My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
01/08/21 Well & Boring Sealing Record
Orono
>
Property Files
>
Street Address
>
N
>
North Shore Drive
>
2455 North Shore Drive - 09-117-23-44-0008
>
Land Use
>
01/08/21 Well & Boring Sealing Record
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/22/2023 5:51:30 PM
Creation date
3/4/2021 11:12:49 AM
Metadata
Fields
Template:
x Address Old
House Number
2455
Street Name
North Shore
Street Type
Drive
Address
2455 North Shore Dr
Document Type
Land Use
PIN
0911723440008
Supplemental fields
ProcessedPID
Updated
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
Page 1 of 1
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
WELL OR BORING LOCATION" <br />MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring <br />Sealing No. <br />WELL AND BORING SEALING RECORD Minnesota unique Well ND: <br />Minnesota Statutes, chapter 1037 or W-series No. <br />(emeaaN if .1 wmm> <br />H 381514 <br />County Name <br />Hermep .n <br />Township Name <br />Orono <br />Township No. <br />1117 <br />Range No. <br />23 <br />Section No. <br />109 <br />Fraction (sm. -r Ig.) <br />,SS /° SH <br />Date Sealed <br />Date Well or Boring Constructed <br />GPS LOCATION - decimal degrees (to four decimal places) <br />Latitude Longitude <br />Depth at Time of Sealing_ _ ft. <br />AQUIFER(S) <br />Single Aquifer ❑ Multtaquifer <br />Original Depth ft. <br />STATIC WATER LEVEL <br />Measured Date Measured ) ❑ Estimated <br />Numerical Street Addressor Fire Number and City of Well or Boring Location <br />WELL/BORING <br />Show exact IOCabOn o we or bor ng ap.ei wel or boring?` <br />in section grid°with "X:' location, showing operty <br />lines, roa , and b iidings. <br />N y <br />9 Water-Supply Well ❑ Env. Well <br />El Tempi Boring El Other. <br />_) <br />ft. [below Elabove land surface <br />CASINGTYPE(S) <br />, 1. <br />Steel ❑Plastic ❑Tile' ❑ Other ' <br />WELLHEAD COMPLETION <br />Outside: / Pitless AdapterNnit ❑ At Grade Inside: ❑ Basement Offset <br />/❑_Well <br />?h Mile <br />## <br />- -s <br />Pit ❑ Buried ❑ Well House <br />El Well Pit <br />El Other <br />❑ Buried <br />I 1 Mile <br />t.� s <br />El Other <br />For-temporary borings, provide additional location 14dCASING(S) <br />information, a site sketch, and geology on a separate page. <br />Di er Depth _ Set in oversize hole? Annular space initially grouted? <br />in, from -) toft. ❑ Yes rXo '' El Yds, ` [:1 No El Unknown <br />in. from to ft. El Yes ❑ No ❑ Yes ❑ No ❑Unknown <br />PROPERTY OWNER'S NAME/COMPANY NAMEy�� <br />O & - Z as <br />Property owner's mailing address if different than well location address indicated above <br />18212 om Blvid <br />Deepbavenj M 55391 <br />in. from to ft. ElYes ❑ No ElYes ❑ No [:1Unknown' <br />SCREEWOPEN HOLE <br />Screen from to IIIft. Open Hole from to ft. <br />WELL OWNER'S NAME/COMPANY <br />'NASsME o <br />B SJ & a �[1ie Heffes <br />,,,,O-BSTRUCTIONS <br />pO Rods/Drop Pipe El Check Valve(s) Debris El Fill El No Obstruction <br />rType <br />Well owners mailing address if different than property owners address indicated.above <br />f❑j <br />of Obstructions (Describe) <br />Obstructions removed? gYes ❑ No Describe <br />I <br />PUMP <br />❑ Not Present {Present, Removed Prior to,Sealing ❑ Other <br />Type, ,-- •y y.` , <br />GEOLOGICAL MATERIAL <br />COLOR <br />HARDNESS ORFORMATION <br />FROM <br />TO <br />If not known,' indicate estimated <br />formation log from nearby well or boring. <br />j <br />y r"METHOD <br />i <br />USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE <br />No Annular Space Exists ❑ Annular Space Grouted with Tremie Pipe + ❑ Casing Perforation/ReImovai <br />Casing Diameter <br />in. from to ft. ❑ Perforated ❑ Removed <br />in. from to ft. ❑ Perforated ❑ Removed <br />Type of Perforator <br />VARIANCE <br />Was a variance granted from the MDH for this well? ❑ Yeso TN# <br />GROUTING MATERIAL(S) <br />Grouting Material 'y r civ ° frofi = 40 yards f bags <br />from to ft, yards bags <br />from to : ft, yards bags <br />OTHER WELLS AND BORINGS '- <br />Other unsealed and unused well or boring on property? ❑ Yes XNo How many? <br />LICENSED OR REGISTERED CONTRACTOR CERTIFICATION <br />This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report <br />REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING <br />is true to the best of my knowledge. <br />DON SM' W DR1U. # ; =Ct 1.69.1 <br />Licensee Business N e License or Registration No. <br />y <br />ili F7e/iresentalive Signe `` Cethfied Rep No " Date ` <br />LOCAL COPY <br />H <br />3815 4 <br />f <br />Name of Person Sealing Well or Boring <br />HE -01434-17' ID# 53159 <br />it. <br />
The URL can be used to link to this page
Your browser does not support the video tag.