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Home My WebLink About2001 Well & Boring Sealing record �-_..�.,-.� _�-_, - — --�-,-- _ . � . , _ � �..� - > __ °� WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HFALTH Minnesota Weli and Boring I �t ?�� , Counry Name WELL AND BORING SEALING RECORD MinnlesoNa Unique Well No. I�l -- -- � ' Hennepin Minnesota Statutes.Chapter 7031 or W-series No. _ — y (Lseve denk tt rM krawn) Townshlp Name Township No. Ranqe No Section No. Fradion(sm.-s Ig.) Date Sealed Date Well or Boring Constructetl Urono 117 23 ' " � Numencal Street Address or Fire Number and Crty of Well or Bonng Location Depth Before Sealing �� R. Onginal Depth � „ ow exact bca ion o v.• or Sketch map of well or bonng ApUIFER(S) STATIC WATER LEVEL ' m section grid with"X". location, showing property Single Ayuder � MultiaquAer � lines,roads,and bwldings. N WELL/BORING Measured ❑ Estimated �-� �Water Supply Well ❑Monit.Well •` • � . ❑ Env.Bore Hole ❑Other ��ft. �below ❑ above land surface W --�- - -- -�-- --i-- E � CASING TYPE�S) � � � � , � , . � � � � � .' --�- -�-- -i-- --�-- '' ''� �Steel ❑ Plastic �Tile �Other ylmile --�- -�-- -,�-- --�-- � CASINCa�S) Diameter Depih Set in oversize hole? Annular space initia�ly grouted? S �i m;�� '� in.from� to�� fl. ❑ Yes �No ❑ Ves ❑ No ❑ Unknown PROPERTY OWNER'S NAME in.from to tt. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Properry owner's maiBng aAdress if tliHerent than well locanon address indicated above. in.from to R. ❑ Yes ❑ No ❑ �es ❑No ❑ Unknown - SCREEWOPEN HOLE Screen trom 7j to_�.i- ft. Open Hole from to ft. OBSTRUCTIONS WELL OWNER'S NAME � Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction p Well owners meiling adAress if diflerent Man properry owner's address indiwted above. Type ot ObS��uctions(DesC�ib6) Oda �0[�� Obstruclions removed? �Yes ❑ No Describe i 1 ' PUMP . . .. . . . � TYPQ stroke � � �p OEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO �ry,Removed ❑ Not Present ❑ Other � FORMATION �ry If not known,indicate estimated formatbn log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING ANO BORE HOLE: � i �No Annular Space Exists D O �1 ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.irom ro ft. ❑ Pertorated ❑ Removed in.irom to tt. ❑ PeAorated ❑ Removed t Type of pertorator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material D�r4.1 �swA from � to_�L_ fl_ yards �_-�1 begs _ from to ft. yards bags trom to k. yards bags . from to__ ft. yards bags REMARKS,SOURCE OF DATA,DiFflCULT1ES IN SEALING OTHER WELLS AND BORINGS �� - - .Other unsealed and unused well or boring on property? ❑Yes �]No How many? UCENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this teport is �:true to the best of my knowledge. �� -� � -• RES J�1,],--Dt,i,l1-i�a�_�a---2�2�6---- _ Confracror Business Name . Ucense or Reg�istrafion Cio. �'��' C:� ,��" ,j�-, . j��' ,.-. �, .,,,�,.-�:-. ' Authonzed Representative Signature Date -- - -_ Bob 6-1�-01 LOGAL COFY H ��[f�� Name ol Person Sealing Well or Bonng �� , , ,: ;�.;..�, � A�. ,;,,,_a, ._�� ;-��y � -<• „ �,, . � �, ;: v�-_ ' �� . � . . . . .. , . ..Y�� ., . . . . �. ' ._. ,`.� ":� . . . � _ , , • , . WELL OR BORING LOCA710N MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 13 9 4 4 3 WELL AND BORING SEALING RECORD Sealing No H County Name Minnesota Unique No. H@[lII@p121 Minnesota Sta�utes.Chapter 1031 or W-series No. � (Leave�lank�t not known) Township Name Township No. Range No Section No. Fraction(sm.�Iq.) Date Sealed Date Well or Boring Construded Orono 21� 23 20 . ,. 6/2�/98 Numerical Street Address or Fire Number and City of Well or Bwing Loca6on :�195 C.dsC� C:�l�Cle DepthBeforeSealing z�v tt OriginalDepih 1`.��ft. Show exact location of v.�ell or boring Sketch map ol well or bonng ApUIFER(S) STATIC WATER LEVEL in section grid wrth"X". � } �1 location, showing property �Single Aquifer � Multiaquiter v �� lines,roads,and buildings. N WELUBORING $�Measured ❑ Estimated � � � � �Water Supply Well ❑Monit.Well -�- 'i-- � C —� , '�r. �'�� '�""' ❑ Env.Bore Hole ❑Other V 1 ft. �below ❑ above land surtace f.� � � � : ..-.. ..- .. . .: � � � . _ ..,.��.,,-�,.,..P, __f_ ',__ _l__ __l__ -�..,..x*+' yy E � CASING TYPE(S) � � � � � � � � � � � � ""—""'"`"�� f�Steel ❑ Plastic ❑Tile �Other -�-- -�— --r- --r- .. � � � � r mde 'y6 ; � ' ' ' ' � An � { CASING -�-- -�— --�-- --�— ��i�� Diameter Depth Set in oversize hole? Annualar space initially grouted9 �l� S rmile� � in.irom o to ��7 ft. ❑Yes �No ❑ Yes ❑No ❑ Unknown PROPERTV OWNER'S NAME in.from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown Juei �t�o lan Property ownei s mailinq add�ess if diHerent than well bcation address indicated above. in.from to ft. ❑ Yes ❑ No ❑ �es ❑ No ❑ Unknown � SCREEWOPEN HOLE Screen trom ro fl. Open Hole from `�7 to l`�� ft. OBSTRUCTIONS WELL OWNER'S NAME � Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑Fill ❑ No Obstruction Well owner's mailing address if different than property owner's atldress indicated above. Type of Obstructions(Describe) �u�Q�7/ j�1�7� a nd �1 r f4� Obstructions removed? [�Yes ❑ No Describe PUMP Type submersible GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed ❑ Not Present ❑ Other FORMATION If not known,indicate estimated tormation log from nearby well or twnng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � No Annular Space Exits ❑ Annular space grouted with tremie pipe ❑ Casing PerforatioNRemoval in.trom to ft. ❑ PeAorated ❑ Removed in.from to n. ❑ PeAoreted ❑ Removed Type of pertorator ❑ Other GROUTING MATERIAL(S) �p t GroutingMaterial Pvrtiancl from � to� tt. yards _frY_ bags from to ft. yards bags from to ft. yards bags from to__ ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes �No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was seated in accordance wi[h Minnesota Rules,Chapter 4725. The infortnation contained in this report is true to Ihe best of my knowledge. RES W�11 Drilliny 17L'�6 Contractor Business Name License or R istrallon l�o. � ' . .. / 1'„' / Authonzed Representative Signature ` Date Jcl1Tt�'S �,�d LOCALCOPY H 13 9 4 4 3 Name ol Person Sealing Well or Bonng HE-01434-03 2/97 R