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Home My WebLink Aboutwell & boring sealing record WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring HSeang No. 205675 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Hennepin Minnesota Statutes,Chapter 1031 o W-series No. Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed Orono 118 23 33 41-0012 FF (:53 GPS Latitude degrees minutes seconds / LOCATION: Depth Before Sealing /SS / ft. Original Depth /5' / / ft. Longitude degrees minutes seconds AUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer WE L/BORING $Measured ❑Estimated 365 Willow Dr N, Orono \ Water Supply Well ❑Monit.Well / Show exact location of welt or boring /ketch map of well or beri� 2 in section grid with"X" cation,showing property 0 Env.Bore Hole ❑Other /U_t ft. elow ❑above land surface N lines,roads,and buildi"9 CASING TYPE(S) T ` _ ®�� C��' XSteel 0 Plastic ❑Tile ❑Other ` W E 0% WELLHEAD COMPLETION ' T Outside: ❑Well House Inside: ❑Basement Offset I I I ftmib ❑Pitess Adapter/Unit Nell Pit S 0 Well Pit ❑Buried I md. '. �.. ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Ingram Excavating Diame rrr Depth �l / Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above //�� /L. in.from 0 to /5 ft. ❑Yes [ 14o ❑Yes 0 No 0 Unknown 18900 Pioneer Trl Eden Prairie, MN 55144 in.from to ft. ❑Yes ❑No ❑Yes ❑No '0 Unknown in.from to ft. ❑Yes 0 No ❑Yes ❑No 0 Unknown( WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE C 9 / Well owner's mailing address if different than property owners address indicated above Screen from /10 to / / 7ft. Open Hole from to ft. \ OBSTRUCTIONS ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill Xio Obstruction 1 of 2 Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes 0 No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring 4,Type di- METHOD Type❑ Removed lot Present ❑Other USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: Plo 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 lbs.,one bag of bentonite w 50 lbs.) Grouting Material ,011144/ L!—///6 from 0 to /99 ft. yards /C6 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 XNo How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION XNo 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 BusinessName License or Registration No. /V/ 1 i '� /G - 03 d e res to i SignalDate LOCAL COPY H 9 fl S A 7 Name of Person Sealing Well or Boring yY`, i. . WELL OR BORING LC CATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 205676 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Hennepin Minnesota Statutes,Chapter 1031 or W-s ek riesot�ownNo. ) — Township Name Township No. Range No. Section No. Fraction(sm-e Ig) Date Sealed Date Well or Boring Constructed Orono 118 23 33 41-0012' 7 l,? 03 rf GPS Latitude degrees minutes seconds �} LOCATION: Depth Before Sealing ft. Original Depth Z 1 ft. Longitude degrees minutes seconds AOUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Numbert� and� City of Well or Boring Location ),/Single Aquifer 0 Multiaquifer 365 Willow Dr N, Orono WE L/BORING [ vleasured ❑ Estimated [Water Supply Well 0 Monit.Well Show exact location of well or boring Sketch map of well or b<ri� f in section grid with"X" s location,showing prope ty 0 Env.Bore Hole 0 Other /O 3 ft. Xelow ❑above land surface r'\ �ines,roads,and buildin)s. r — N 6�� d CASING TYPE(S) 1 teel 0 Plastic ❑Tile 0 Other 9 — W,-- --- ----'--_--'--'E ‘A� WELLHEAD COMPLETION { .. Outside: ❑Well House Inside: 0 Basement Offset I f I I f4mile ,�( Xtess' Adapter/Unit ❑Well Pit IS ❑Well Pit ❑Buried fr.—r mM ' ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Ingram Excavating Diame Depth t Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above 2 .tet in.from U to Zi`1 ft. 0 Yes 17�`Jo 0 Yes 0 No 0 Unknown 18900 Pioneer Trl 7` Eden Prairie, MN 55344 in.from to ft. ❑Yes ❑No ❑yes ❑No ❑Unknown in.from to ft. 0 Yes 0 No ❑Yes ❑ No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE f� Well owner's mailing address if different than property owner's address indicated above Screen from 2 13 to 2 I ! ft. Open Hole from to ft. OBSTRUCTIONS XRods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction 2 of 2 Type of Obstructions(Descrii....b"e)c.l AJIL/� t ///Y1 Q GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? es ❑ No Describe FORMATION If not kn,indicate estimated formation log from nearby well or boring PUMP ``TType 506 Pump 6 lemoved 0 Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: Annular Space Exists 0 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 off cementem' =94 lbs.,one bag of bentonite=50 lbs.) Grouting Material L T /�f-"�4(rfm_�to 21'7ft.r yards /8 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 ''lo How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION f� 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 We1lDrilling Co. , Inc. 27172 Contractor Business Name --. License or Registration No. / �. !G 03 o•e. -a resentative Signature .- Date LOCAL COPY H 2 l l 5[)7 6 Name of Person Sealing Well or Boring