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Home My WebLink About4485 North Shore Drive - Well Permits - Well Sealing Record MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 1 WELL OR BORING LOCATION WELL AND BORING SEALING RECORD Sealing No. 1. ..,. County Name Minnesota Unique Well No. HENNEPIN Minnesota Statutes,chapter 1031 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 07 NKNE'a Sid 11/12/2025 GPS LOCATION—decimal degrees(to four decimal places) Depth at Time of Sealing 35 ft. Original Depth ft. Latitude Longitude AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location L1 ingle Aquifer ❑Multiaquifer 1 1 +� q G W ELUBORING ®Measured Date Measured 1 1/12/2 5❑Estimated 4485 NORTH SHORE DR. ,ORONO,MN s Later-Supply Well ❑Env.Well Show exact location of Ai SSi614 Sketch map of well or boring in section grid with"X." location,showing property ❑Temp.Boring ❑Other 26 ft. [lbelow ❑above land surface lines,roads,and buildings. N }�� CASING TYPE(S) ...+ �x r� Li teel Plastic ❑Tile ❑Other ---'---'--'----'`--'---'--- Q WELLHEAD COMPLETION VI - E T Outside: [1 Pitless Adapter/Unit ill At Grade Inside: [Basement Offset 'k Mile ❑Well Pit ❑Buried ❑Well House 1 ❑Well Pit s6 ❑Other ❑Buried I I Mile ❑Other For temporary borings,provide additional location CASING(S) information,a site sketch,and geology on a separate page. Diameter 7 Depth Set in oversize hole? Annular space initially grouted? PROPERTY OWNER'S NAME/COMPANY NAME q 2 in.from 1 to 31 ft. ❑Yes ❑No ❑Yes ❑No [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 ' .'It,. WELL OWNER'S NAME/COMPANY NAME Screen from 31 to 35 ft. Open Hole from to ft. OMNI C JST9M UIt DERS LLC OBSTRUCTIONS Well owner's mailing aoddress iif afferent an property owners address indicated above [Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction DROP PIPE Type of Obstructions(Describe) Obstructions removed? I Yes ❑No Describe PUMP GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO FORMATION ❑Not Presentn ®Present,Removed Prior to Sealing ❑Other If not known,indicate estimated formation log from nearby well or boring. Type JET ET DRIFT 1 35 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE ❑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 Q No TN# pp - GROUTING MATERIAL(S) / NEAT C 1 Grouting Material CEMENTfrom to 35 ft. yards bags d/ from to ft. yards bags ) from to ft. yards bags 1 OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes at 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 DRILLING CO. ,INC. 1691 Licensee BfBusiness ame License or Registration No. ., I,+e_ 558 11/12/25 r-di 7d'epresent-''Signature Certified Rep.No. Date LOCAL COPY H 4 2 1 6 1 Nam JEof R RPerson Sealing8A R WRor Boring HE-01434-17 ID#53159 ; 71/InR MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 421682 WELL OR BORING LOCATION WELL AND BORING SEALING RECORD Sealing No. County Name Minn sotasUni ue Well No. H E N N E P I i Minnesota Statutes,chapter 1031 or(peeve Monk r na knavo o. Township Name Township No. Range No. Section No. Fraction(sm.-a lg.) Date Sealed Date Well or Boring Constructed ORONO 117 23 07 NENE :eta' 11/12/2025 GPS LOCATION-decimal degrees(to four decimal places) Depth at Time of Sealing 78 ft. Original Depth ft. Latitude Longitude AQUIFERS) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location L Single Aquifer ❑Multiaquifer 1�# 4485 85 SHORE D e r ttRONO.MN WELL/BORING easured Date Measured i/12!2 ❑Estimated �i NORTHSHORE V O [Water-Supply Well ❑Env.Well Show exact location of 45364 Sketch map of well or boring ❑ Boring ft. ®below in section grid with"X." location,showing property Temp. ❑Other ❑above land surface lines,roads,and buildings. N CASING TYPE(S) i - -- S 11 tikE Pla Steel El Plastic ❑Tile El Other WELLHEAD COMPLETION W , ' r r ET Outside: itless Adapter/Unit ❑At Grade Inside: ❑Basement Offset 'h Mile K ❑Well Pit ❑Buried ❑Well House 1:1 ❑Well Pit 1 ❑Other s ❑Buried 1 1 Mile -I ❑Other For temporary borings,provide additional location CASING(S) information,a site sketch,and geology on a separat ge. Diameter Depth Set in oversize hole? Annular space initially grouted? PROPERTY OWNER'S NAME/COMPANY NAME in.from to 74 ft. ❑Yes ❑No Li Yes ❑No A 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` T Screen from 74 to f 8 ft. Open Hole from to .,ft. WELL OWNER'S NAME/COMPANY NAME OMNI CUSTOM BUIfDERS 1 LC OBSTRUCTIONS Well owner's mailing address if different than property owner's address indicated above A Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction Type of Obstructions(Describe) DROP PIPE Obstructions removed? LitYes ❑No Describe PUMP GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO FORMATION ❑Not Present [resent,Removed Prior to Sealing ❑Other If not known,indicate estimated formation log from nearby well or boring. Type S U BME R S I BL E DRIFT 1 78 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE ®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 [ Jo TN# GROUTING MATERIAL(S) phry�tp+ pp��tt 7 Grouting Material NEAT CEMEN rom 1 to 78 ft. yards bags e from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes ❑ Jo 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.,INC. 1691 Licensee Business ame License or Registration No. 558 11/12/25 d epres Signature Certified Rep.No. Date LOCAL COPY H 4 21682 JERRY BARR Name of Person Sealing Well or Boring HE-01434-17 ID#53159 tt/t9R