Laserfiche WebLink
MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 413680 <br /> 'WELL OR BORING LOCATION Sealing No. H <br /> County Name WELL ANDBORING SEALING RECORD Minnesota Unique Well No. <br /> H ENNEPIN Minnesota Statutes,chapter 1031 4 i or W-series No. <br /> (Leave dank if not known) .- <br /> .Township Name Township No. Range No. Section No. Fraction(sm.—.lg.) Date Sealed Date Well or Boring Constructed <br /> . ORONO _ ' 117 23 03 SESENW 'A 11/5/2024 <br /> GPS LOCATION—decimal degrees(to four decimal places) <br /> Latitude Longitude Depth at Time of Sealing 131 ft. Original Depth ft. <br /> • AQUIFER(S) STATIC WATER LEVEL <br /> Numerical Street Address or Fire Number and City of Well or Boring Location.. ,XJ Single Aquifer ❑Multiaquifer <br /> 325 DROWN 'RD. ,ORONO,MN. 553 6 WELL/BORING ®Measured Date Measured 1 1/S/?IL ❑Estimated <br />;! 11 Water-Supply Well ❑Env.Well <br /> Show exact location of well or boring Sketch map of well o boring 'f <br /> in section grid with"X° location,showing p( rty ❑Temp.Boring ❑Other 2 ^2 ft. 7❑below ❑above land surface <br /> - N lines,roads,and bui ings. CASING TYPE(S) <br /> ^]Steel ❑Plastic ❑Tile ❑Other <br /> —I-- - ' WELLHEAD COMPLETION - <br /> w E <br /> Outside: ❑Pitless Adapter/Unit ❑At Grade Inside: 111 Basement Offset <br /> /Miler I ❑Well Pit ❑Buried • ❑Well House <br /> 1 : <br /> ❑Well Pit <br /> s ❑Other <br /> ❑Buried <br /> I--1 Mile r - <br /> ❑Other <br /> For temporary borings;provide additional location CASING(S) - r. , <br /> information,a site sketch,and geology on a separate pa.: Diameter Depthy *� _ Set in oversize hole? Annular space initially <br /> PRO E TY WNR'S AME/COMPANY NAME 4 in.from I to 123 ft. ❑Yes ❑No ❑Yes ❑No 41 Unknown <br /> Property owner's mailing address if different than well location address indicated above in.from to _ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown <br /> in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown <br /> SCREEWOPEN HOLE - - - <br /> -WELL OWNEyRa'S NAME/COM1l•PANY NAME Screen from" `-to 13'1.. ..--ft. ;Open Hole from to ft. • <br /> HARALR ED LLC OBSTRUCTIONS <br /> Well owner's mailing address if different than property owner's address indicated above ❑Rods/Drop Pipe•_. :❑Check Valve(s) ❑Debris•-'1,;❑Fill 7.-IIII No Obstruction .. _ - - <br /> Type of Obstructions(Describe) , <br /> Obstructions removed? ❑Yes ❑No Describe <br /> . .. _ _ - - PUMP <br /> GEOLOGICAL MATERIAL', COLOR HARDNEss DR FROM . TO <br /> FORMATION ij Not Present ❑Present,Removed Prior to Sealing ❑Other <br /> If not known,indicate estimated formation log from nearby well or boring. `-. Type - <br /> DRIFT ` 1 1-31 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE <br /> - if No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal <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? ❑Yes /i I No TN# <br /> GROUTING MATERIAL(S) - .. <br /> ,,• - Grouting Material NEAT- CEMENT from to_1.31 ft. 'yards,.;_ bags <br /> ' f from to ft. yards bags <br /> l Y <br /> I from to ft: yards bags ` <br /> ' OTHER WELLS AND BORINGS <br /> I <br /> i Other unsealed and unused well or boring on property? :❑Yes Til No How many? <br /> ' LICENSED OR REGISTERED CONTRACTOR CERTIFICATION <br /> I REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING • This well or boring was sealed in accordance with Minnesota Rules,;Chapter 4725.The information contained in this report <br /> I is true to the best of my knowledge. I <br /> I ;mot. <br /> DON STODO A• WELL DRILLING CO,; ,INC. 1691 <br /> Licensee Business Name - - ). - License or Registration No. <br /> 5/24' "ed e'R resentative ignature r/V/ , ' , <br /> 9 Certified Rep.No. Date <br /> FH <br /> 4 JERRY BARR .. _. <br /> . LOCAL COPY _. H 413 6 8 0 <br /> Name of Person Sealing Well or Boring' - <br /> - HE-01434-17 ID#53159 -:4 ; : 11/19R <br />