Laserfiche WebLink
WELL OR BORING LOCA710N MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 10 7114 <br /> Counry Name <br /> WELL AND BORING SEALING RECORD Mennle90 aoUnique No. <br /> Henr�e #.Fi Minnesota Statutes,Chapter f031 or W-series No. <br /> P (Leave blank if not known) <br /> Township Name Township No. Range No. Section No. Fraction(sm.�IgJ Date Sealed Date Well or Borin Gp�structe �'� <br /> Orono 117 23 7 � � � 7/3A/95 S�Y <br /> Numerical Street Address or Fire Number and City ot Well or Boring Location <br /> 1390 Par� Drive DepthBeforeSealing 7� ft. OriginalDepth � ft. <br /> Show exact location of well or boring Sketch map of well or boring AOUIFER(S) STATIC WATER LEVEL <br /> in section grid with"X". � j location, showing property ingle Aquifer ❑ Multiaquifer <br /> ���� lines,roads,and buildings. <br /> N WELUBORING [�vleasured ❑ Estimated <br /> � � � � [�Water Supply Well ❑Monit.Well <br /> -�-- --;-- --;-- <br /> ❑ Env.Bore Hole ❑Other �ft. $] below ❑ above land surface <br /> yy --�- -Y- --;-- --;-- E CASING TYPE(S) <br /> � � � <br /> --�' -�-- -�-- --�-- � � X € [�6teel ❑ Plastic ❑Tile ❑ Other <br /> %mile � <br /> -�-- -�-- --�-- --�-- � ��—� CASING <br /> Diameter Depth Set in oversize hole? Annualar space initially grouted? <br /> llL""" S ""�J"" �f� <br /> �w---t mi�e�s, � in.from�_ to�y ft. ❑Yes [�No ❑Yes ❑No ❑ Unknown <br /> I I <br /> PROPERTY OWNER'S NAME in.from _ to ft. ❑ Yes ❑No ❑Yes ❑No ❑ Unknown <br /> Property o ner's mailing address if different than well location address indicated above. in.from to ft. ❑ Yes ❑No ❑ Yes ❑ No ❑ Unknown <br /> SCREEN/OPEN HOLE <br /> Screen from�_to�.� ft. Open Hole from to ft. <br /> O B ST R U CT I O N/D E B R I S/F I L L <br /> WELL OWNER'S NAME [�Obstruction ❑ Debris ❑ Fill ❑ No Obstruction <br /> Well owner's mailing address if diflerent than property owner's address indicated above. Type of Obstruction/Debris/Fill . <br /> Obstruction/Debris/Fill removed? [�Yes ❑ No <br /> PUMP <br /> Type <br /> GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO � Removed � Not Present ❑ Other <br /> FORMATION <br /> If not known,indica�e estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: <br /> �No Annular Space Exits <br /> ❑ Annular space grouted with tremie pipe <br /> ❑ Casing Perforation/Removal <br /> in.from to ft. ❑ Perforated ❑ Removed <br /> in.from to_. ft. ❑ Perforated ❑ Removed <br /> Type of perforaror <br /> ❑ Other <br /> GROUTING MATERIAL(S) <br /> GroutingMaterial a�+r+�� ++�a from �_ to� ft. yards _� bags <br /> from to ft. yards bags <br /> from to R. yards bags <br /> trom to ft. yards bags <br /> REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS <br /> Other unsealed well or boring on property? ❑ Yes '�No <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 is <br /> true to the best of my knowledge. <br /> R.E..S. W��ir-nrilling 27276 <br /> Contractor Business Name License or Registration No. <br /> � �-_ ,� � � / �, 1 <br /> i_�._ , !f�.. '�_ 1'e' %�'1/ �(L,.. <br /> Authorized Representat�ve$ign'atar�' Date <br /> i <br /> '- �C��i' '}j�-� ��� .!� CL— <br /> Name ol Person ling Well or Boring <br /> LOCAL COPY �"� ? 0 7 � �. 4 <br /> HE-01434-02 10/95R <br />