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Home My WebLink AboutWell/Boring sealing Record WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring HSeal261702�} O/� ng County Name WELL AND BORING SEALING RECORD Minnlesso aoUnique Well No. L 1 G Minnesota Statutes,Chapter 1031 or W-series No. Henmpin (Leave blank N not known) Township Name Township No. RangeNo. Section No. Fraction(sm. Ig.) Date Sealed Date Well or Boring Constructed Orono 118 1 32 25' j-&A N 07 GP Latitude degrees minutes seconds Depth Before Sealing �"7 ft. Original Depth ft. I Longitude degrees minutes seconds IFER(S) STATIC WATER LEVEL eri res.or Fire Number and City of Well orLocation Single Aquifer ❑Multiaquifer WELL/BORING Measured ❑Estimated Date Measured..)/?/�M Wa to Blvd Oron Water-Su ppIy Well ❑Montt.Well r Show exact location of well or boring h map of well boring �,,/ in section grid with"X.' �' loca roperty [I Env.Bore Hole ❑Other ft. JEy below [Iabove land surface roads,a uildings. N CASING TYPE(S) Steel [_]Plastic F1Tile ❑Other ` WELLHEAD COMPLETION W EI Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset h Mile X Pitless Adapter/Unit ❑Buried ❑Well Pit T + d < ❑Burie s � 4 '6� ❑Well Pit -1-78-445. ❑Other TH1� A 178+45 110' T Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) M WT Dia et�r� /�I Depth r Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different thaniwe�lllocation address indicated above in.from E,r to�5 ft. ❑Yes )(No ❑Yes ❑No ❑Unknown C/(l�arl bolander So 13 CQmp$ny in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown 251 Starkey St St Paul, MN 55107 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE Well owner's mailing address if different than property owner's address indicated above Screen from 195' to ft. Open Hole from_ to ft. OBSTRUCTIONS - Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction Type of Obstructions(Descri1beL--7-JhlK,< "O'X— 11L 191)4"40 GEOLOGICAL MATERIAL COLOR HARDNESS OR FORMATION FROM TO Obstructions removed? es E]No Describe_ - --"— PUMP C !? If not known,indicate estimated formation log from nearby well or boring. j Type 7 o fe) P- D ` Removed ❑Not Prelent ❑Other ( 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.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 lbs.) Grouting MaterialW6, f e,061e—f m tol 2q ft. yardsj'� bags from to ft. yards bags from to Ir yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes Xo 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. Doa Stodola Well Drilling Co,. Inc. 1691 Contractor Business Name License or Registration No. 00, tiff F7epresentative at a Certified Rep.No. Date LOCAL COPY H261702 ��Qn-v�i Yv.I...Ilrv�✓ 2 6 17 0 2 Name of Person Sealing Well or Boring , HE-01434-09 ICa 140-0423 6/OeR WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H. Sealing County Name 261703 WELL AND BORING SEALING RECORD Minnesota Well No. _ Minnesota Statutes,Chapter 1031 or W-series No. Hf n (Leave blank it not known) Township Name Township No. Range No. Section No. Fraction(sm.—Ig.) Date Sealed Date Well or Boring Constructed Orono 118 23 32 '' '' '' GP A Latitude degrees_ minutes_ seconds Depth Before Sealing J ft. Original Depth ft. - L ICON: Longitu minutes seconds pUIFER(S) STATIC WATER LEVEL mer tregLAddress-or Fire Numbei arr4,q y of Well or B Location Single Aquifer ❑Multiaquifer O y�►,}� WELLBORING Measured ❑Estimated Date Measured /61 --_wzat8 Blvd, O� Water-Su I pp y Well ❑Monit.Well r Show exact location of well or boring `, of well or boring Env.Bore Hole in section grid with"X:' ng property ❑ ❑Other ft. below ❑above land surface ads,a buildings. CASINGTYPE(S) Steel ❑Plastic ❑Tile F-!Other -- '--- ------- - �� WELLHEAD COMPLETION W E T +----- ---T--- Outside: ❑Well House At Grade Inside: Basement Offset -�-- -4- 'h Mile itless Adapter/Unit L�Buried ❑Well Pit ❑P' E]Buried s r ❑Well Pit --_ .J'� ❑Other ❑Other 7845, nOi PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) MomK/1 Diameter Depth r Set in oversize hole? Annular space initially grouted? Property owners mailing address if different than well location address indicated above :z t in.from�_ to 1i e ft. ❑Yes ox No El Yes ❑No El Unknown srMBolander a Sons Company in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown 251 Sark* Set1� A SPaul li� M 55107 2 of 2 in,from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE I � Well owners mailing address if different than property owner's address indicated above Screen from to ft. Open Hole from t0 ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill WNo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ElYes ❑No Describe FORMATION PUMP If not kpown,indicate estimated formation log from nearby well or boring: s Type t v ❑Removed Not Present F1 Other 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.from _to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=941bs,one bag of bentonite=50 Ibs.) Grouting material 04A romJ�_ to" 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 Xo 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 Stodola Well Drilling Co,. Inc. 1691 Contractor Business Name License or Registration No. 01.1 7 rti depresentative Si at Certified Rep.No. Date LOCAL COPY H 261703 Name o/Person Sealing Well or Boring HE-01434-09 IC#140-0423 6/06R