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Home My WebLink Aboutwell info 4 � WELL DRILLING FOR FOUR GENERATIONS 15688 JARVIS STREET N.W. / ELK RIVER, M N 55330 ■ ■ PHONE: (612) 427-6100 / FAX: (612) 427-0533 INCORPORATED January 15, 2001 � �� 1�� :�, Dear Sir or Madam, Th:, followir�g Well Record(s} and/or Sealing Record(s) are from the construction of new wells and/or the sealing of old wells within the past months. Please notify us if you no longer wish to retain these documents for your records, or if any of the forwarding information has changed. Thank you for your prompt attention to this matter. Please notify us if we can be of any further assistance to you. Sincerely, � , � Emy M. White General Office Clerk An Equal Opportunity Employer 7 ". WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring ir ��A —� Counry Name WELL AND BORING SEALING RECORD sea''�9"°. i H_ � Minnesota Unique Well No. ��x��.� Mmnesota Stafutes.Chapter 1031 or W-series Na �_ � hmrs da�x rc�a x�� Township Name Township No. Range No. Section No. Fraction�sm.-i Ig� Date Sealed Date Weli or Bonng Constructed � 1�# 2� ft S 1+��: ��:`' l�Lli� «3C?, �t:3{3{� 19�J{3" w Numencal Street Address or Fire Number and Ciry of Well or Bonng Local�on . �� ^ �.�� R��# Depth Before Sealing ��¢�� tt. Original Depth __h Show exact location of N-ell oi bonng Sketch map ol weli or boring ApUIFEF(S) STATIC WATER LEVEL m secfion grid wrth"X'. location, show�ng property �Single Aywter � Multiaquifer tt'; lines,roads,and build�ngs. N t� WELUBORING �'Measu�ed ❑ Eshmated � � � � R Water Supply Well ❑MoniL Well I �� ❑ Ern.Bore Hole ❑Other ��} R �below ❑ above land surtace W - -- - -- --,-- E X�! � l�,` CASING TYPE�S) --f- I i �u i I � �Steel ❑ Plastic �Tde � Other -�-- � ---' -�— - }�1 mile --�- -�-- -�-- --1— � ��t CASING(S) '�� Diameter Depth Set�n oversize hole? Annular space initially grouted? �l� S �mi�e� ! � in.from� to�� ft. ❑ Yes �No ❑ Yes ❑No ❑ Unknown PROPERTV OWNER'S NAME �� in.trom to k. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown ' NWYN = _, roperty owner's mai ing a ress� i erent than well location address indlcared above. in.from to R. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown SCREEWOPEN HOLE ��S �� .�.�,�..�.a�. ��.��.� � �,�.,��.� Screen irom ��j ro �q ft. Open Hole from to ft. WAYZATA, oesraucnoNs WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �No Obstruction Well owner s mailing address if tli8erent than properry ownei s address mdicated above. Type of Obstructions(Describe) Obstructions removed? ❑ Yes ❑ No Describe , PUMP ^ TYPQ �.�� 6EOLOf31CAL MATERIAL COLOH HARDNESS OF FROM TO �Removed ❑ Not Present ❑ Other - FORMATION If not known,inAicate estimated formatbn log trom nearby weli or bodng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Annular Space Exists Y�� g�� ❑Annular space grouted with tremie pipe � �� ❑Casing Perforation/Fiemoval in.from �o tt. ❑ Perforated ❑ Removed . � in.from ro ft. ❑ Perforated ❑ Removed . Type of peRorator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=501bs.) i�+�3�'�'�..A1�T� f��! £� � � Grouting Matenal from ro fl. yards bags from to R. yards bags from to ft. yerds begs irom to_ fl. yards bags REMARKS,SOURCE OF DATA,DIFFICU�TIES IN SEALING OTHER WELLS AND BORINGS ��, �.R�• �� t O I. and unused well or boring on property? ❑Yes �No How many? ryt�^+�y ��y��^�rtyp� }� LI O REGISTERED CONTRACTOR CERTIFICATION Al.�il[ �al.J1(fi!� �A� �iYL'.a ��i�a: �-i{l� This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The infortnation contained in this repoA is A'.C�: WI�TT�R I,.�'s11TEL T�K�N t 1 f�j� �� true to the best of my knowledge. �i�" C:t�€7� { f�-•-1 si�l k;.[i. k�,�i�+i�:It � 5C?NS# �LIaiG. 7;x�.3�t.� SE A L E Q Contractor Business Nam ��^ License or Registrefion fio. According to MN State Regulations � � �'�� Authonz re ntative Signature Date �1'.s��:.� .��.��.'��a��J�{�x��..� ��p�"�' ;�_-�t 'e��Y H �.6 9�7 9 Name o/Person Sealing Well a Boring �T.....�,�,.....�,�.9.�.�..� _ _ �_ wEll OR BORiNG LOCA71oN MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring j ��A��A � CounlyName WELL AND BORING SEALING RECORD sea''"9"°. iH__ _ 3 _L Minnesota Unique Well No. ��Ep�� Minnesota Statutes,Chapter 1031 or W-series No. (Leew Herik M not known) .. � Township Name Township No. Range No Section No. Fracuon�sm.-s Iq� Date Sealed Date Well or Boring ConsVuctea C?ltl�O i 1� 2 3 3 fs �''�A�'° �L� l�tU� �O, �063U 19 5t1►'�t Numencal Sireet Address or Fire Number and City of Well or Bonng Locahon �� a�rs�=*y n� Depth Before Sealing y�.� fl Original Depth j� tt S C�AiT3.Rtfi�ta-r A Show exact location of N•ell or boring Sketch map of well or bor�ng AOUIFER(S) STATIC WATER LEVEL in section grid with"X". locauon, showing property Single Aywfer � Multiaquifer '�j lines,roads,and buildings. N .CR WEWBORING �Measured ❑ Estimated _ _ _ __ _ __ __ __ � W Water Supply Well ❑Monit.Well C�� ❑ Ern.Bore Hole ❑Other _ __�_fl. �below ❑ above land surtace � �'� W —�- -i-- -i-- --i— E CASING TYPE(S) � � � � . � � � � --�- -�-- -�-� --��- � �� Steel ❑ Plastic �Tile �Other Yemile __�_ ��` CASING(S) -�-- -�-- —�-- � �1i Diameter Depth Set in oversae hole7 Annular space initially grouted7 � S J� Yes �No ❑ Yes ❑No ❑ Unknown im��e—ary in.irom Q to �6 fl. ❑ � Z t?�' 2 PROPERTV OWNER'S NAME in.from to fl. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown L�ENWYN BECKSTRt� • Property owner's maihng address if tlifferent than well location address indicated above. in.from to ft. ❑ Yes ❑No ❑ �es ❑ No ❑ Unknown 2�� F�� SCREEWOPENHOLE [�1�YZ[�T�� Ij �f'j;j�� Sc�eentrom �� to �g tt. OpenHolefrom to R. OBSTRUCTIONS WELL OWNER'S NAME � Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill [�No Obstruction �� Well ownets meiling aAAress if ditterent tnan property owner's a�ress indicated above. Type of Obslructions(Describe) Obstructions removed? ❑Yes ❑ No Describe PUMP TyPe HA� FU1�IP Iiq YARL} GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO �Removed ❑ Not Present ❑ Other FORMATION It not known,indicete estimated fortnatbn log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Annular Space 6cists CLAY �� $ ❑Annular space grouted with tremie pipe R�'� �� _Q ❑Casing Perforation/Removal in.from to tt. ❑ Pertorated ❑ Removed in.irom to n. ❑ PeAorated ❑ Removed Type of perforator ❑ Other GHOUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) �arrrz.� z� o x Grouting Material _ __ from _ ro fl. yards bags from to ri. yards bags from to ft. yards bags from to__ R. yards bags REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALIHG OTHER WELLS AND BORINGS �i,��sY �,R�' i��Q ��s�i �.��,• Oth nd unused well or boring on property? ❑Yes No How many? � LICEN D EGISTERED CONTRACTOR CERTIFICATION WAT�R I,�§T�I. It�i AAc3V� td�I.1�: 1 U/1 j88 � This well or bonng was sealed in accordance with Minnesota Rules,Chapter 4725. The intormation contained in Mis report is DATE iiiATER LEV�L T.AK�3: 12() true to the best of my know�edge. e� MAP ('�E f C—] 5 l_ S r H. RF.�dNE�. & S+E�S, II�C. 71�15 S E A L� � Con trci(ress Name t"^ L�cense or Registration 170. � ..�. �r5�c�o According to MN State Regulations AuthonzedRep sen tiveSignature Date KIs'i�I�t �tCN�R'E�t3.ETN/lCEVIM HOPPL? --- :, LOCAL COPY ' ��A Name ol Person Sealing Well or Boring G