HomeMy WebLinkAbout06-30-1988 Abandoned Well RecordSTATE OF MINNESOTA DEPARTMENT OF HEAL Til
ABANDONED NaL RECORD
Township Name Township Numbar Range HumLtr Section No.fraction 4. WEll depth (completed)Date sealed
N E «i % of H
Orono 117N 23W r 10 Nl^ NE m 205 6-30-88
I. tOCATIW Of mil I
c««.rHennepin
MINNESOTA UNIQUE NELL NO.
(Uav* blank If not known)
Hu9tHCD'Strttt of W#!l location or OUianc* from Road
Inttrstctfon
Mil 553231295 Arbor Street, Costal Bay,
anow taact locitlon^of
(tn stctlon qrld with •i“)
5. DRlLLthG HETHOD (If known)
□ Cable too) <0 Heverje ?□ Driven IcQ Dug
2Q Hollow Bod SQAIr gQ Bored llQ___
O Rotary 6Q Jetted 9Q Po-er Auger
Sketch Rip of well location 6. OBSTRUCTIONS
Well obstructed □ Yei 0 No
Obstructions renovcd Q Tes □ Ho If obstructions cannot te
removed, contact HOH
before sealing.
r )SE
10 Oo<^*tlc
<□ Irrigation
JQ Test Well
aQ Monitoring BQ Heat loop
SQ Public 9Q Industry
«Q Municipal IcQ Corr>erclal
Conditioning llQ_ _ _
2. PROPERTT OWNER'S NAME
Arlene Hoppe
Helling Address If different than
property address Indicated above
HARDNESS OF
2. FORMATION LOG COIOR FORMATION FROM
If not known, Indicate fonaatlon log from new well or nearby well.
0. CASINC(S)
lKl0^«k 40 Threaded O,
CICalv. 5Q Welded
3G Plastic 6Q Stainless Steel
_________3 In. to
_____________ In, to ___________
Jt,
Topsoil
Clay
Clay
Clay
black
yellcAT
blue
1. 5CKEEN
E) Screened well fro« __ ft. to ,
□ Opeh Hoi# fron_ _ ft. to ^ft.
(If known)
205
10. STATIC WATER lEVEl
59 ________ft. 13 below □ above
land surface Date Measured 6**30~OO
U. WEllHEAO COMPIETION
iQ Pitless Adapter
?Q flaseRent offset
30 well Pit
Q Found Burled
o- - - -
16. REMARKS. CIEVATION. SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED. ETC.
Formation log taken from new well drilled
6/29/88 - Unique well # 442431
U. CPOUTiNG INFOAMTtCN
1(3 Neat Cement 2Q Bentonite
Grout material irt. cu. yds « 3[
OFFICIAL AIANOONEO WEll RECORD (May be used for Property Transfer)
IMPmVAMTt FILM Win DKED
13. NEAREST SOURCES OF CONTAMINATION
____ feet __________direction . type
Well disinfected before sealing? Q Yes
14. PUHP 0 fleooved Q Hot Present
lype: 10 Submersible ]Q L.S. Turbine Q Reciprocating
r(3 Jet flQ Centrifugal 6PI
15. EXISTING WEllS (Please sketch locations of abandoned and
active wells In rinarks section or on back.)
Other unused well(i) on property? [3 Yes (3 No
Abandoned; □ Per«anent Q Temporary (3 Not seated
i;. WATER WEll CONTRACTORS CERTIFICATION
This well was sealed under my Jurisdiction and this report
Is true to the best of my knowledge and belief.
,Mr.it 6240 llwy^l2. Maple Plain, MN 55
Signed
^12, Map
1^0 J ^Date 8-4-88
Joe Stevens 8-4-88
Ni.. or Orllltr
359