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Home My WebLink Aboutwell info WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 328030 ® County Name WELL AND BORING SEALING RECORD M nnleso aoUnique Well No. Minnesota Statutes,Chapter 1031 or W-series No. Hennepin P uea�e aa�a a�m e�ow�t Township Name Township No. Range No. Section No. Fraction(sm. Ig.) Date Sealed Date Well or Boring Constructed Oran 117 71 07 Af GPS LOCATION-decimal degrees(to four decimal places) ^�- r Depth Before Sealing ..+� ft. Original Depth / -J ft. Latitude Longitude AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location IQaIngle Aquifer E]Multiaquifer 4680 North Shore Drill, Orono WELL/BORING Measured ❑Estimated Date Measured ❑Water-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring Env.Bore Hole ❑OtherId ft. elow n section grid with"X:' location,showing property ❑ ❑above land surface lines,roads,and buildings. N CASING TYPE(S) 1 VE0 '- `- V --'-----;--- -- WELLHEAD COMPLETION de h _ ❑P ❑T' ❑Other N o 15 W EI y Outside: ❑Well House ❑At Grade Inside: �4asemenLOffset Mile Pitless Adapter/Unit ❑ urged We Pit h ❑ OF ORO NO ❑ W -----T---------- -- I h ❑Buried 0 1 i El Well Pit S �rJF;� Z. E]Other 1 Mile ElOther PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above / in.from___it' to ft. ❑Yes rvd ❑Yes "O ❑Unknown 1515 Constawe Blvd -ir.-.--in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Hm Lake, MR 55304 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME S REEWOPEN HOLE Well owner's mailing address if different than property owner's address indicated above Screen from to Open Open Hole from t0 ft. OBSTRUCTIONS �r E]Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill . Obstruction Type of Obstructions(Describe) ��ii GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. f Type ❑Removed � of Present ❑Other MOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No Annular Space Exists ❑Annular Space Grouted with Triennia Pipe ❑Casing Perforation/Removal in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator VARIANCE Was a variance granted from the MDH for this well? ❑Yes ;04"'Ko TN# GROUTING MATERIAL(S) �y (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material�Lf:" 17 om to _ ft. yards bags from to ft.____ 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 ❑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. Dan Stodola Well Drilling Co,. Inc. 1691 Licensee Business Name - Licen��se or Registration No. /l r o esen'tative Signature X Certified Rep.No. Date LOCAL COPY H � 3 L 8 0 3® Name of Person Sealing Well or Boring HE-01434-14 IC#140-0423 5/138 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 'I "r%0 County Name WELL AND BORING SEALING RECORD Minn'eso a°Unique Well No. - Minnesota Statutes,Chapter 1031 or W s erieskNo. %[1LiC� Township Name Township No. Range No. Section No. Fraction(sm.—Ig.) Date Sealed Date Well or Boring Constructed - o P 4 GPS Latitude degrees minutes___ seconds Depth Before Sealing /f,tel ft. Original Depth ft. LOCATION: Longitude degrees__ minutes seconds AIwIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ogle Aquifer ❑Multiaquifer [ r teeasured ❑Estimated Date MeasuredWE ORING 80 Mirth S Dr. ftow 55 " - r-Supply Well ❑Monit.Well � Show exact location of well or boring Sketch ma well or boring El above land surface in section grid with"X." location, owin erty ❑Env.Bore Hole ❑Other ft. elow N lines,roads,and build s. CASING TYPE(S) --i----`-- XSteel ❑Plastic ❑Tile ❑Other _ --'--'-' ---- -' -' WELLHEAD COMPLETION , T W EI Outside: E]Well House Grade Inside: ❑Basement Offset Mile IteesslAdapter/Unit ❑Buried ❑well Pit ❑P' T ❑Well Pit ❑Buried S E]Other / �1 Mile y f , ^ ❑Other PROPERTY OWNER'S NYAME/COMPANNAME{Lj„�, CASING(S) Diameter* 01 Depth ' Set in oversize hole? Annular space initially grouted? Property owner's mailing addres if different than well location address indicated above in.from to ft. ❑Yeslo ❑Yes ❑No ❑Unknown n.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE It Well owner's mailing address if different than property owner's address indicated above Screen from // to l ft. Open Hole from to ft. OBSTRUCTIONS �iods/Drop Pipe ❑Check Valve(s) ❑Debris �[❑Fill ❑No Obstruction Type of Obstructions(Describe)--A? .— �/ CK00-1-A✓�ti_ 9C GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? [A ❑No Describe_ FORMATION _---_-- -----_ _ —- If not known,indicate estimated formation log from nearby well or boring. / PUMP _p�,�/ t /� Type S� �IO t�V m Q ❑❑Amoved F1 Not Present E]Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: o 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 Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material j0kdtA710 ft. yards bags from to ft. 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 AHow many? LICENSED OR REGISTERED.CONTRACTOR CERTIFICATION This ywell ,foreboring q(was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report s Rolle, A �M j w dge .... ,+IQ:*• NICs a division of Don Stodola Well frilling Co., Inc. 1691 Licensee Business me License or Registration No. iw 9�g Certified epresenfative SignaQpe Certified Rep.No. Date LOCAL COPY H 274396 Name of Person Sealing Well or Boring HE-01434-11 IC#140-0423 2i08R