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Home My WebLink AboutWell info.,� — MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring ��f1�� - WE��oR Bop�N��o�AT�oN _ WELL AND BORING SEALING RECORD sea�i�g No. j H U County Name Minnesota Unique Well No. -- Minnesota Statutes,Chapter 1031 or W-series No. � � Henae in ��n�k�, _— Township Name Townsh�p No. Range No Section No. Fraction�sm.-s Ig.) Date Sealed Date Weli or Bonng Consiructeh l�ound 117 23 8 � �� 8/15/00 F��CE) Numencal SVeet Address or Fire Number and City ot Well or Bonng LocaGon /�f'(' Q . 3826 Gherrp �ve, ��d Depth Before Sealing I� fl Original Depth �4 HU(7 � v �oo� Show exact locahon of well or bonng ��i�, Sketch map ol well or boring ApUIFER(S) STATIC WATER LEVEL p in section grid wrth"X". � j 1� locahon, showing property Single Ayuifer ❑ MulOaqwfer MOUND FLt�i�NIIVG & INSr, �- � lines,roads,and buildings. N WELUBORING �Measured ❑ Eshmated �Wa1er Supply Well ❑Monit.Well I I I ' � � ❑ Env.Bore Hole ❑Other _ __3II_R. ,�below ❑above land surface W --�-- E CASING TYPE(S) � � � , � � � � ^ —�- -�-- -;-- --�— � Steel � Plastic �Tile �Other �� I � � � �e mile —�- -i-- -i-- --�— � � CASING(S) Diameter Depth Set�n overs�ze hole? Annular space initially grouted? S nn ��mNe� � �,1�..�/Y \� � in.from__�� to_��_ R. ❑ Yes �J No ❑ Yes ❑No ❑ Unknown PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown Di k �ians ti Property owner's mailing aadress If diHerent than well location address�ndicated above. in.trom to tt. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown SCREEWOPEN HOLE Screen from�to� ft. Open Hole from to ft. OBSTRUCTIONS WELL OWNER'S NAME Rods/Dro Pi e p p ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Well owner's mailing address if diHerent than property owner's address indicated above. Type o}ObslructiOnS(Desc�ibe) P f n� � i�et. Obstruclions removed? (�Yes ❑ No Describe PUMP Type T s.� OEOLO(i1CAL MATERIAL COLOH HARDNESS OF FROM TO ',i�Removed ❑ Not Present ❑ Other FORMATION N not known,iMicate esBmated tortnatbn log from nearDy well or bonng. 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 in.from to ft. ❑ PeAorated ❑ Removed in.from to R. ❑ Perforated ❑ Removed Type ot peAorator ❑ other GROUTING MATERIAL(S} (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Matenal pOl�tl�n� from � to� h yards �� bags !� -- irom to ft. yards bags irom to R. yards bags from to__ ft. yards . begs REMARKS,SOURCE OF DATA,DIFFlCUlT1ES IN,SEAUNG OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes �No How many? �.,��-,;,f' LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or bonng was sealed!n accortlancs wirn Minnesot2 Ru1es,Chapter 4725. ?he informafior cr,�.:-� -��- �- - ---- . true to the best of my knowledge. t , - 88S �ieli Drf 111�g 27276 Confractor Business Name ,.� L�cense or Regisfration ia�. � ' ` t �.,��-'-� ��-�� t� ' Authonzed Representative Signatwe Dafe ..r._ �obert S. Stedo2�sL� LOCAL COPY u��A I Name ol Person Sealing Well or Bonng- r� � WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL AND BORING RECORD 5 7 2 7 21 H�nnep i n Minnesota Statutes Chapter 103/ Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed OrOna 117 23 8 W ,SE, Sid , 2�� " 9/18/96 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 3826 Cherry AV� ❑ CableTool ❑ Driven ❑ Dug ❑ Auger �] Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. ❑ X �� Showing property lines, ��j roads and buildings. DRILLING FLUID L� N UETItOC�l I. . � � � � -,- -;- -,-- -,- USE ❑ Monitoring ❑ Heating/Cooling i i i � �7 Domestic -�- -�- -�- -�- ❑ Irrigation ❑ Community PWS ❑ Industry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial w i i I i E T ❑ Test Well ❑ Dewatering ❑ -i- -,- -r- -r �2IM_1e CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. _i_ _i_ _L_ _i_ I ❑ Steel ❑ Threaded ❑ Welded � � � � 1 �1 Mile� X 3�] Plastic ❑ CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 4 ;� �0 203 n. 20Q 3�S.�h. 8� in.to�7��6�0n. - Richard Hanson ;�.,o tt. ,bs.,n. �in.ttf��+ft. Property owner's mailing address if different than well location address indicated above. in.to ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE MakeJa CO from ft.to ft. Type Diam.__,_�_ _ SIoUGauze �f Length Setbetween � ft.and L0� ft. FITTINGS:K Packer STATIC WATER LEVEL WELL OWNER'S NAME 3 5 ft.� below ❑ above land surface Date measured PUMPI LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. �� ft. after 3 hrs.pumping 50+ g.p.m. Vj��FLLHEADCOMPLETION w�itewater �J�S�� d�itless adapter manufacturer Model ❑ Casing Protection ❑ 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �'Yes ❑ No HARDNESS OF Grout Material ❑ Neat ce �7 Bento e ❑ Concrete ❑ Hi h Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO �� 9 from to ft. ❑ yds. ❑ bags �O� 5��1 black �'{f?C�. Q � from to__ft ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags sandy Cld� hro�n �e�� NEARESTK�5NSOURCEOFCONTA�M�INATION SO�t � � feet direction�eWEr pi�ee Well disinfected upon completion? �1 Yes ❑ No a i r te$'t��C� san� �ro�n zn�d. 9 19 PUMP g/24/96 ❑ Not installed Date installed SdI1(�y clay h1U� 1� $� rNanufacturer'sname St3—R�tE Model number `S � � HP Volts�- s a n c� �r a y f i n� 8 5 2�8 Length of drop pipe ft. Capaciry 1 L g.p.m. Pressure Tank Capacity Type:x'] Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? � Yes ❑ No VARIANCE Was a variance granted from the MDH for this well? ❑ Yes 'L7 No WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. R.E.S. rr7e11 Drillin� 2'727$ OCT 4 b:�''�, Licensee Business Name Lic.or Reg.No ` ��''/�%" > %'�_��t,-��.---/;�.�-`,._,. %-''�t�/%�.. Authonzed Representative Signature Date Ftobert E. Stodola, Jr, 9/7Q/96 Name ol Driller HE 01205-05(Rev.1/95) LOCAL COPY �� ,.