Loading...
HomeMy WebLinkAboutWell & Boring Sealing Records —'•` a MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL OR BORING LOCATION H ng No. 213824 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Hennepin Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank it not known) Township Name Township No. Range No. Section No. Fraction(sm-s Ig) Date Sealed Date Well or Boring Constructed Orono 118 23 l NW SW veiD 03 GPS Latitude degrees minutes seconds 2_4 �j LOCATION: Depth Before Sealing `l ' ft. Original Depth 'w r ft. Longitude degrees minutes seconds AOUIFER(S) STATIC WATER LEVEL Numerical� cStreet Address or Fire Number and City of Well or Boring Location Single Aquifer 0 Multiaquifer 340 Willow Dr Orono (see attached EL %ORING Measured ❑Estimated 1 ! r Supply Well 0 Monit.Well / Show exact location of well or boring Sketch map of well or boring in section grid with"X" location,showing property 0 Env.Bore Hole 0 Other /U ft. A�below 0 above land surface N .. lines,roads,and buildings. 7� i1 t.y , ( H 4 ' F 1 i1 1 a CASING TYPE(S) eel ❑Plastic ❑Tile ❑Other W---r---,----,-----,--•E y211tHEAD COMPLETION f — — T , ") Outside: 0 Well House Inside: 0 Basement Offset I I 4 hmiis O XPitless Adapter/Unit 9 Well Pit It 30 9 Well Pit 0 Buried S ` J �tmM I 1 9 Buried PROPEREISAN�R'S Nq[NE/COMP��Y lel � 1A CASING(S) } j �1 _JS�s'i`s>f` j j,� 4 Diameter Depth / Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above Construction in.from O t0 7.7 ft. ❑Yes No 0 Yes 0 No 0 Unknown Mee onstruction 2000 Ames Dr in.from to ft. ❑Yes 0 No 0 Yes 0 No 0 Unknown Burnsville, MN 55306 in.from to ft. ❑Yes 0 No ❑Yes ❑No 9 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 to ft. Open Hole from_2.7to ,Z4-1,S ft. OBSTRUCTIONS Nods/Drop Pipe 0 Check Valve(s) 0 Debris ❑ Fill (Xtlo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? 0 Yes ❑ No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP d. .),,,„Type ype` 0 Removed lot Present 0 Other G. -'r s 1/-METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: VNo Annular Space Exists 0 Annular space grouted with tremie pipe 0 Casing Perforation/Removal in.from to ft. ❑ Perforated 0 Removed in.from to ft. 0 Perforated 0 Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material N4 4/ ( //f -1/from_Q to yards 2.7 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? 0 Yes XNo 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 Co., Inc. 27172 Contractor Business e License or Registration No. ,/,,- , _ �� � 9-4-03 A it/d'.resenta ive Sigmail, Date H 213824 Jim Antonson LOCAL COPY Name of Person Sealing Well or Boring WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H /�q 3825 WELL AND BORING SEALING RECORD MSeinnesota Uno. ique Well No. �/1 L County Name " Hennepin Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank ii not known) Township Name Township No. Range No. Section No. Fraction(sm-s Ig) Date Sealed Date Well or Boring Constructed Orono 118 23-- 33 NE SW s,cf, O GPS Latitude degrees minutes seconds , f LOCATION: Depth Before Sealing 62 ft. Original Depth 5"4- ft. Longitude degrees minutes seconds AOUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location X Single Aquifer 0 Multiaquifer m Old Crystal Rd, Q� WELL/BORING �1fAeasured 0 Estimated XXX Crystal.ara Bay ❑Water Supply Well XYMonit.Well f Show exact location of well or boring Sketch map of well or boring ]� in section grid with"X" #313.50 (see '(ptrg a�v Env.Bore Hole ❑Other /v��/�� ft. ❑below ❑above land surface ---r-_-T-N \ � �Pb Ilah}!fs'� CASING TYPE(S) U( l i i 4 ( i- I I e i it ❑Steel Xlastic ❑Tile ❑Other W r , , , E + WELLHEAD COMPLETION • r f — tv 3'` Outside: 0 Well House Inside: 0 Basement Offset I • I f I hmife 0 Pitless Adapter/Unit 0 Well Pit 0 Well Pit 0 Buried S `t• I n1s- \ ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME? CASING(S) PM DI project 2713-75 5 12 Diameter Depth �^) / Set in oversize hole? Annular space initially grouted? Property owners mailing address if different than well location address indicated above z. # /in.from 0 to 4/ ft. ❑Yes C'No ❑Yes 0 No ❑Unknown Ames Construction 2000 Ames Dr in.from to ft. 0 Yes 0 No ❑Yes 0 No ❑Unknown Burnsville, MN 55306 in.from to ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � r Well owners mailing address if different than property owners address indicated above Screen from 8' to f ft. Open Hole from - to ft. OBSTRUCTIONS ❑ Rods/Drop Pipe 0 Check Valve(s) ❑ Debris ❑ Fill tx No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? 0 Yes 0 No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP Drift 0 52 Type 0 Removed X Not Present 0 Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: (kNo Annular Space Exists 0 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 of bentonite=50 lbs.) .. Grouting Material A14"Yr c9JfJ7 from O to 57 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? 0 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. Don Stodola Well Drilling Co., INc. 27172 Contractor Busi•:ss r•me License or Registration No. i / liip .ii-../' 9-4-03 •itho�•Representati •Sig ar Date 213825 Jim Antonson LOCAL COPY H Name of Person Sealing Well or Boring WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H213 213826 Sealing County Name WELL AND BORING SEALING RECORD Minneso aoUnique Well No. c 3 Hennepin Minnesota Statutes,Chapter 1031 o aW -seve blank,riest not kNo. Township Name Township No. Range No. Section No. Fraction(sm>Ig) Date Sealed Date Well or Boring Constructed Orono 118 23 24 VW SW .,/ , ./._/) b GPS Latitude degrees minutes seconds �+ Q LOCATION: Depth Before Sealing ! , ft. Original Depth 3 I , ft. Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL Nume'al Street Ad r ss or Fire NuerandmbCity of Well or Boring Location Dingle Aquifer ❑Multiaquifer 'Ai �� WELL/BORING ❑Water Supply Well (M ❑ easured Estimated #3t►.)o see atfacFied sheet} [ vlonit.Well r Show exact location of well or boring Sketch map of well or boring `` in section grid with"X" location,showing property 0 Env.Bore Hole 0 Other 2C ft. below ❑above land surface N lines,roads,and buildings. CASING TYPE(S) alp 0 Steel [11Plastic ❑Tile 0 Other W E -\ P O. WELLHEAD COMPLETION Outside: ❑Well House Inside: 0 Basement Offset I I t hmils ❑Pitless Adapter/Unit ❑Well Pit +---I 1--- 1 +,, 0 Well Pit ❑Buried I S I4 t mM-4 •`- 0 Buried lirbyrri ry;gLIt O Yq�1VE, CASING(S) J j ,T� j+=©J"`�'� r 75 12 Diameter Depth 0, Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above r/in.from Oto 3c ft. 0 Yes No ❑Yes ❑No ❑Unknown Ames Constvrction 2000 Ames Dr in.from to ft. 0 Yes 0 No 0 Yes 0 No ❑Unknown Burnsville, MN 55306 in.from to ft. ❑Yes ❑No ❑Yes 0 No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE r Well owner's mailing address if different than property owners address indicated above Screen from ?S to .-1 S / ft. Open Hole from to ft. OBSTRUCTIONS ❑ Rods/Drop Pipe 0 Check Valve(s) ❑ Debris 0 Fill ljNo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? 0 Yes ❑ No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP Type drift 0 39 0 Removed ck,Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: XNo Annular Space Exists ❑ Annular space grouted with tremie pipe 0 Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. 0 Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material /U�47 c4/7-g-A/from to 35 tt. yards _____I 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? 0 Yes ❑❑lo 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 Co., Inc. 27172 Contractor Busines 'ame License or Registration No. mal ..,;.4"0"5 representative Sig Oft 'e Date LOCAL COPY H 213826 Jim Antonson Name of Person Sealing Well or Boring •