HomeMy WebLinkAboutwell info WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H
County Name
WELL AND BORING SEALING RECORD
1551 Li 5
Sealing
a Unique No.
Hennepin Minnesota Statutes,Chapter 1031 of W-series No.
(Leave blank M not known)
Township Name Township No. Range No. Section No. Fraction(Sm.i.1g) Date Sealed Date Well or Boring Constructed
Orono 118 22 35 , W 8/`26/99
Numerical Street Address or Fire Number and City of Well or Bonng Location s
845 Old Long Lice Rd Orono Depth Before Sealing 140 h. Original Depth 140 ff.
Show exact location of well or boring 11 Sketch map of well or boring AOUIFER(S) STATIC WATER LEVEL
in section grid with'X'. location, showing properly Single Aquifer 0 Multiaquifer
lines,roads,and buildings.
N WELL/BORING a Measured 0 Estimated ..
l I I Water Supply Well 0 Monit.Well
`-T---T---Y---Y-_
I I I ❑ Env.Bore Hole 0 Other 73 ft. 4below 0 above land surface
-r — ;- - i-- i
W I 1 I J E CASING TYPES)
--+----i----i----i--- TX Steel 0 Plastic 0 Tile ❑Other
I I I I
— i i i 1
I CASING
11111 Diameter Depth . Set in oversize hole? Annualar space initially grouted?
r ruse �S h f4 6 in.from 0 to 36 n. ❑Yes No 0 Yes 0 No 0 Unknown
PROPERTY OWNER'S NAME in.from to ft. 0 Yes ❑No 0 Yes 0 No 0 Unknown
Department of Natural Resources
Property owners mailing address if different than well location address indicated above. . in.from to ft. . 0 Yes 0 No 0 Yes 0 No 0 Unknown
®ttn z Larry Watson SCREEN/OPEN HOLE
2300 Silver Greek Road HR 136 140
Roch$i ter: MN 559Q6 Screen from to ft. Open Hole from to ft.
OBSTRUCTIONS
WELL OWNER'S NAME
Rods/Drop Pipe ❑:crack Valve(s)::'❑Debris' 0 Fill-__,0 No-Obstruction
WN owner's meting address if different than property owners address indicated above. Type of obstructions(Describe) pump' pipe wire
Obstructions removed?.-- '[ Yos -❑No: =Describe
PUMP
Type submersible
HARDNESS OF 4 Removed 0 Not Present 0 Other
GEOLOGICAL MATERIAL COLOR FORMATION FROM TO
H not Known,indicate astlms4d formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE:
ANo Annular Space Exists
drift 0 140 0 Annular space grouted with tremie pipe
I 0 Casing Perforation/Removal
• in.from to ft. 0 Perforated 0 Removed
in.from to ft. 0 Perforated 0 Removed
•
Type of perforator
0 Other
GROUTING MATERIALS) t *s
Grouting Material Portland fro,,, 340 to 0 n t 25
from to ft. yards bags
from to ft. yards bags
from to ft. yards begs
REMARKS.SOURCE OF DATA,DIFFICULTIES IN SEAUNG OTHER WELLS AND BORINGS ,�[''
Other unsealed and unused well or boring on property? 0 Yes L!No How many?
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed In accordance with Minnesota Rules,Chapter 4725. The Inforrtlsbon contained in this report is
true to the beet of myatnbwledg: '
- . SIRS Well Drilling 27276
Contractor Business Name llosrns.ril2.
l
`/x"11
•
AUHortzed Representative Signature Data
1t �.
�: Rob Stodola
LOCAL COPY - H '155105 Name of Pelson Sealing Well or Boring