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Home My WebLink Aboutwell info WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. � CountyName WELL AND BORING RECORD 5 7 2 710 ; Henne�in Minnesota Statutes Chapter 103/ �� Township Name Township No. Ran e No. Section No. Fraction WELL DEPTH(completed) Date Work Completed ' Orono 1188 2� 33 E SE SE 79 tt 8/6/96 '% �. ��, �a ; House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD � ``[ 125 Hackberrp Hi21 ❑ CableTool ❑ Driven ❑ Dug ' ' `q ❑ Auger 7�1 Rotary ❑ Jetted� Show exact location of well in section grid with"X". � ` �'"� Sketch map of well location. ❑ �;� �`J / t Showing property lines, roads and buildings. DRILLING FLUID N Bentonite _� � � �_ . � � -;- -,-- -, �� `�+ "^ USE ❑ Monitoring O Heating/Cooling -�,�. i i i i � � y �] Domestic ❑ Communit PWS ` _i_ _a_ _�_ _i_ tr C, � Y ❑ Industry/Commercial i � i i t�J Q) ❑ Irrigation ❑ Noncommunit PWS �� J`- . fr� Y ❑ Remedial �� w e-r ❑ TestWell � � i i i ❑ Dewatering ❑ � i i r -r +2IM,ia CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. _i _i_ _i _ _i_ � ❑ Steel ❑ Threaded ❑ Welded i i i i Xl Plastic ❑ S �-1 Mile-� CASING DIAMETER WEIGHT ; PROPERTY OWNER'S NAME 4 in.to 74 ft 200 �bs./ft. 8�in.to�� ft. � �h i 1 NQ 1� in.to fl. Ibs./ft. �in.to7 g ft. r Property owner's mailing address if diHerent than well location address indicated above. in.to ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE � Make �a �� from ft.to ft. � Type Diam. SIoVGauze Length � Set between ft.and it. FITTINGS: STATIC W TER LEVEL WELL OWNER'S NAME 3� ft. p(below ❑ above land surface Date measured PUMPI�,LEVEL(below land surface) 3 3 5 Well owner's mailing address if different than property owner's address indicated above. '3 1 ft. after hrs.pumping g.p.m. WELL HEAD COMPLETION �7 Pitlessadaptermanufacture�itewater Model "S'e5�4 ❑ Casing Protection ❑ 12 in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? �l Yes ❑ No HARDNESS OF Grout Material ❑ Neat cem �Bent ite ❑ Concrete ❑ Hi h Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO �'� � 9 from to ft. ❑ yds. ❑ bags (.'`],�y brovn al@d• � 37 from to ft. ❑ yds. ❑ bags from to ft. ❑ yds. ❑ bags C.I.i3Y b2ue ,� 31 �Q� NEARESTKNOWNSOURCEOFCONTAMINATION t� �2 feet F' direction S�j��f� � Well disinfected upon completion? E'�Yes ❑ No a sand � r�ravel broWn med. �2 79 PUMP g/8/96 ❑ Not installed Date installed Manufacturer'snamen� �r$ Model number �J�Ju;"'� HP Volts Length of drop pipe 6� ft. Capaciry 1� Pressure Tank Capacity Type: �Submersible ❑ L.S.Turbine ❑ Fieciprocating ❑ Jet ❑ ABANDONED WELLS y Does property have any not in use and not sealed well(s)? ❑ Yes O-tJo VARIANCE Was a variance granted from the MDH for this well? ❑ Yes xE] No WELL CONTRACTOR CERTIFICATION Use a second sheet,ilneeded 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. Well �t'�lling 272�i Licensee Business Name Lic.or Reg.No � � r� ;-. . ,�- ��e�` �_ � '7 Authorized Representative Signature � D e Robert E. Stodr�la, Jr. 8/7/96 Name ol Driller Date LOCAL COPY 5 7 2 71 Q HE-01205-05(Rev.1/95) wELL OR BOR�NG LOCA71oN MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL AND BORING SEALING RECORD Sealing No. H 10 712 6 County Name Minnesota Unique No. Hennepia Minnesota Statutes,Chapter f031 or W-series No. (Leave blank if not known) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well r��1q Const�y.(cted. Orono ll�j 23 33 � � � 8J�/46 ��1 �! .R.-3,�;n Numerical Street Address or Fire Number and City of Well or Boring Location �25 R kberry K��.�. Depth Before Sealing 17�. ft. Original Depth �11 ft. Show exact location of well or boring Sketch map of well or boring ApUIFER(S) STATIC WATER LEVEL in section grid with"X". location, showing property �Single Aquifer ❑ Multiaquifer �lines,roads,and buildings. N WELUBORING 4cMeasured ❑ Estimated �Water Supply Well ❑Monit.Well - - --i-- --;-- --;-- E ❑ Env.Bore Hole ❑Other �Q_ft. [�elow ❑abpve land surtace �-...�..��. W —�- -i-- -i-- --i-- E CASING TYPE(S) � i � � � --�-� � i � � � -�-- --;-- --�-- [*Steel ❑ Plastic ❑Tile ❑Other Ya mile -�- -�-- --�-- ---I-- � i CASING - � Diameter Depth Set in oversize hole? Annualar space initially grouted? lll""" S �w--t mi�e� � in.from�_ to�� ft. ❑Yes [�No ❑ Yes ❑No ❑ Unknown I PROPERTY OWNER'S NAME in.from _ to ft. ❑Yes ❑No ❑Yes ❑No ❑ Unknown Pro o n 's aili g e ifferent than well location address indicated above. in.from to ft. ❑ Yes ❑No ❑Yes ❑No ❑ Unknown SCREEWOPEN HOLE Screen from 3�,? to�_ ft. Open Hole from to ft. OB STR U CTI O N/D EBRI S/FI LL WELL OWNER'S NAME �Obstruction ❑ Debris ❑ Fill ❑ No Obstruction Well owner's mailing address if different than property owner's address indicated above. Type of Obstruction/Debris/Fill �� n m Obstruction/Debris/Fill removed? � Yes ❑ No PUMP Type�ai. GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed ❑ Not Present ❑ Other FORMATION If not known,indicate estimated formation log f�om nearby well or boring. METHOD USED TO SEAL ANNULAH SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: � No Annular Space Exits c�rift 0 1� ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal e in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) Grouting Material ��'�,��+�� from 1 71 to�_ ft. yards � bags from to ft. yards bags \_ from to tt. yards bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑ Yes �No 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 of my knowledge. R.E.S. iaell Drillin� 27276 Cont�actor Business Name License or Registration No. �- � C Authorized Representafive Si nature '� � � D e James Lea r Name of Person Sealing WeII or Boring LOCAL COPY H � � � � � p HE-01434-02 10/95R