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Home My WebLink Aboutwell info Minnesota Well and Boring 4 3 9 3 � WELL OR BORING LOCarION MINNESOTA DEPARTMENT OF HEA�TH Sealing No. H �o�ntY N�me WELL AND BORING SEALING RECORD M��esota��q�e No. �p„„� }� Minnesota Statutes.Chapter 1031 or W-series No. Gt,�1Gp1 F� (Leave blank if nol knownl Township Name Township No. Range No. Section No. Fraction(sm. �Ig.) Date Sealed Approximate Date Well Orono 117N 23W 7 NF„NE�„SE�„ 3/2/94 or Boring Constructed •� Numerical Street Address or Fire Number and City of Well or Bonng Location 1220 Loma L i nda, 1'RJ�n�� i`Nl ��17'F Depth Before Sealing T�� ft Onginal Depih ft. Show exact location of well or boring Sketch map of well or boring Static Water Level ❑Accurate � in section grid with'X". location.showing property lines. roads,and buildings. ❑Approximate N � � � � __ ___ '-_ _i �Single Aquifer ❑Multiaquifer ft. below above land surface i i i i _i_ _�_ _i_ _i_ CASING TYPE W i i i i E � � � � T -r -�- -r- -r '�' i i i i �Steel ❑Plastic ❑Tile ❑Other mile _i i i i_ � i i i i S Screen from� to � tt. Open Hole from to ft. ��mi�e—�I OBSTRUCTION/DEBRIS/FILL ❑Obsirucfion ❑Debris ❑Fill PROPERTY OWNER'S NAME Dr. W att PNoe Type of debns/obstruction . Maiting Address il different ihan property address indicated above. Obstruction/Debris/Fill removed7 ❑Yes ❑No PUMP �Removed ❑Not Present ❑ Other CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Set in oversrze hole? Annular space initially grouted7 � If not known,mdicate estimated formation log irom nearby well or boring. �in.from _.Si--to —.J3— ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown METHOD USED TO SEAL ANNULAH SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �No Annular Space Exists ❑Annular space grouted with iremie pipe ❑Casing Perforation/Removal � � in.from to ft. ❑Perforated ❑Removed '��'�- in.from �o fl. ❑Perforated ❑Removed Type of perfora�or MA 1` y� ❑Other •-• GROUTING MATERIAL . Grouting material Fleat CPmPnt from �to 1�ft. yards�bags from to fl. ya�ds bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEAI�NG from to ft. yards bags trom to fl yards bags UNSEALED WELI�S AND BORINGS Other unsealed well or boring on property? Q Yes ❑No i n u se 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 ihe best ot my knowledge. Stevens Drilling & Env., inc 8665� Contractor Business Name License or RegistraGon No. — _ 3j4/94 Authorized Repiesentative Signature Date LOCAL COPY H 4 3 9 3 5 ph�1]i p Otto Name ol Person Sealing Well or Boring . HE-01434-01 � .,_:�._. ., _. . E " ._. .,_ ._ WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName WELL RECORD �-5 3 7 3 6 2 Minnesota Statutes Chapter 1031 Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed tt. '/ � i, v. � �� Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD . ❑ Cable Tool ❑ Driven ❑ Dug ❑ Auger � Rotary ❑ Jetted Show exact location of well in section grid with"X". Sketch map of well location. O Showing property lines, N roads and buildings. DRILLING FLUID I � ' --r'--1- -j _1_ . � � i � i i ,USE � Domestic ❑ Monitoring ❑ Heating/Cooling y� -a ; i , E ❑ Irrigation ❑ Public ❑ Industry/Commercial _1_ _�_ __ � T [� Test Well ❑ Dewatering O Remedial I i ' � - �'^"� CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM. --�- �- -, -r- I C Steel ❑ Threaded ❑ Welded ' ' 1 �7 Plastic �(C7 (}�� /milr� - CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME __�in.to 134 i112 _ Ibs./ft �I��o�� n. ;� in.to ft. Ibs./ft. in.to ft. Mailing address if different than property address indicated above. in.to ft. Ibs./ft. in.to ft. SCREEN OPEN HOLE Make J�yC� from ft.to ft. Type �� p Diam. �,. SIoVGauze li7 � Length Set between ft.and ft. FITTINGS: STATIC WATER LEVEL GEOLOGICAL MATERIALS COLOR H MA�EERIAL�� FROM TO !�y ft. f�below ❑ above land surface Date measured-��F;--i f��' PUMPING LEVEL(below land surface) ��CI, /� � ft. after 3�¢ hrs.pumping � g.p.m. R V WELL HEAD COMPLETION G�a � C.,,�d Y��Q� ❑ Pitless adapter manufacturer Model sci ❑ Casing Protection O 72 in.above grade Cla & Sand B� � GROUTINGINFORMATION � Well grouted? ❑ Yes ❑ No � Grout Material ❑ Neat cement ❑ Bentonite ��a from to ft. ❑ yds. � bags from to tt. ❑ yds. ❑ bags � & from to ft. ❑ yds. ❑ bags NEAREST KNOWN SOURCE OF CONTAMINATION � " feet direction type • II disinfected upon completion? ❑ Yes ❑ No PUMP ❑ Not installed Date installed Manufacturer's name �f„�, Model number HP� Volrts Length of drop pipe ft. Capacity �J g.p.m. Pressure Tank Capacity / Type: � Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS � . -- -''--" � i '' Does property have any not in use and not sealed well(s)? Yes ❑ No � ..._. ..- 1�"...., ... ! �� ' WELL CONTRACTOR CERTIFICATION ' � _ .- This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. . The information contained in this report is true to the best of my knowledge. Use a second sheet,il needed REMARKS,ELEVATION,SOURCE OF DATA,etc. ��4 icensee Busn ss m ' '� � . Reg, �� M�R 7 YS �� "��Z�28/84 ,.- - Authorized Representative Signature Date Michael Stevens 2/28�94 Name ol Oriller Date LQt:AL C��'`l 5 3 7 3 6 2 HE_o,zo5_o4,Re�.5,�2>