HomeMy WebLinkAboutwell info r-
k
MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 144052
WELL OR BORING LOCATION Sealing No. H
County Name WELL AND BORING SEALING RECORD Minnesota Unique No
Hennepin Minnesota Statutes,Chapter 1031 or W-series No
(Leave blank if not known)
Township Name Township No. Range No Section No. Fraction Ism.i Ig.) Date Sealed Date Well or Boring Constructed
Orono 117 23 07 w ti ka i7 ele
� -,-
Numerical Street Address or Fire Number and City of Well or Boring Location
4040 N Shore Dr, Orono 55391 Depth Before Sealing ft Original Depth 'Z '
]? h
Show exact location of well or boring Sketch map of well or boring AOUIFER(S) STATIC WATER LEVEL
in section grid with"X'. location, showing F?Pestsl
In le A uiferlines,roads,and buings g q ❑ Multiaquifer
N I WELL/BORING )(1 Measured ❑ Estimated
-T---T---,----,--- :_...___..._ - • y.Water Supply Well ❑Monit.Well r
,45
( 1 I ❑ Env.Bore Hole ❑Other ft. J4i below ❑ above land surface
W E -'y ‘ CASING TYPE(S)
' I I
---r --------i-----{--- t `_,. i )6 Steel ❑ Plastic ❑Tile ❑Other
I I I ne
—1—
_ I
_ _—_ i_ CASING
Diameter Depth Set in oversize hole? Annualar space initially grouted/
s1 _ ,d
t'nee--- _ in.from to ft. ❑ Yes No ❑ Yes ❑No ❑ Unknown
I r.
PRO2PERTY OWNERS NAME in.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown
Ti
� Flet~, onr`orf 472-4240 Yes No Unknown
Property owner's mailing address if different than well location address indicated above. in.from to ft. ❑ Yes ❑No ❑ ❑ ❑
SCREEN/OPEN HOLE
s
Screen from P to 92 ft. Open Hole from to ft
OBSTRUCTIONS
WELL OWNERS NAME Rods/Drop Pipe p ❑ Check Valve(s) ❑ Debris ❑ Fill 0 No Obstruction
r �'"!h�I j
Weil owner's mailing address A tlifferent than property owner's address indicated /it,�.l above. Type of Obstructions(Describe) f( ui2/ Q 'v/f i
Obstructions removed? , Yes ❑ No Describe
PUMP ������111111
r Pon",Type f^rF-t ya
GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO +Removed ❑ Not Present ❑ Other
FORMATION Jl
M not known,indicate estimated fonnaoon log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE:
XNo Annular Space Exits
ii . _-4) t7 1;=1
❑ Annular space grouted with tremie pipe
' i
❑ Casing Perforation/Removal
in.from to ft. ❑ Perforated ❑ Removed
infrom to ft ❑ Perforated ❑ Removed
Type of perforator
-- _-_-_ - _ CIOther
GROUTING MATERIAL(S)
i
Grouting Material /4.1..,f47-��/rjtlf/om 0 to 92Z ft. yards ill bags
--- _--- --- -- from to ft yards bags
from to ft. yards bags
from to_ ft. yards bags
REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS
Other unsealed and unused well or boring on property? ❑Yes>5 No 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 of my knowledge.
Dpn Stodola Well Drilling Co. , INc. 27172
Contractor Business Name License or Registration Iro.
(7',
�y / L7jlve signature.- Date
Name of Person Well or Boring
LOCAL(tnPV H 14 4 3 5 2
HE-01434-03 2/97 R