Laserfiche WebLink
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH No. and Boring H 244420 <br /> Sealing <br /> County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. <br /> Minnesota Statutes,Chapter 1031 or W-series No. <br /> y��,t� a..Y.artrnarm..,) <br /> Township NemB A Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed <br /> Orono 118 23 35 41-OiO2 '" ' 73 >-F Q elf. <br /> GPS Latitude degrees minutes ' <br /> LOCATION: Depth Before Sealing /,30 ft. Original Depth ft. <br /> Longitude degrees minutes seconds MOWER(S) STATIC WATER LEVEL <br /> Numerical Street Address or Fire Number and City of Well or Boring Location Aquifer 0 Multiaquifer <br /> WELL/BORING Cbtheasured 0 Estimated <br /> • !, 7. ¢ • .• Nater Supply Well ❑Montt.Wel <br /> ng <br /> m section grid with'X" location,showing 0 Env.Bore Hole 0 Other ft. R/below 0 above land surface <br /> N }� Iphes 'a • CASING TYPE(S) <br /> i 1 jSteel 0 Plastic 0 Tile 0 Other <br /> W E WELLHEAD COMPLETION <br /> 1 I 1 Outside: ElWell House Inside: Basement Offset <br /> 1 1 1 I Uwe -.-t.:-.1 Pitless Adapter/Unit 0 Well Pit <br /> 1 0 Wet Pit 0 Buried <br /> S <br /> 4 r mrr I ❑Buried <br /> PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) <br /> Diameter <br /> . DepthSet in oversize hole? Annular space initially grouted? <br /> PrXdie� �affitd(erent5v igatine1in.from ) <br /> to /2 ft. ❑Yes 'lo ❑Yes 0 No 0 Unknown <br /> in.from to ft. ❑Yes ❑No ❑Yes ❑No 0 Unknown <br /> in.from to ft. ❑Yes ❑No ❑Yes ❑No 0 Unknown <br /> WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE <br /> r I <br /> Well owners mailing address if different than properly owners address indicated above Screen from /26p to /36 ft: Open Hole from to ft. <br /> OBSTRUCTIONS <br /> X Rods/Drop Pipe ❑Check Valve(s) 0 Debris 0 Fill 0 No Obstruction <br /> Type of Obstructions(Describe) Wen") frau6 j a i 4r1.1</;'S <br /> ESS OR <br /> GEOLOGICAL MATERIAL COLOR �FORNMp FROM TO Obstructions removed? NYes 0 No Describe <br /> If not known,indicate estimated formelon log from nearby well or boring PUMP �°'�, <br /> � <br /> '` tr_�� Type ST Pi w m D <br /> `�-' r V -� VRemoved <br /> 0 Not Present 0 Other <br /> / METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BOREHOLE: <br /> *No Annular Space Exists 0 Annular space grouted with tremie pipe 0 Casing Perforation/Removal <br /> in.from to ft. 0 Perforated 0 Removed <br /> in.from to ft. ❑ Perforated 0 Removed <br /> • <br /> Type of perforator <br /> ❑ Other <br /> GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one beg of bentonite=Me Ars.) - .. `?`, <br /> Grouting Material.4/4/49-‘74_!i"`�C/T from_to )p ft. yards 3 bags <br /> from to ft. yards bags <br /> from to ft. yards bags <br /> OTHER WELLS AND BORINGS <br /> REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? 0 Yes X No How many? <br /> UCENSED OR REGISTERED CONTRACTOR CERTIFICATION <br /> This well or boring was sealed in accordarde w lth'Minnesot Ruled,Chapter 4725.Tim informaton "contained In this report is <br /> true to the best of my knowledge. <br /> + .. s 'N—ld 0 Drilling Co., <br /> orb T s 27172 <br /> Corgi BuiassmRegis <br /> tation No. <br /> s.ejnkr 3-IP"-AP 4:7<' e,'1 7 c:;,62 <br /> t1v Dare <br /> LOCAL COPY H 244420 ''s,s. i f.' ,,nm-' <br /> Name of Person Sealing Well or Boring <br />