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Home My WebLink Aboutwell & boring sealing record WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H County Name WELL AND BORING SEALING RECORD MinnSealiesota 231346 Minnesota Unique Well No. HennepinMinnesota Statutes,Chapter 1031 ooreW seN es�No. t Tenship Name Township No. Range No. Section No. Fraction(sm-).Ig) Date Sealed Date Well or Boring Constructed Orono 117 23 20 24-0045 v. % S LT/3. 04/ GPS Latitude degrees minutes seconds /-f} f / LOCATION: Depth Before Sealing ea ft. Original Depth ( )f./ ft. Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL — Numerical Street Address or Fire Number and City of Well or Boring Location ASingle Aquifer 0 Multiaquifer 26147ZZTPI AVP ry�� WELLL/BORING XMeasured 0 Estimated / Oronn 55191 >/''''ater Supply Well 0 Mont.Well Show exact location of well or bonng Sketch map of well or burin. in section grid with"X" location,stowing prope r 0 Env.Bore Hole 0 Other Nt)NEft. *low ❑above land surface N lines,roads,and buildi o _ f` 1 CASING TYPE(S) 1STSteel ❑Plastic 0 Tile ❑Other w^ r , ' ' E v WELLHEAD COMPLETION Outside: 0 Well House Inside:)?'Basement Offset I I I I Led, —rNN I tt� �\ ❑Pitless Adapter/Unit 0 Well Pit S 0 Well Pit 0 Buried Ili—t mkt-- 111I, 0 Buried PROPERTY OWNER'S NAME/COMPANY NAMEg CASING(S) Gordan AmundsonAmundson952-4 952-471-7700 Diameter Depth ` Set in oversize hole? Annular space initiallyinitiallygrouted? Property owner's mailing address if different than well location address indicated above2 r in.from U. ) 5(44_ yhlo 2 of 2 to ft. ❑Yes /` 0 Yes 0 No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes 0 No ❑Unknown in.from to ft. ❑Yes 0 No 0 Yes 0 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 from56 to �> I.ft. Open Hole from to ft. OBSTRUCTIONS El Rods/Drop Pipe El Check Valve(s) I9/Debris ,,rrr 0 Fill 0 No Obstruction V Type of Obstructions(Describe) /:-kJ f GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? SDIC^��¢ r� /� FORMATION /�Yes El No Describe rJ If not known,indicate estimated formation log from nearby well or boring PUMP drift 0 60 Type El Removed XNot Present ❑Other � / METHOD, USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: yr No Annular Space Exists ❑ Annular space grouted with tremie pipe 0 Casing Perforation/Removal /` in.from to ft. ❑ Perforated El Removed in.from to ft. El Perforated El Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Maten94rom 6 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? 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 Business Name License or Registration No. eg' „"''- / - 1-6-05 Auef¢Presentat Signature• Date LOCAL COPY H 231346 Jim Anton Name of Person Sealing Well or Boring WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring ng No. '„I 231301 �3 1 3 0 1 County Name WELL AND BORING SEALING RECORD MinSeanesota Unique Well No. L eHenntdin Minnesota Statutes,Chapter 1031 or W-series No. (Leave Inv*n not known) Township Name Township No. Range No. Section No. Fraction(sm-s-Ig) Date Sealed Date Well or Boring Constructed Orono 117 23 20 24-0045 .5.-' ,tom 05 GPS Latitude degrees minutes seconds / r LOCATION: Depth Before Sealing81 ft. Original Depth R Longitude degrees minutes seconds QUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer 0 Multiaquifer L/BORING Measured ❑Estimated 2647 Rtht"1 Ave, flrnno 55191 Water Supply Well 0 Monit.Well ! Show exact location of well or boring cap of �J in section grid with"X" locatSketionhm,showingwell proor oring rty'.` 0 Env.Bore Hole ❑Other / ft. below 0 above land surface N lines,roads,and buil 9��J CASING TYPE(S) ---f-----l-----, A \t Steel0 Other 0 Plastic 0 Tile W E ,— ( WELLHEAD COMPLETION T1 1 1, Outside: ❑Well House Inside: ❑Basement Offset I f I , I 14mifs i VJ pt<Pitless Adapter/Unit 0 Well Pit S I 9, 0 Well Pit 0 Buried �—r"rs ' \I 0 Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Gordan Amundson 952-471-7700 Dia eterif Depth ! Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above / in.from t0 � f'ft. ❑Yes Jo 0 Yes D No ❑Unknown in.from to ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown in.from to ft. 0 Yes 0 No ❑Yes 0 No 0 Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE t Well owner's mailing address if different than property owner's address indicated above Screen from PA to C.JLJ ft. Open Hole from to ft. OBSTRUCTIONS Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) j,tjA i j( /1 7 ." 9-- aimp GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? )(Yes ❑ No Describe FORMATION — If not known,indicate estimated formation log from nearby well or boring PUMP ,+ Pomp//�� "i T c)___,(---,),..?, Type .�C,e 1- o m/ + ( *Removed 0 Not Present Cl Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �/No Annular Space Exists CI Annular space grouted with tremie pipe CI 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=50 lbs.) y�,1� (t/ Grouting Material �" t rom�to C l . yards bags from to tt. yards _ bags _from to ft. _ yards bags fi OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes KNo 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 amee License or Registration No. ''duthotaed't sentafive Signature= Date \ �.. _ _�. LOCAL COPY H 231301 Name of Person Sealing Well or Boring