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Home My WebLink About10/16/2020 - well and boring sealing record WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 3 8 8 3 County Name WELL AND BORING SEALING RECORD Minnesota Slng NoUnique Well No. 8 0(� Minnesota Statutes,chapter 1031 or W-series No. pin ea a dank it not known) „HenneTownsffip Name Township No. Range No. Section No. Fraction(sm. Ig.) Date Sealed Date Well or Boring Constructed oro�m___ _� ust-2�15 s� 1 r - !to t 0 GPS LOCATION—decimal degrees(to four decimal places) /t�/ Depth at Time of Sealing / ft. Original Depth ft. Latitude Longitude AOUIFER(S) STATIC WATER LEVEL • Numerical Street Address or Fire Number and City of Well or Boring Location 4Single Aquifer ❑Multiaquifer ' tJ,, } a yELL/BORING Measured Date Measured )ti - kJ° -v`6 ❑Estimated °I) • • .t.i# _' < .___ _s . $1 •.!i► Water-Supply Well ❑Env.Well �» • Show exact location of well or boring in section grid with"X." loc tion,showing property Temp.Boring ❑Other ft. [below El above land surface N lin:.,roads,and buildings. CASING TYPE(S) `_ ntf Steel ❑Plastic ❑Tile El Other '--'---__4_------`-------" \N WELLHEAD COMPLETION w-_-_-_ E T 4. Outside: ❑Pitless Adapter/Unit ❑At Grade Inside: V.Basement Offset 'h Mile 1 ❑Well Pit ❑Buried ❑Well House 4.-------- --- 1 S ❑Other illWell Pit T I" S I ❑Buried I--1 Mile ..�� lp�, (f� El Other For temporary borings,providetadd�dffal locgtion - 12 CASING(S) • information,a site sketch,and geology on a separat ge. Dia ter Depth Set in oversize hole? Annular space initially ? � 6 p pgrouted. PROPERTY OWNER'S NAME/COMPANY NAME in.from to `/ 1 tt. ❑Yes ❑No ❑Yes ❑No ❑Unknown T Scheeler Demolition A ftcasating Property owner's mailing address if different than well location address indicated abov in.from to ft. ❑Yes ❑No El Yes ❑No ❑Unknown 11415 Valley Dr in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Rogers, 55374 SCREEN/OPEN HOLE /(,� WELL OWNER'S NAME/COMPANY NAME -` of 2 Screen from /4-1 I to / /++? ft. Open Hole from to OBSTRUCTIONS Well owner's mailing address if different than property owner's address indicated above fy Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction Type of Obstructions(Describe) [ \` ._ Obstructions removed? [Ties ❑No Describe PUMP GEOLOGICAL MATERIAL 1 COLOR HARDNESS OR FORMATION FROM TO ❑Not Present [resent,Removed Prior to Sealing ElOther If not known,indicate estimated formation log from nearby well or boring. Type ...].�d '""y r_a r.-, . • 0 / •}s.METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE '�VV.+� r. No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal sing Diameter in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator VARIANCE Was a variance granted from the MDH for this well? ❑Yes [ r ° TN# GROUTING MATERIAL(S) 11 6 G Grouting Material�O�ri� c� ,, n,frdm to �9 J5" a ft. yards bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes 0No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION �'` REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING 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,.Tnc. 1691 Licensee Business Name License or Registration No. /r/ ,*''''' '/ J ;;efltveSignaturee /J. - ao -c,,,R0 Certified Rep.No. Date " 380883 X1—'�'1\t LOCAL COPY Name of Person Sealing Well or Boring/ / HE-01434-17 ID#53159 .111 11r198 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. and Boring H 3 8 0 6 8 4 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes,chapter 1031 or W-series No. Rspin Bea desk if not known) Township Name Township No. Range No. Section No. Fraction(sm.-+Ig.) Date Sealed Date Well or Boring Constructed Orono 11R 21 15 mit c* fit /0 • 1 7 - '�' GPS LOCATION-decimal degrees(to four decimal places) Depth at Time of Sealing 1641 ft. Original Depth ft.Latitude Longitude A UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer {(� 900 Lake R� 0�� ELL/BORING Measured Date Measured r " 1 -, 'rT(. ❑Estimated i�taRg , • Water-SupplyrinWell ❑Env.Well ,.-� Show exact location of well or boring Sket h map f well or borin ___9;___J� in section grid with"X" local n,sh Temp.Boring ❑Other ft. y below ❑above land surface and buildings. N lines roads, CASING TYPE(S) i L 1,�. �,.�,.,i y�Steel ❑Plastic ❑Tile ❑Other -- -----'-------`--------- ,,,...\:,..„.:%\%\\~ WELLHEAD COMPLETION w ET Outside: R�Pitless Adapter/Unit ❑At Grade Inside: ❑Basement Offset S Mile ❑Well Pit ❑Buried ❑Well House • -------- -.------ ❑Well Pit S 1 El Other ❑Buried 1 Mile • ❑Other For temporary borings,provide io I I ion ).,, • CASING(S) information,a site sketch,and Dia ter Depth Set in oversize hole? Annular space initially grouted? PROPERTY OWNER'S NAME/COMPANY NAME in.from C) to1.40 ft. ❑Yes lo ❑Yes ❑No ❑Unknown T Stherber Demolition & Reeavating T ' Property owner's mailing address if different than well location address indicated abo in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown 11415 Valley Dr in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown re, MN 55374 2 of 2 SCREEWOPEN HOLLE/, J/ (/ WELL OWNER'S NAME/COMPANY NAME Screen from (fJCJ to /t 2'7 ft. Open Hole from to ft. OBSTRUCTIONS Well owner's mailing address if different than property owner's address indicated above )(Rods/Drop Pipe ❑Check Valve(s) ❑Debris ElFill ❑No Obstruction Type of Obstructions(Describe) r"'JCnn..A_ A/ d Obstructions removed? Xes ❑No Describe PUMP GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO FORMATION ❑Not Present Present,Removed Prior to Sealing ❑Other If no known,indicate estimated formation log from nearby well or boring. Type drj.. .y,,-,o„t, /� t� METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE 1....6v No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal asing Diameter in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator VARIANCE Was a variance granted from the MDH for this well? ❑Yes °No TN# GROUTING MATERIAL(S) / Grouting Material h 0£a.-/1 -am 0 to f C V ft. yards CA, bags �� from to ft. yards bags j from to ft. yards bags i t OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION ♦!�' REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING 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 DrillingCo,. Inc 1691 Licensee Business Name License or Registration No. //as v y / 0 - 0-oC() C 1�€(Aesentative Sigliature Certified Rep.No. Date • LOCAL COPY I H 3 8 0 6 8 4 ' 1 Name of Person Sealing Well or Boring 7....)HE-01434-17 ID#53159 1 11/19R 1