HomeMy WebLinkAboutwelll info � :,
CITY of ORONO
Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
•
� - � � On the North Shore of Lake Minnetonka
October 19 , 1990
David and Betty Hess
1925 Concord�a St.
�vavzata, MN 5�391
Dear �Sr, and ti7rs . Hess :
mi1A C��y or Orono �:as received a copy oi an Abandone� We� l Record
�or your proz.�erty at 1925 Concordia Street, verifying that the
weil has beer. re�:^ane^t�y sea?ed. This record will be kept on
fiie at the City offices and at the Niinnesota fieal.th Department
for future refererce.
Protection of our individual and community water suppiies is
imperative as Gronc and surrounding areas continue �o develop.
Thank you for vcur e�forts ir. hel�-ing to preserve the auaZity of
our ground water.
S�nc�r�? j
. '��,� �
��
���� , �
Michae�. P. Ga r n
Assistant Pl.anning & Zcning Administrator
MPG/lsv
BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359
ASSFSSWG FA)i-473-0510
., _r w. . _�, _
STATE OF MINNESOTA DEPARTMENT OF HEALTH
ABANDONED V�lELL RECORD Z
1. LOCA7IOM OF �Ell M(eaEe�lank NtQ oE w own)NO. ��
County name -
Tornsnlp Mane Tornship mber Range Number Section No. Fraction 4. 4ELL DEPTH (completed) Date sealed
U�v� G / �� ��� [ 7 k .4 of 'k 1 J � ft. �
�- 7- �-�
Nwnerical Street Address and CTty of Well Location or Dlstance from Road 5. ORILLIHG METHOD (if known)
Tntersection / �j 7 /1 _ - ,/ L 2�]Cable tooi 4Q Reverse 7[]Driven lC[1 Dug
! /o�l S C.iCl'�/�.G✓✓C�''��LC J..
2� Hollow Rod 50 A1r 8�gcred 11[]
/l--�r�—
Shor exact locatton of we11
30 Rotary 60,letted 9�Power Auger
(in settion grid vith "X') Sketch map of well loca[ton
y i 6. OBSTRULTIONS
T ��tructed�Ye5 � No
_ � _ ._ _. � " tons removed�Yes []No If obstructionz cannot be
� � � � removed, contact MDH
w - ` - - • - - -I- - E 9
beforc sealin .
' ' : : T �. �sE
' ' " y„�. 1�Domestic 4�Monitoring F�]Heat Loop
_'
' � ' : I 20 irrlgation 50 Public 90 Industry
..�_ . .,. _ . j 3(]Test ?1ei1 b0 11uni�ipa] IC[�C�emercial
�--1 SL � 1(]Mr Condttloning 1][]
2. PROD;RTT OWHER'S NAME Ma111ng Address if difterent than 8. CASIN6(5)
F7� - /1 � � property address indicated above l�Black 4�Threeded 7(]
1��� �^'���
2[]Galv. 5[]Melded
��^L 30 Plastic 6[]Stainless Steel
HARDNESS OF _ � J �� ft.
3. FORHATION LOG COLOit FORMATION FROM TO 1n• to <
If not known, indicate formation log from new well or nearby well. in. to ft.
9. SCREEN
�Screened well from L��. Co�'+ft.
(I� known)
' �Open Hole fron_ ft, to_ ft.
10. STATIC NATER LEVEL
�y_ft. e below []above
land surface Date Measured � - J I-c a
11. WELLHEAD CONPI.ETION
10 Pitless Adapter �Faund Buried
2�J Basement offset 50
3�Mell Pit
16. REMARKS, ELEVATI011, SOURCE OF DATA - CASINGS REHOVED, CASINGS PERFORATED. ETC.
12. GROUTIN6 INFORMATION
1�Neat Cement 2�Bentonite �
Grout materlal � from/�td�ft. cu. yds
13. NEAREST SOURCES OF CONTAMINATION /' �
/L feet [�ti dtroction `�i2.�i�..-._ type
Neil disinfected before sealing? e Yes
14. PUMP �Removed �Not Present
Type: 1[1 Submersible �L.S. Turbine � Reciprocating
2�'Jet a0 Centrifugal 60
15. EXIS7ING 4ElLS (Please sketch loc�ttons of abandoned and
� activ� wells Tn remarks sectton or on back.)
� Other unused w�ll(s) on propertyt �Yes � No
Abandoned: � Permanent �Temporary �]Not sealed
17. WATER NELL CONTRACTORS CERTIFICATION
This well was sealed under my jurisdiction and this reDort
is [rue Co the best of my knowledge and belief.
� L� .�L". �'L�t [r ! _
Licensee �siness Name � `, L1c se No�
. .6...��� !
r'
Address
Signed _ � Cate - J `J� 7
� Z�, , Date �- > 7—�
FFICIAL ABA11ppHED 41E11 RECORD (May be used for Property Transfer) 'Hame f Dr ler ✓
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