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Home My WebLink Aboutwell info MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H �73 / 8i WELL OR BORING LOCATION County Name -- Sealing No.WELL AND BORING SEALING RECORD Minnesota Unique Well No. 1- - { Minnesota Statutes,Chapter 1031 or W-series No. Hennepin (Leave dank x not known) Township Name I Township No. Range No Section No. Fraction Ism.i Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 4 k i4 11/6/00 . Numerical Street Address or Fire Number and City of Well or Boring Location 790 S Old Crystal Bay Rd, OronoDepth Before Sealing 104 _ ft Original Depth 104 it Show exact location of well or boring 0 t Sketch map of well or boring AOUIFER(S) STATIC WATER LEVEL in section grid with"X" location, showing property X Single Aquifer ❑ Mulhaqurter lines,roads.and buildings. N WELL/BORING "Measured ❑ Estimated I $�Water Supply Well ❑Monit.Well G ,-v� r , , , J �0)( (( ❑ Env.Bore Hole ❑Other 51 ft. LXoelow ❑ above land surface W---r----1----i-----n--E `{J�' `1iL CASING TYPE(S) ---�--------i--,--A--- T .Steel ❑ Plastic ❑Tile ❑ Other ' I I kmi +--H 1--- iCASING(S) 'PE. Diameter Depth Set in oversize hole? Annular space initially grouted? LLL S qJJ'� , µ t mile in.from to 10 ft. ❑ Yes X No ❑ Yes ❑No ❑ Unknown PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown Arthur Blair Property owner's mailing address if different than well location address indicated above. in.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown SCREEN/OPEN HOLE Screen from 100 to 104 ft. Open Hole from to ft. OBSTRUCTIONS WELL OWNER'S NAME yf! Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris Fill ❑Jet Obstruction Well owner's mailing address if different Than property owner's address indicated above Type of Obstructions(Describe) Pump, Pipe, u e t & Tank Obstructions removed? "Yes ❑ No Describe PUMP ��Tyype Jet GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO yf�Removed ❑ Not Present ElOther FORMATION If not known,indicate estimated fonnatan log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: ItNo Annular Space Exists Drift 0 104 ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. 0 Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material Portland from 104 to 0 ft. yards 4 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 "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. &ES Well Drilling 27276 Contractor Business Name License or Registration No. 4 :Authonz Reprissentative Signature Date James Lea LOCAL COPY H 173781 Name of Person Sealing Well or Boring y WELL LOCATION '` MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name WELL AND BORING RECORD 621588 Henna .l n � , va`` Minnesota Statutes Chapter 1031 Township Name Township No. Range No. Section N;..y Q ction WELL DEPTH(completed) ft. Date Work Completed Orono 117 23 4U� SW,, SW SE. lib 11/6/00 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD 790 S Old Crystal iiay onRd, Oro ❑ AugTool ❑Doter ❑ ❑ Auger EKTool 0 Jetted Show exact location of well in section grid with"X". Nyr. Sketch map of well location. 0 Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES CKNO N Water W,--k FROM ft.to ft. ---- Oe I( USE 0 Monitoring 0 Heating/Cooling I '"Tht.4 domestic ❑ Community PWS 0 Industry/Commercial OMMOMIN0 Irrigation -I i 0 Noncommunity PWS 0 Remedial w r -- 0 Test Well r 1/2" CASING Drive Shoe? 0 Yes XNo HOLE DIAM. ____ r ) ❑ Steel 0 Threaded 0 Welded W CPlastic 0 s (.X 1 Mile CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 4 in.to 16 b ft. _lbs./ft. 8 into ��3773C�ft... Artnur Blair in.to ft. lbs./ft. 64 in.toJZyr. Property owner's mailing address if different than well location address indicated above. in.to ft. _lbs./ft. in.to ft. SCREEN tY OPEN HOLE Make Bigfoot from ft.to ft. Type SiO n04.Sing Diam. t* Slot/Gauze 116 1.3of Length Set between ft.and ft. FITTINGS: STAT C,WATER LEVEL � WELL OWNER'S NAME J �[ _ ft. L'below 0 above land surface Date measured 11/3/00 PUMPIIyG((,J,F�EL(below land surface) 50 Well owner's mailing address if different than property owner's address indicated above. jj ft. after hrs.pumping g.p.m. ��YpLL HEAD COMPLETION Wni tewater L'Pitless adapter manufacturer Model ❑ Casing Protection _- GA in.above grade ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? ❑ 'es 0 No HARDNESS OF Grout Material 0 NBentyEite ❑ Concrete (High Solids Bentonite GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO atereat cement 1933 from to ft. 0 yds. Cbags from to ft. 0 yds. 0 bags 1til,:3O1 1 lilac: Soft 0 3 from to ft. 0 yds. ❑ bags NEA T KNOWN SOURCE Q.FyCONMI T NATION Clay Brown Med 3 15 feet "'fir direction Sewes L1 RA Well disinfected upon completion? X Yes 0 No S, /Sandy Clay Blue Het 15 d4 PUMP 1 /tTl t�V 0 ❑ Not installed Date installed Saady Clay Brawn Soft. 64 98Sta-rite Manufacturer's name Med Model number HP j/4 Volts 230 Sc1 i1 C' Mix ✓ O iA r;j 98 126 Length of drop pipe 80 ft. Capacity 10 g.p.m. Type: (Aubmersible ❑ L.S.Turbine 0 Reciprocating 0 Jet 0 ABANDONED WELLS ' Does property have any not in use and not sealed well(s)? 0 Yes Cid/go . VARIANCE Was a variance granted from the MDH for this well? ❑ Yes L'XNo WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. RES Well Drilling 27276 Licensee Business Name Lic.or Reg.No. //j l: 1 ,..._ : / ` 7-<=/oi Authorized Representative Signature Date Robert E Stodola, Jr Name of Driller Date LOCAL COPY 621588 HE-01205-06(Rev.9/97)