HomeMy WebLinkAboutwell info J I A(E tiF M i NNESU T A 1lEF'AK I I'�Nl UF HtAL I M " .
ABANDONED MELL RECORD
l, L�CATiON Oi MELI MINNESOTA UNIQUE MELL N0.
(It�v� bl�nt 1f not knorn)
ca���tr N+�. Hennepin
Tornship Ma�r Tovnshlp Nwib�r pany� Nw�Der S�ctlon No. Frattton 1. WELL DEPTH (co�pl�tW) Dat� st�l�d
N E 4 y of �
117,,,.,,,,,,,.,t,... Mr �S � S� SE /�{ s 1t. O� � ,� 1 ���
NwxNul Str��S,.=Atfdns• �nd Ctty o� M�1-J,, u on or Dittanu frwi Road 5. ORIlLtN6 METHOD (11 known)
Inqrsect9on • 1[]C�bl� tool 1�14vers� 7[�Drlv�n 1�Wq
3300 Fox St. , Orono • �O N0�101 "a �1"+'' eo e��w 1'0
.,.._ _ : , �aoury 60 J.cs.a 9Q vowr wy�r
snur ea,cc toetrton or rrFr...-__....__._
(tn s�ct10� gr10 rlth 'Y•) Slc�tth Yp of�Ail 1oCittoe
6. 06STRUCTIONS
N , wii oescrucun�rts ❑ ►a
_ � _ . ,_ _. oescruceto.s n.owd�r.f p Mo If opstructlons �,��oe ee
' . ' i • n�ov�d. consacc MDH
� ' - • -�- � - E �!y�aaltnq.
M . - •
` ; ; T �. �sE
- • - -- y�. �Oo�stit �Monttoriiy �Hut loop
._�. . __... _.,.. ..� _ I 2[]Irrt9atlon 50 Pub11c � InOustry
' � � ' 1 �T�st Wll 6�Mmtclpal 1C0 Co�rcial
�—1 St.--� � rl�I� 7[�Atr Cosdlttoniny 110
2. FitOpERTY OYNER'S NAME Matllnq Addnss tf dtff�nnt tAan 8. GSiN6(S)
property �ddn�s indiut�d �Eow l�Bl�tk �Thry�d�d 7[]
6030 kidge �ci. 2p�,i., ,0„�,,.,
:iteve Bruce Shorewood NbV 55331 3p P,,,n� �se,+a�.:s sc..�
HIIRONESS OF L'f ��. � � y I f�.
l. iOWNTION lOG COLO� FOIUMTION FRON TO
If not knovn, indtutt fo�tlon loq fro� nw w�ll or n��rDy wll. in. W ft.
i 9. SCREEM
� �Stre�ned iwl l iro��ft. to�ft.
(If known)
[]Op�n Nolt fra�_ft. to_ It.
10. STATIC WTER �EYE
r _ft. b�lor ��Oow G 1
��Ild !Y u� D�L� IY��YIW o
11. �LMEAD COIilETI011
1 Vitl�ss Adapt�r �Fou�d luNW
2Q Bas�wnt ofts�t �
�IN11 Ptt
16. REIMRKS, ELEVATION, SOURCE OF OATA - CASIN6S RElqYED, GSIN6S PERFORATE�, ETC.
12.,FROUTIN6 INfORIMTION
J`C�at CNent 70 B�nWnite �
Grout yt�rt�l f��to� ft, cu. yds
Grout 4" Well Approx. 145' _ _
ll Bags Cement
14 Lbs. �2Z1�O:llt? 17. NEAREST SOURCES Of COMTAMINATION
_ `aat Gtratttor� ty�
2 Men, Rig, Labor, anct Cement w�� a,:,�rKc.a e.ron :..i��T ❑Y.s
Grout PLnnp.
. 11. PUMP RapvW �Not ins�nt
; Type: ipp Su0rn1b1• �]1.5. TuMin� �R�ciprocating
^—, �--�
-�.�, 2[j JK �C�ntMfuqal 60
� e
15. EXISTINC MELIS (Pl��s� slutcA lxatlo�n of aDandon�d �nd
aettv� r�lls tn r s s�ctton or on Dack.)
Oth�r unus�d w�ll(t) on prop�rtyt s � No
AWndon�d: C1 P�ryn�nt �Twporar Not s�al�d
�
11. IMTER YEIL CONTRALTORS CERTIFIGTION
D�n Thts w�ll was sul�d und�r�y �uNsdtction �nd tbts report
�� � p � is true to tM b�tt of ry knorledge �nd beliN.
� Lblv STODOIA w'ELL Gi<II�,Ii3G C0. , INC.
u�.�:.. e�.,�... h... u�.�.. �.�717`l
Addnss 153 6 H ,f N;t a. I�i s
' Styn D�t�
Mark Stoaola o.0 �
OFFiCIAL ABANOONEO MELL RECORO (May be us�d for Prop�rty Tr�ntfer) � Nae ot pr111�r
IMPGRTIIM!'r lILS MITH DBD
�� � -- -
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring � ���(�(��
County Name
— WELL AND BORING SEALING RECORD Mennlego a�Unique Well No. "��
Minnesota Statutes,Cha/�ter 1031 or W-series No.
��� r .LeTva blank�if no�kn wn)
Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed
Orono lI7 2. 05 9s :�E ��3 S�P
�
GPS Latitude degrees . minutes seconds Depth Before Sealing �� ft. Original Depth ft.
LOCATION: Longitude degrees minutes seconds
qxp�IFER(S) STATIC WATER LEVEL
Numerical Street Address or Fire Number and City of Well or Boring Location i ASingle Aquifer [j Multiaquifer _ �1�f,. h�/
3� P� Ot� �t� 5 5 3 5 6 W�,/ELL/BORING �Measured '_ 1 Estimated Date Measured_�/��/+rt 'JM
',� ,�wYUater-Supply Well ❑Monit.Well � �
` Show exact location of well or boring Sketch map ot well or boring -- � �/ ❑above land surface J
in section grid with"X." location,showing property -_�:Env.Bore Hole ❑Other _ .____,_______. ft. ��^below
N ss lines,roa�s, tlwldings. CASING TYPE(S)
�� --'----'-----`-- ---'- --
�;�teel ❑Plastic �Tile ;�Other
e
�� -''-----.-" '-'`-' '-'`" WELLHEAD COMPLETION '��
.'� W _ �_ _ � � i E T � utside �_i Well House ❑At Grade Inside: �Basement Offset
O ' :
--�---- -- .-- '
���� �I'-Mlle � �� '-1 PitlessAdapter/Unit ❑Buried ❑Well Pit
� , � i
--�----;--- --%— - - I R�� ❑Buried ;
� 1 �VJell Pit
S ❑Other
�-1 Mile� L��the�
PBQPF�jY QyJN. E�'S_N_�E!COMPANV NAME CASING(S)
t�l l� I��c Diamete�/ � DepthI� � Set in oversize hole? Annular space initially grouted?
Property owner�s mailing address it dittereni than well location address indicated above � �p !�/' h. [�Yes �0 �_�J Yes ❑NO ❑UnknOwn
in.from to
�
in.from to ft. ❑Yes LJ No U Yes ❑No ❑Unknown
in.from to ft. ❑Yes ❑No ❑Yes ❑No 'Lj Unknown
WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE
/�/�t (� �
Well owner's mailing address if diflerent than property owner's address indicated above SCfeen from j L`� to v� ft. Open Hole from _to_ ft.
� OBSTRUCTIONS '
�
❑Rods/Drop Pipe �`]Check Valve(s) I_ ebris ❑Fill ❑No Obstruction
Type of Obstructions(Describe)_ 4-�=�T___
GEOLOGICAL MATERIAL COLOR HARDNESS OR pROM TO Obstructions removed? '�Yes r�No Describe C-�T �.:�G '�' ��` ��
FORMATION --
PUMP
If not known,indicate estimated formation log from nearby well or boring.
� TYPe-- -- ---
drift ��Removed �Not Present ❑Other
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. ❑Perforated ❑Removed
in.from to ft. ❑Perforated ❑Removed
Type of Pertorator_
❑Other
GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) -
n�! T ♦ �
GroutingMaterial /�'L/�r�l C�I���/1 trom �O to �� ft. yards_� bags
from to R. yards bags
__________ from to ft. yards bags
OTHER WELLS AND BORINGS
REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes �o How many?
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report
is true to the best ol my knowledge.
Don Stodolu t�ll Thcilling Co,. r�. �s�i
Licensee Business Name License or Registration No.
f J
f/. '.
�/� � T27��1
i e resentative Signa"ture Certiiied Rep.No. Date
299064 J� �t°`�" , �`
LOCALCOPY H — �
— - ---—._._._ -- ---
Name of Person Sealing Well or Boring
+';
HE-01434-12 IC#140-0423 - si09R