Bore Hole ❑Other _ _ —_.ZC.a ft. [Xelow ❑ above land surface W --_ _i__ -_ E f- -- CASING TVPE(S) --i --� - Y eel ❑ Plastic ❑Tile ❑ Other Yz mile u-- -,-- --�-- CASING(S) Diameter f�, Depth Set in oversize hole? Annular space initially grouted? LLLLS ! {'► I lY�r milegr in.from r+ _ to fl. [j Yes LOA ❑ Yes ❑No ❑ Unknown PROPERTY OWNER'S NAME !` in.from to It ❑ Yes ❑j No ❑ Yes ❑ No ❑ Unknown tr r Property own s mailing address if different than well location address indicated above infrom to ft. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown SCREEN/OPEN HOLE Screen from—X0 to �` , ft Open Hole from to ft. OBSTRUCTIONS WELL OWNER'S NAME Rods/Drop Pipe p E] Check Valve(s) ❑ Debris ❑ Fill YNo Obstruction Well owner's mailing address if different than property owner's address indicated above Type of Obstructions(Describe) Obstructions removed? ❑ Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO El Removed )< Not Present ❑ Other FORMATION It not known,indicate estimated formation log from nearby well or boning. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: io Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to h. ❑ Perforated ❑ Removed in.from to h. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL($) ,(OO�ne bag of cement=94 lbs.,one bagofbentonite=50 lbs.) f Grouting Material <'� A'' from —0lo Ile) /ft. yards �[_ bags from to ft. yards bags from to ft. yards bags from to_ ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes *o How many? LICENSED OR REGISTERED CONTRACTOR CERTIrICATION 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. Don Stodola Well Drilling Co- � Inc 2_Z17.2 Contractor Business Nam �: License or Registration Pro. 11-19-99 uthon epresental Signature - Date Jim Antonson LOCAL COPY JH 161880 Name of Person Sealing Well or Boring MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL DR BORING LOCATION WELL AND BORING SEALING Sealing No. �H RECORD 161881 County Name Minnesota Unique Well No. r --- Hennepin Minnesota Statutes.Chapter 1031 or W-series No. (Leave desk n ria k-1) L Township Name Township NTRan;ge No. Section No. Fraction(sm.i Ig.) Date Sealed Date Well or Boring Constructed Orow IIF 27 31 Q Numerical Street Address or Fire Number and City of Well or Boring Location r TOrono Depth Before Seating _-_ft Original Depth h 3760oo Rd Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL in section grid with"X' Ioc Y Single Aquifer ElMuluaquder roads.and burden s N .3u.* W�LL/BORING Measured El Estimated f/. r �EJf Water Supply Well ElMonit Well °(} 20 or E] Env Bore Hole ❑Other — ry below ❑ above land surface W ---- - -- - -- --'-- E CASING TYPE(S) - - - -- -;-- --i-- Steel ❑ Plastic ❑Tile ❑ Other }smile -- CASING(S) Dianer Depth mac,41 to in oversize hole? Annular space initially grouted? 01 f mile s �4' A in.from �✓ to- ft. ❑ Yes No ❑ Yes ❑No ❑ Unknown 2PT PROPERTY OWNER'S NAME in,from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown r Property owner s maihng address if different than well location address indicated abovein,from to ft. ❑ Yes ❑ No ❑ Yes ❑No ❑ Unknown it /1 2 SCREEN/OPEN HOLE 1f tf Screen from 3 U to �L ft. Open Hole from to ft. OBSTRUCTIONS WELL OWNER'S NAME ❑ Rods/Dro Pipe Check Valve(s ) E] Debris E] Fill WNo Obstruction Well owner's mailing address if different than property owner's address indicated above Type of Obstructions(Describe) Obstructions removed? ❑ Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL I COLOR HARDNESS OF FROM TO ❑ Removed A Not Present ❑ Other FORMATION If not known,indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: )6o Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ry. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 lbs.) _ r.1 SMG � �1 Grouting Material N4,4,T(,�,� A-llfrom �..�/ to_sL I ft. yards bags from to _ ft. yards bags . -. from to... ._ _ ry.-, yards bags from to— fL yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS 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 true to the best of my knowledge. Dan St©dols WEli Drilling Co., Inc. 27272 Contractor Business Name - L"nse or Registration rvo. > I1-1,9'9 [�Auhg�i6�'nzed Representative Signature Date Jtm Antonson i_OCAL COP,6H {�Q 161©81 Name o/Person Sealing Well or Boring