HomeMy WebLinkAbout3233 Casco Circle - Well Permits - Well Sealing Record 7-28-25 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 419762
WELL AND BORING SEALING RECORD
County Name Minnesota Na Unique Well No.
H E N N E P I N Minnesota Statutes,chapter 1031 orrW-series .No Ln not kna
Township Name Township No. Range No. Section No. Fraction(sm.—.lg.) Date Sealed Date Well or Boring Constructed
ORONO 117 23 209 Sit, SW SE 7$2B/2O25
GPS LOCATION—decimal degrees(to four decimal places)
Depth at Time of Sealing 74 ft. Original Depth ft.
Latitude Longitude
AQUIFER(S) STATIC WATER LEVEL
Numerical Street Address or Fire Number and City of Well or Boring Location E, Single Aquifer ❑Multiaquifer
,:, } 1 ry CASCO
C gq� iT y Measured Date Measured 2 Estimated
��- J�JJ Lrl�• �IWA1A.rA�A�1"Ii '�� wELL/BORING ® 7 2�3 �� ❑
` E Water-Supply Well ❑Env.Well
Show exact location ng Sketch map of well or boring
in section grid with"X" location,showing property ❑Temp.Boring ❑Other 34 ft. je below ❑above land surface
lines,roads,and buildings.
N CASING TYPE(S)
]Steel ❑Plastic ❑Tile ❑Other
�'. ---'--- '----'-`--------- WELLHEAD COMPLETION
w ET ' Outside: ❑Pitless Adapter/Unit ❑At Grade Inside: SEI Basement Offset
' + ❑Well Pit ❑Buried Well House
h Mile ❑❑
1 r Well Pit
'F ❑Other Q
S \\ ❑Buried
..fI 1 Mile I ❑Other
For temporary borings,provide additional location CASING(S)
information,a site sketch,and geology on a separat page. Diameter Depth 7 n Set in oversize hole? Annular space initially grouted?
PROPERTY�ppOggW^yy NjE7R'S NAME/COMPANYyi��sP NAMEtY �t 3 in.from 1 to r 0 ft. ❑Yes ❑No ❑Yes ❑No 11 Unknown
WVV0DAL✓E HOMES LLC
Propel`ty 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 �f
WELL OWNER'S NAME/COMPANY NAME Screen from 70 to r4 ft. Open Hole from to ft.
OBSTRUCTIONS
Well owner's mailing address If different than property owner's address indicated aljpve ]Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction
U DROP PIPE
Type of Obstructions(Describe)
Obstructions removed? Yes ❑No Describe
PUMP
GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO
FORMATION ❑Not Present Lii Present,Removed Prior to Sealing ❑Other
If not known,indicate estimated formation log from nearby well or boring. �!} Type JET
DRIFT 1 0 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'ZJ No TN#
GROUTING MATERIAL(S)
Grouting Material NEAT
+AT C M E i'9 T from to 7 4 ft. yards 4 bags
from to ft. yards bags
from to ft. yards bags
OTHER WELLS AND BORINGS
it
Other unsealed and unused well or boring on property? ❑Yes It 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. ,IdC. 1691
Licensee Busiiness Name License or Registration No:.,_
558 7/28/25
e ied Representative Signature Certified Rep.No. Date
LOCAL COPY H
419762 ����� ����
Name of Person Sealing Well or Boring
HE-01434-17 ID#53159 11/19R