The URL can be used to link to this page

Home My WebLink Aboutwell info 2 � � MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring Ll �� WEI�OH BORING LOCATION $@811f1J NO. I fl Counry Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. -- ��I�D�pin Minnesota Statutes.Chapter 1031 0�W��senes No. �----- � Townshlp Name Township No. Range No Section No. FracUon�sm -i Ig) Date Sealed Date Well or Boring Constructetl f�t@ifa �Y� �� "`��.Z Numger+ic�al Streget AddQress or Fire NumTber and Ciry of Well or Bonnq Locat�on �ry �JL� i7 r7�0�� YT.� ��' Depth Betore Seal�ng Jl��.� _ft Originai Depth .f�r h� Show exact locatwn of N-ell or boring Sketch map ol well or boring AOUIFER�S) STATIC WATER LEVEL m section grid wdh"X". bcaUon,�Bying�property Single Aywfer ❑ Multiaquifer lines,roa �n�6�ildings. � N WELUBORING ( �Measured ❑ Esumated �� ❑Water Suppty Well�Monit.Well � '�' — - - -- --i-- --�-- �j � I �i� ,�� ❑ Em.Bore Hole ❑Other _ _. + N. �below ❑ above land surtace � y,� -- - - -- -i-- --�— E �� • �kIO CASING TYPE�S) r � � � � � �, � � � � � —�- -i-- -i-- --;— a� ❑Steel [�lasac �Tile � Other � i � � �mile ��.j! ' ' ' ' � � CASING(S) —�- -i-- -�-- --�— Diameter Depth Set in overs¢e hole? /lnnular space initially grouted7 �l� S "�� t i mi�e� �in.Irom�,� to_�_ ft. ❑ Yes �o ❑ Yes ❑No ❑ Unknown � PROPERTV OWNER'S NAME in.irom to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Property owner's mailing address if tlitferem than well iocation address indicated above. in.from to ft. ❑ Ves ❑No ❑ Ves ❑No ❑ Unknown �t,��+ g,��.� g�„3�� SCREEWOPEN HOLE � i3 1 t� 1 +b �!,�� $�� #�� ,� Screen trom�to ��. __ ft. Open Hole from to ft. l�T1tl8Ct�fl�f8� �T �'��l�l' � t`t� ,�' oesraucnoNs WELL OWNER'S NAME Rods/Dro Pi e ❑ p p ❑Check Valve(s) ❑ Debris ❑ Fill �No Obstruction . Well owner's mailing address if diRerent Man properry owner's address mdicated above. Type ot Obstrucli0ns(Describ8) Obstructions removed? ❑Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL COLOR MARDNESS OF FROM TO � Removed ❑ Not Present �Other FORMATION If not known,indicate estimated tormatbn log from nearby well o�bonng. METHOD USED TO SEAL ANNULAH SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �'fJo Annular Space Exists f� ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.irom ro ft. ❑ PeAorated ❑ Femoved in.irom to fl. ❑ Perforated ❑ Removed Type o�peAorator ❑ Other GROUTING MATERIAL(S) (One bag af cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material �.{/f��om _y� to� tt. yards _� bags from to R. yards bags from to ft. yerds begs from to__ R. yards bags REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS 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 wiM Minnesola Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. D4n Stodo�.a WeI� �iri��.i�g G�. , Inc. 27112 Contracror Business e , .. l License or Registrafion I'+o. �. `� - �,,j�� *✓ti.J o ed Representative Signature'' Dafe ..�'.��` �_>^.��0/'.2....►�"+i'...�a► . �4��,� u � ��I�� Name ol Person Seelin 1 a Boring r, h ��j MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring �� wE��oR Bop�NG�o�AT�oN —_ WELL AND BORING SEALING RECORD Sealing No. I H Counry Name Minnesota Unique Well No. Ir — ��'��e�}Qi� M�nnesota Statutes, Chapter 103/ o�W�enes Na I - -- � L— Township Name Township No. Range No Section No. Fracuon�sm.-s Ig) Date Seaied Date Well or Bonng Consiructed Qr��o 1�? 23 08�1—flt31� -� Numerical Streel Adtlress or Fue Number and Ciry of Well or Boring Locahon �1/,�t �� Depih Belore Sealing i.+�F+ tt. Orlginal Depth . ?,,,,t�f, n ,., Show exact location of v.•ell or boring Sketch map of well or boring AO IFER(S) STATIC WATER LEVEL � .. in section grid with"X" bcahor��ho� property ingle Aywfer � Mulhaquder lines,roa �n buildings. - , N � WELUBORING [�leasured ❑ Estimated .. ., � � � � �� t�' ❑WaterSupplyWell'�lonit.Well �� -- - - -- - -- - -- � �+ • �ry ,,b ❑ Env.Bore Hole ❑Other _ _ ft. �below ❑ above land surlace i i � i i✓ ... W —�- -i-- -i— --i-- E � � CASING TYPE(S) -�:: � � � � ;� � � � � ��. .,:: ,. � � � � �! -�- -'-- -i— --�-- X�� Steel �lastic �Tile �Other � I � � y�mile # . __L_ J__ _.i__ __i__ � f� CASING(S) Diameter Depth Set in oversize hole? /lnnular space initially grouted? I�—imiie—qa �� from� to� it. ❑ Yes �vo ❑ �es ❑No ❑ Unknown i i ,'� PROPERTV OWNER'S NAME in.from to ft. ❑ Ves ❑No ❑ Yes ❑No ❑ Unknown Property ownei's mailing address if difterent than wel localion address indicated above. in.from to ft. ❑ �es ❑No ❑ Yes ❑No ❑ Unknown ��#II= ^��v �_�¢� SCREEWOPENHOLE Sx 615t? B��er 8d � Screen from_�_to� ft Open Hole from to ft. . �AIIl.''L Qti�lt A� ��Ei�3 � A� �' ossraucnoNs WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill f�lo Obstruction �� Weil owners mailing address if diflerent than properry owner's address indlcated above. TypB of Obstructions(Describe) Obstructions removed? ❑Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed Not Present ❑ Other FORMATION If not known,iMicate estimated tormatbn log from nearby well a bonng. � METHODUSED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: . j • o Annular Space Exists �rt ' �`-�''�'` �� '�� ❑Annular space grouted with tremie pipe � ❑Casing Perforation/Removal in.from �o ft. ❑ Perforated ❑ Removed in.from �a n. ❑ Perforated ❑ Remrned Type of peAorator ❑ Other a GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=501bs.) Grouting Material �om �_ ro�� ft. yards —� ba9s irom to fl. yards bags irom to h. yards bags from ta_ ri. yards bags REMAHKS,SOURCE OF DATA,DIFFICUITIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on propeAy? ❑Yes o How many? UCENSED OR HEGISTERED CONTRACTOR CERTIFICATION � � This well or boring was sealed in accordance with Minnesola Rules,Chapter 0725. The information contained in Mis report is true to the best of my knowledge. D08 Si'tOt�tflfl iri'1�11 t�rll.liif,g, CQ.�, IaC� 2�'1'�?_ � Conhacror Business Name . License a Regisfrafion Y:o. r, i,, � .r..,�� A o nt �ve ignBture � Date ..�.... .�1;��rtr� 1�`�..,.• . ��1��. ,,.�a�,� u � w�A� � Neme o!Person Seali ►Nell or Bonng �7 h � � i _ - - - � MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring +� C�c�� WELL OR BORING LOCATION Sealing No. ��"� �o��ry Name ---- WELL AND BORING SEALING RECORD �v v_ Minnesota Unique Well No. I -1 ��II&�p�� M�nnesota Sfatutes. Chapte�1031 o�W-�eries No. �--- � �� Townshlp Name Township No. Range No Section No. Fiact�on�sm.-s Ig) Date Sealed Date Well or Bonng Constructed 8rt��a II7 23 b8 i�-Q£��2�. 4 ��. Numencal Street Address or Fire Number and Cny of Well or Bonng Locat�on y � t 332# N S�Qre lJ�* Vtd�d Depih Before Sealmg �i _ft Orig�nal Depth �� tt Show exact loca6on of well or boring Sketch� of well or bonng ADUIFER(S) STATIC WATER LEVEL m section grid wrth"X". bcation, s1�o�A�g property Single Aquder � Mult�aquder lines,roads a dbwldings. N �� . WELUBORING �Measured ❑ Esnmated � � � � �� R�� f/�Water Supply Well [�1oni1.Well —�- -i— —i-- --;-- �r� f + 4 ❑ Em.Bore Hole ❑Olher �._tt. �ielow ❑ above land suriace � � � � " —�- -i-- -i-- --;-- � �' CASING TYPE(S) � � � W � � I �,i i i � G� -;-- -�-- --i-- --i-- Steel Plastic �Tile �Other - }�mile -�-- -�-- -�-- —�— � CASING(S) Diameter Depth Set m oversize hole? Annular space initially grouted? S +� � /� � � �r miie� _{'.`_�in.trom v �o� ft. ❑ �es No ❑ �es ❑ No ❑ Unknown PROPERTY OWNER'S NAME in.from to M. ❑ Yes ❑No ❑ Ves ❑No ❑ Unknown w. Property owner's iling addres f diN rent Ihan wetl locanon address indiwted above. in.irom to ft..�z�` ❑ Yes ❑No ❑ �e5 ❑No ❑ Unknown atttt:�ssp �r��g8 tq�� BAy�� 4 �t � SCREEWOPENNOLE `, .� .. ��a �aa� s s ��,��t(�jj,�� +�� „�j Screeni�om to R,��:�f7penHolefrom�to� ft. OBSTRUCTIONS WELL OWNER'S NAME � ❑ Rods/Drop Pipe ❑ Check Valve(s)� �❑ Debris�n Fill �No Obsiruction Well owners mailing address it diflerent than property owner's address indiwted above. Type of Obstructions(D85Cribe) Obstructions removed? ❑ Yes ❑ No Describe PUMP TYPe GEOLOOICAL MATERIAL COLOR HARDNESS OF FROM 70 � Removed �Not Present ❑ Other FORMATION N not krawn,indicate estimeted tormatbn log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE MOLE: � � � � �Jo Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing Perfo�ation/Removal in.from to ft. ❑ Pertorated ❑ Removed in.trom �o ft. ❑ PeAorated ❑ Removed Type of peAorator ❑ Other GROUTING MATERIAL(S) (One bag of cement=941bs.,one bag of bentonite=50 Ibs.) Grouting Matenal _��,� � from �— ro.� ft. yards � bags from to R. yards bags from to fl. yards begs from to__ tt. yards bags REMARKS,SOURCE OF DATA,DIFflCULT1ES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The infortnation contained in Mis report is true to the best of my knowledge. �1c�r� St+��la 6#eI.2Ucfliin �. I�c. Contracror Business me ` License a Regishation I'�io. , ; �' �� .z� �,..i uthonzed epresentative Sigdature � Date r v'ti•`... . �v �!�aC2.t1"��.. ;-.��A�,r.�p�, u � �+�/1� � Name ol Person Sealing.�� ell or Bonng fl �h '-� � � � WEIL OR BORING IOCATION MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring ��{ � —� WELL AND BORING SEALING RECORD sea��9 No. i H 1 Counry Name Minnesota Unique Well No. r -- Minnesota Statutes,Chapter 1031 or W-series No. I — � 11.aM dank tl rwl known) L_ Township Name Townsh�p No. Range No. Section No. Fraction�sm i Ig) Date Sealed Date Well or Boring Const�ucted � �1 V� � �n`�1J �� Numencal Street Address or Fire Number and Gry ot Well or Boring Locahon � � � � � Depth Before Sealing � R Onginal Depth h Show exact locahon ot veell or boring Sketch ma d wely,or bonng A IFER(S) STATIC WATER LEVEL in section grid with"X". locahon,��`� property Single Aywfer ❑ MWtiaquifer lines,roads. n11 uildings. N � WELUBORING ` �leasured ❑ Estimated � � � � f;d� ❑Water Supply Wellz�MoniL Well � - - - -- -- -- -- -- • i "'� {�� ";�o ❑ Env.Bore Hole ❑Other _ _�ft. �elow ❑ above land surtace i � i k W --�- -�-- -i-- —�— E e �� CASING TYPE(S) � � � � ^ � � ;:� � � � —�- -�-- -i— --i-- � �� ❑Steel �Plastic �Tile � Other ylmile � —`- -�-- -�-- --�— � CASING(S) Diameter Depth , Set in oversrze hole? Mnular space initially grouted7 II(�—t miie� �Jin.from� to�� R ❑ Yes �tNo 0 �es ❑No ❑ Unknown /� PROPERTV OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Property owner's maihng address a diHerent than well Iceation adtlress indicated above. in.from to fl. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown , $�.,�,�: e^�a�,.� $�,.t Qg� SCREEWOPENHOLE � 1pGi ��Q �� Screen from�to� fl. Open Hole from ro R. �.i�TZ�L�n��f �ii� �l��S � �� OBSTRUCTIONS WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill �No Obstruction Well owners mailing address it ditterern Man property ownar's atltlress indicated above. Type of Obslruc�ionS(D9SC�ibe) � Obstructions removed? ❑ Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed ❑ Not Present Other FORMATION � It not known,indicale estimated formatbn log from nearby well or bonng. METMOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: . , t77vo Annular Space Exists �"'J• ` ❑Annular space grouted with tremie pipe ❑Casing PeAoration/Removal in.from to ft. ❑ Perfora[ed ❑ Removed in.from to R ❑ PeAorated ❑ Removed Type of peAorator ❑ Other GROUTING MATERIAL(S) (One bag of cement=941bs.,one bag of bentonite=50 Ibs.) 9 �-�-�i�7*sr^�� Y � 9 Groutin Material +� to R. ards ba s irom to fl. yards bags . � from to fl. yards bags from to__ ft. yards bags REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS 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 accrordance wiM Minnesota Rules,Chapter 4725. The infortnation contained in Mis report is true to the best ot my knowledge. �t�� SEt�de2a �eI1 �zi313ng �a., I�c. 27172 Confractor Business Name License a Registretion Cvo. �..-- '� �----"�' r— j �r' �,j — ,,�/-G C�J on R p sentative Signature " Date '`.`, .. �„ti✓^"1- .�:`>�Y"-'�.�-�'f�� /v:•: , L��.,�py� H � �� p Name o/Person Sealing W I or Boring x � �� MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �C�� WE��aR BOR�N��o�AT�oN _ WELL AND BORING SEALING RECORD sea''"9"°. i H o Counry Name Minnesota Unique Well No. - ��e�rj,�Q Mmnesota Statutes, Chapter 1031 or W-series No. �— � �L�tleM M iwt known) Township Name Township No. Range No Section No. Racuon�sm.-►Ig.) Date Sealed Date Well or Bonng Constructetl 0ttf3!@ 1I� Z Q$ �,�"{�Qj� Numencal SVeet Adtlress or Fire Number and City of Well or Boring Location r � 33�� I� Sh+�re 7Jr� Qr(�Q� Depth Before Seahng_�___tt Original Depih �_tt Show exact location of v.�ell or bonng Sketch map of v,�ll or bonng AO IFER�S) STATIC WATER LEVEL v m section grid wrth"X". locay�n.�'Jjsh� property Single Aqwfer � Multiaqwfer lines,ro36,F a d buildings. ,�/ ry � WELUBORING L/4Measured ❑ Esfimated �� E� - � � � � ❑Water Supply Well �Monit.Well -�- -�-- --;-- --� � � • �,{�k i�rp ��4 ❑ Env.Bore Hole ❑Other _ ft. I�,below ❑ above land surface �+.rE d W --�- - -- -i` -- -- E • � CASING TYPE�S) � � � � � � � � �y � � � � � '-k .�' -�-- -�-- -i-- --i— � S � ❑Steel �lastic ❑Tile � Other 3�mile �:� —�- -�-- -�-- —i— � CASING(S) Diameter Depth r Set in oversrze hole? Annular space initially grouted? l� S """��,�� µ---r mae--�e _��m.from�_ to� tt. ❑ �es (�No ❑ Yes ❑No ❑ Unknown I I T• PROPERTV OWNER'S NAME in.from to fl. ❑ Ves ❑No ❑ Yes ❑No ❑ Unknown Properry owner's maihng aadress d diHerent than well location address intlicated above in.from to R. ❑ Ves ❑No ❑ �es ❑No ❑ Unknown ��fl i V'$r� B��gg$ SCREEWOPEN HOLE ��a �� a� Screen trom_��I_to� fl. Open Hole from to R. M�tIl3GLC311�8� I'�Q '��1#� � O� � oesraucnoNs WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Deb�is ❑ Fill ��fVo Obstruction 7� Well owner's mailing address if tliHerent Man propeAy owner's address indicated above. TypB of Obstructions(Describe) Obstructions removed? ❑Yes ❑ No Describe PUMP Type GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed ❑ Not Present �Other FORMATION If not known,indicate estimated formatbn log from nearDy well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,Ofl CASING AND BORE HOLE: Q,Mo Annular Space Exists �� ❑Annular space grouted with tremie pipe ❑Casing PeAoration/Removal in.from to ft. ❑ Pertorated ❑ Removed in.from to fl. ❑ PeAorated ❑ Removed Type of pertorator ❑ Other GROUTING MATERIAL(S) (One bag of cement=941bs.,one bag of bentonite=50 Ibs.) Grouting Matenal��„�iG6m � ro�_ ft. yartls �_ bags from lo ft. yards bags from to ft. yards bags from to—_ k. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALIHG OTHER WELLS AND BORINGS Other unsealed and unused well or boring on propeAy? ❑Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or bonng was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in Mis repoA is true to the best of my knowledge. l)O� �'tedel� �d�l l t')ri�t tr,�(;A. $.'E.� t 7� Confracror eusmess Name �`icense or A �s a. '� `' �� '� 5-3I-�t?0 Au orized Represenfative Signature Date .Ti� Antonson �� lb p� � �� Name o/Person Sealing Well or Bonng H