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Home My WebLink Aboutwell info Minnesota Well and Boring 28907 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. H County Name WELL AND BORING SEALING RECORD Minnesota unique No. Hennepin Minnesota Statutes,Chapter 1031 or W-series No. 1 (Leave blank if not known) Township Name Township No I Range No. Section No. Fraction ism. ,Ig.) Date Sealed Approximate Date Well Orono 118N 23V 3 S tlSE lNW 14 4/28/93 or Boring Constructed Numerical Street Address or Fire Number and City of Well or Boring Location 142 425 N. Old Crystal Bay Road Depth Before Sealing ft. Original Depth 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. N roads.and buildings. Approximate Single Aquifer ❑Multiaquifer ft. X below above land surface t t i i -�- - - - -t- CASING TYPE " W t Ix E T Steel El Plastic El Tile ❑Other a mile S Screen from to ft. Open Hole from to ft, t mile OBSTRUCTION/DEBRIS/FILL qt PROPERTY OWNER'S NAME PJ Obstruction ❑Debris ❑Fill L, tl ; G. L. Vickermn � rods 4 Type of debris/obstruction Mailing Address if different than property address indicated above. Obstruction/Debris/Fill removed? IX Yes ❑No 425 N. Old Crystal Bay Road' PUMP Orono, int 55356 $ �g3 X Removed ❑Not Present ❑ Other CASING GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION Diameter Depth Set in oversize hole? Annular space initially grouted? IF not known,indicate estimated Formation log from nearby well or boring. 2 in.from to ft. ❑Yes IN No ❑Yes ❑No 99 Unknown in.from to Ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: ®No 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 Grouting material neat cewnt from 142 to 0 ft. yards 3 bags from to ft. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING from to ft yards bags from to ft yards bags UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? Yes ❑No in use 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. Stevens Well Drilljng DrillingCo. 27194 Contractor Business Name License or Registration No. 4129193 Authorized Pepresentattve Signature Date LOCAL COPY �' n n n O Randy Johnson 4/29/93 Ga`� Name of Person Sealing Well or Boring HE-01434-01 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 241648 o. County Name WELL AND BORING SEALING RECORD SealMinnlesotta Unique Well No. Minnesota Statutes,Chapter 1031 Hennepin or W-series No. (Leave Wank ii rat kmw,) Township Name Township No. Range No. Section No. Fraction(sm-i-Ig) Date Sealed Date Well or Boring Constructed Orono 113N 23W 33 S'- ,. Septwnber 29, _006 GPS Latitude degrees minutes seconds 151 LOCATION: Depth Before Sealing ft. Original Depth_ h. Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ETSingle Aquifer ❑Multiaquifer 425 Old Crystal Bay Rd N, Ororo WELL/BORING Measured ❑Estimated [Q,Water Supply Well E]Monit.Well Show exact location of well or boring Sketch map of well or bo 78 in section grid with"X" /� location,showing prope ❑Env.Bore Hole E]Other ft. &J below ❑above land surface N lines,roads,and building CASING TYPE(S) [Steel E]Plastic ❑Tile ❑Other W - ------:-- -;-- --i-- E fi +- WELLHEAD COMPLETION Outside: ❑Well House Inside: ❑Basement Offset i — )✓lmib " [XPitless Adapter/Unit ❑Well Pit 4_4_4_ --i-- ❑Well Pit ❑Buried 5.. it s. I r ` . ❑Buried PROPERTY OWNER'S NAMEICOMPANY NAME CASING(S) Land Ventures, LLC Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above150 in.from t0 ft. ❑Yes No Yes E]No Unknown 7847 Creekridge Circle 1113inn_eapolis, MN 55439 in.from to ft. ❑Yes ❑No ❑Yes ❑ No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE Land Ventures, LLC �1 Well owner's mailing address if different than property owner's address indicated above Screen from 150 to 154 ft. Open Hole from to ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ba No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OFORMATION R FROM TO Obstructions removed? ElYes ElNo Describe If not known,indicate estimated formation log from nearby well or boring If Type SUbID tQ Removed ❑ Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: [k No 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 neat Cummitt from 0 to 154ft. yards 1 7 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 EX 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. OCT 1 sevens vrilliag & Environmental_ Services, Inc 2255 Contractor Business Name License or Registration No. CITY 4F C,t,',L, 9/29/06 Authorized Representative Signature Date Windy Johnson LOCAL COPY H 241648 Name of Person Sealing Well or Boring