HomeMy WebLinkAboutWell Sealing Record 11-5-24 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 413680
'WELL OR BORING LOCATION Sealing No. H
County Name WELL ANDBORING SEALING RECORD Minnesota Unique Well No.
H ENNEPIN Minnesota Statutes,chapter 1031 4 i or W-series No.
(Leave dank if not known) .-
.Township Name Township No. Range No. Section No. Fraction(sm.—.lg.) Date Sealed Date Well or Boring Constructed
. ORONO _ ' 117 23 03 SESENW 'A 11/5/2024
GPS LOCATION—decimal degrees(to four decimal places)
Latitude Longitude Depth at Time of Sealing 131 ft. Original Depth ft.
• AQUIFER(S) STATIC WATER LEVEL
Numerical Street Address or Fire Number and City of Well or Boring Location.. ,XJ Single Aquifer ❑Multiaquifer
325 DROWN 'RD. ,ORONO,MN. 553 6 WELL/BORING ®Measured Date Measured 1 1/S/?IL ❑Estimated
;! 11 Water-Supply Well ❑Env.Well
Show exact location of well or boring Sketch map of well o boring 'f
in section grid with"X° location,showing p( rty ❑Temp.Boring ❑Other 2 ^2 ft. 7❑below ❑above land surface
- N lines,roads,and bui ings. CASING TYPE(S)
^]Steel ❑Plastic ❑Tile ❑Other
—I-- - ' WELLHEAD COMPLETION -
w E
Outside: ❑Pitless Adapter/Unit ❑At Grade Inside: 111 Basement Offset
/Miler I ❑Well Pit ❑Buried • ❑Well House
1 :
❑Well Pit
s ❑Other
❑Buried
I--1 Mile r -
❑Other
For temporary borings;provide additional location CASING(S) - r. ,
information,a site sketch,and geology on a separate pa.: Diameter Depthy *� _ Set in oversize hole? Annular space initially
PRO E TY WNR'S AME/COMPANY NAME 4 in.from I to 123 ft. ❑Yes ❑No ❑Yes ❑No 41 Unknown
Property owner's mailing address if different than well location address indicated above in.from to _ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown
in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown
SCREEWOPEN HOLE - - -
-WELL OWNEyRa'S NAME/COM1l•PANY NAME Screen from" `-to 13'1.. ..--ft. ;Open Hole from to ft. •
HARALR ED LLC OBSTRUCTIONS
Well owner's mailing address if different than property owner's address indicated above ❑Rods/Drop Pipe•_. :❑Check Valve(s) ❑Debris•-'1,;❑Fill 7.-IIII No Obstruction .. _ - -
Type of Obstructions(Describe) ,
Obstructions removed? ❑Yes ❑No Describe
. .. _ _ - - PUMP
GEOLOGICAL MATERIAL', COLOR HARDNEss DR FROM . TO
FORMATION ij Not Present ❑Present,Removed Prior to Sealing ❑Other
If not known,indicate estimated formation log from nearby well or boring. `-. Type -
DRIFT ` 1 1-31 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE
- if No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal
Casing 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 /i I No TN#
GROUTING MATERIAL(S) - ..
,,• - Grouting Material NEAT- CEMENT from to_1.31 ft. 'yards,.;_ bags
' f from to ft. yards bags
l Y
I from to ft: yards bags `
' OTHER WELLS AND BORINGS
I
i Other unsealed and unused well or boring on property? :❑Yes Til No How many?
' LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
I 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
I is true to the best of my knowledge. I
I ;mot.
DON STODO A• WELL DRILLING CO,; ,INC. 1691
Licensee Business Name - - ). - License or Registration No.
5/24' "ed e'R resentative ignature r/V/ , ' ,
9 Certified Rep.No. Date
FH
4 JERRY BARR .. _.
. LOCAL COPY _. H 413 6 8 0
Name of Person Sealing Well or Boring' -
- HE-01434-17 ID#53159 -:4 ; : 11/19R