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HomeMy WebLinkAboutwell and boring sealing records / MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring L� A 1007 • y) WELL OR BORING LOCATION - H 1 f WELL AND BORING SEALING RECORD Minns ota Unique Well No. C County Name —,Hennepin Minnesota Statutes,Chapter 1031 oorW-ssve eN es No. Township Name Township No.• Range No. Section No. Fraction Ism.-e Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 05 23r-0043 ?a AtIS 00 Numerical Street Address or Fire Number and City of Well or Boring Location r t 364 W Laky! St, Orono Urf Depth Before Sealing 9 WO ft Original Depth ?WI ft / Show exact location of well or boring Sketch map of weler bringpAQUIFER(S) STATIC WATER LEVEL in section grid with'V. location, erty !ySingle Aquifer ❑ Mulliaquifer lines,roa ,and build' S. 11YAA 1 N - WELUBORING ,'Measured ❑ Estimated I- yWater Supply Well ❑Monit.Well { ❑ Env.Bore Hole ❑Other Q h. below ❑ above land surface W---r---r---�-----�--E CASING TYPE(S) ---i-----1-----i------I--- )(Steel Steel ❑ Plastic 0 Tile ❑ Other ) l { { krni ---1----+---1 t- 1 21.'"). N 4�r CASING(S) 1�.j O Diameter /� Depth r Set in oversize hole? Annular space initially grouted? S .11 Z.11 �—i mite W from to �� ft. 0 Yes yNo ❑ Yes 0 No ❑ Unknown PROPERTY OWNER'S NAME c� in.from to ft. ❑ Yes ❑No 0 Yes ❑No ❑ Unknown Beall ig & Sens Property owner's mailing address if different than well location address indicated above. in.from to ft. ❑ Yes ❑No 0 Yes ❑No 0 Unknown 11441 Cty Rd 3 SCREEN/OPEN HOLE Hopkins, MN 55343 Screen from 9Z` to % r ft. Open Hole from - to ft. OBSTRUCTIONS WELL OWNER'S NAME Rods/DropPipe ©a 3 ❑ p 0 Check Valve(s)//��.-- Debris 0 Fill 0 No Obstruction Well owner's mailing address if different than property owner's address indicated above. Type of Obstructions(Describe) C.iC� }I 1 Obstructions removed? Yes 0 No Describe PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO ❑ Removed jiirNot Present 1=1Other FORMATION If not known,indicate estimated formation log from nearby well or bo ng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: drift 0 )(No Annular Space Exists 96 ❑Annular space grouted with tremie pipe O Casing Perforation/Removal in.from to ft. 0 Perforated 0 Removed in.from to ft. ❑ Perforated 0 Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material from 0 to I r ft. yards _Zs_ 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 YJ No 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. Don Stodola Well Drilling Ca., Inc. 27172 Contractor Business Name / - License or Registration No. ././ -a�/�./�i1 t,; o .97 . =s=nta"e Sig,rJlf! Date Jim Antoneon LOCAL COPY H 170072 Name of Person Sealing Well or Boring fl MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL OR BORING LOCATION Sealing No. H 169381 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. 8innopin Minnesota Statutes,Chapter 1031 or W-series No. (lam WW,If not known) -- Township Name Township N . Range No. Section No. Fraction(sm.-,Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 05 23-0043 2. AUC' 00 Numerical Street Address or Fire Number and City of Well or Boring Location Q s E 264 M looks Strast, Orono Depth Before Sealing 9U ft. Original Depth 618 ft. Show exact location of well or boring. R53"g� Tar Sketch map of w boring AOUIFER(S) STATIC WATER LEVEL - in section grid with"X'. ! location, shown rt Sin le A uifer lines,roads,an byi ' s. g q ❑ Mulbaquifer ,. N yJ ` WELUBORING Measured ❑ Estimated Nater Supply Well ❑Monit.Well f T — T lhJ �// ❑ Env.Bore Hole ❑Other 7y ft. ytbelow 0 above land surface i W---r---,----,-----, -"E CASING TYPE(S) • I I --[---i----i------I--- T )(Steel ❑ Plastic ❑Tile ❑Other i I . I I )tmite K --- , a CASING(S) Diam tprt Depth / Setin oversize hole? Annular space initially grouted? ll�� S - (�r. /� Com/) 11�—1 mire "T�1 in.from a to ?• ft. ❑Yes X/ho ❑ Yes 0 No ❑ Unknown PROPERTY OWNER'S NAME in.from to ft. 0 Yes ❑No. ❑ Yes ❑No 0 Unknown Sollig 6 Sons Property owners mailing address if different than well location address indicated above. in.from to ft. D.Yes ❑No ❑ Yes 0 No 0 Unknown Jim 938-4133- SCREEN/OPEN HOLE U/ 11401 Cty Rod 3 / �j Q / Screen from q 7 to !Cl ft. Open Hole from : to ft. Hopkins, KM 58343 OBSTRUCTIONS WELL OWNER'S NAME X Rods/Drop Pipe 0 Check Valve(s) ❑Debris ❑ Fill 0 No Obstruction M Well owners mailing address it different then property owners address indicated above. Type of Obstructions(Describe) �" —#' / 11_ , , f9 , Obstructions removed? ( Yes 0 No Describe PUMP /� /� Type 5 !- uIn $- a GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO R.clemoved ❑ Not Present ❑ Otfier FORMATION II 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: lliCo Annular Space Exists WI ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. 0 Perforated ❑ Removed in.from to ft. 0 Perforated 0 Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement.94 lbs.,one bag oftbentonite.50 lbs.) Grouting Material ili-* cemf.„1FoFn 0 to ie fl. yards 8 bags tfrom 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 weltrtboring on property? 0 Yes VW How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION • This well or boring was sealed in accordance with Minnesota Flutes,Chapter 4725. The information contained in this reporf'is true to the best of my knowledge. Don Stodola WO it Drilling Co., Inc. 27172 Contractor Business N e License or Registration No. Auth ed presentative Signature Date \ H LOCAL COPY 169381 Name of Person Seel;jj ell or Boring . • MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I0 V V WELL OR BORING LOCATION Sealing No. H 170073 County Name — WELL AND BORING SEALING RECORD Minnesota Unique Well No. -- - -- Hennepin Minnesota Statutes,Chapter 1031 or W--se„es No. (Leave Donk Township Name Township No. Range No Section No. Fraction(sm.-►Ig) Date Sealed ,Date Well or Boring Constructed Orono 117 23 05 23-0043 2.1 R co " ` . • Numencal Street Address or Fire Number and City of Well or Boring Location /�� / kr .g� 364 V -Lake St, Orono Depth Before Sealing /O0 ft. Original Depth /Ai ,_ Coq Show exact location of well or boring Sketch map of well ori11 AOUIFER(S) •STATIC WATER LEVEL Cl 0 in section grid with"X". location, showing ope Ingle Aquifer ❑ Multiagwler C Y 2000 lines,roads,and bhlon \/ t✓h\ N ELL/BORING J�Measured ❑ Estimated U coqq� Water Supply Well ❑Monit.Well , rYO Td l l ❑ Env.Bore Hole ❑Other ';2, ft. below ❑ above land surface ---r---1----1-----�--^ CASING TYPES) 11 W l i E --l-----I----i--^---I--- p Steel ❑ Plastic ❑Tile ❑ Other I • I I I �` ___,____+___1 -1--- , �i )\ CASING(S) ,✓ %S Diameter Depth Set in oversize hole? Annular space initially grouted? t mire �'' t• r� in.Irom Q to %I ft. 7 ❑ Yes (�No ❑ Yes ❑No ❑ Unknown PROPERTY OWNER'S NAME 4 4`v� in.from to ft. ❑ Yes ❑iNo 0 Yes 0 No ❑ Unknown Doi owner i& f o pYes No Unknown Pro owner ailin a ress i i Brent than well location address indicated above. in.from to ft. ❑ Yes ❑ No 0 ❑ ❑ 11401 Cty Rd 3 SCREEN/OPEN HOLE, , Hopkins, MN 45343 Screen from 9Co to l•©a ft. Open Hole from to ft. OBSTRUCTIONS • WELL OWNER'S NAME KRods/Dro Pipe 2 of 3 P P 0 Check Valve(s) ❑ Debris 0 Fill Li No Obstruction Well owner's mailing address it different than property owner's address indicated above. Type of Obstructions(Describe) � K ¢ POMP Obstructions removed? XYes 0 No Describe' PUMP �A Type Uer ''POM 4• 1,.- GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO lif Removed CINot 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: drift to Annular Space Exists Annular space grouted with tremie pipe • ❑Casing Perforation/Removal in.from to ft. 0 Perforated ❑ Removed in.from to ft. ❑ Perforated 0 Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material��Jl��� from to /a O ft. yards —JI= bags from to ft. yards bags from to h. 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 'No 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. • Do®°Stodbll` Well Drilling Co., Inc. 27172 Contractor Business Name License or Registration No. 8-22-00 -whop-,. se"live Sign:4 - Date Jim Antoneon LOCAL COPY- . H 170073 Name of Person Sealing Well or Boring