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STATE OF MINNESOTA DEPARTMENT 'OF HEALTH <br /> ABANDONED HELL RECORD <br /> l. LOCA7fON OF YELL • MINNESOTA UNIqUE WELL N0. � � r <br /> (le�ve bl�nt tf not known) 1� � <br /> County Naow Henne in <br /> Township N�ne Townshfp NumDer Range Nunber Section No. Fraction 4. MELL DEPTN (cowpleted) Date sealed <br /> N E k 4 of y <br /> ��Ll� ��/ $r L3 Wr �� � � ft. � V I�� � 1� I <br /> �Numerical Street Address and City of 41e11 Location or Otstance frow Road 5. ILLING METH00 (if knovm) <br /> Intersection �CaGle tool 40 Rewrs� 7[]Driv�n 1�Dug <br /> � <br /> 1860 Shadywood Road Orono, i•uv 55323 �O�>>� aaa 50 A1r ap so��a iip <br /> 30 Rotary 60 J�tted �Poi+er Aug�r <br /> Shor exact location of well <br /> (in sectton 9rid �ith "X") Sketth map o wll locatlon 6. OBSTRUCTIONS <br /> M Well oDst�vtt��Y s No <br /> _ � _ _ : ._ _. Obstructlons r v d Y�s �No !f oDstructlons cannot Ce <br /> � ' rewoved, cont�tt MOH <br /> W ' • - • • -I- - E before s��lfng. <br /> , � ' : ` j r,►� 1. SE <br /> - y.,�, � �Donestic 1�MonitoNnq �H�at Loop <br /> .� ; ! I 2� Irrigation 50 Publie 90 Industry <br /> ' S 1 � 3[]Test W�11 60 NuM cip�l 1C0 Conw�rcl�1 <br /> ►--1 +iL--� 7[]Mr CondltfoMng 13C1 <br /> 2. PROPERTY OWNER'S NAME Mailing Address if dtfferent than B. LAS N6(5) <br /> property �ddress tndtuted above �Black �Thrad�d . 7L1 <br /> T� r�( <br /> 2[]Ga1v. 5[]Wlded <br /> lark JOhnson SAME 3[]Piastic ep se.i�i�:: sc..i <br /> rueoness ov <br /> 3. FORMIITION LOG COLOR FOfUMTION FROM TO ��• � �O ft. <br /> If not known, indicate formation log irow ntr well or nearoy wll. 1n, to ft. <br /> Dr i f t 0 94 9.\scgE� p <br /> r�Scr�tn�d wll fro� 1� ft. W� ft. <br /> �� (If known) <br /> ❑Op�n Hol� fro�_ft. to_ tt. <br /> 10. STATI Y'^ATER IEVE <br /> . �ll fL. �IOM ���OV! <br /> t�nd�c� Oat� lM�sured �� .�. <br /> 11. YELLHEAD COMPLETION <br /> 10 P1tl�ss Adaptar q]Found Burted <br /> Base�nent oltsK � <br /> W�11 Pit <br /> 16. REMARKS, ELEVA7ION. SOURCE OF DATA - CASINC,S REMOVED, CASINGS PERFORATED, ETC. <br /> 12. RO TING INFOWNTION <br /> Neat Ce�ent 2�BenWMt� � <br /> �TOUt �+�� Well 94' Deep. erout oater�a� tro�`��to b tt. �u, ya: <br /> 8 Bags Cement — <br /> 10 lbs. Ber,�cnite — — <br /> 2 Men, Labor, Rig and Cement Grout P�p. 13. NEAREST SOURCES Of LONTAMINATIOM <br /> _ f��t dtr�ction typ� <br /> Ikll dislnf�ttW b�fon s��11ng1 � Y�s <br /> 11. PUMP Raov�d �Not Yns�nL <br /> Typs: 1 Suhw�rsibl� �']L,S. Turbin� '�Reciprocating <br /> -'� 20 J�t �C�nt�ifuyal 60 <br /> ; �� <br /> ` ,.��� �� 15. EXISTING MELLS (Pi��s� sk�tc� louttons of abandoned and <br /> �� +et1w wlls tn n�ark: uc o or on back,) <br /> Other unu 11(f) on prop�rty7 �Yes No <br /> _•..-- Abandoned: P�rwanent �Te�porary ���al�d <br /> 17. VIATER WELL LONTRALTORS CERTIFICATION I <br /> This well was sealed under my JuH sdiction and tM s report <br /> is true to th� best of my knowledge and b�lief. <br /> ' �-� �,'�;';' DON STODOLA WELL DRILLING CO. , INC. I <br /> .• [. �... .J ... . <br /> Ltcens�� Bustn�ss Nu� �7��� Lic�nse No. <br /> Addrtss 1530 Hw M' eton a, 45 <br /> s+a�• ac. 10-21-92 <br /> � 1 au ��- - <br /> FFiCIAI ABAUpONED YELL 0.ECOItO (May b� us�d for Vroptrty Tr�nsfer) Nawe of Or111e� <br /> LIfE'dtT1192': IIId IIIIT9 OdBD <br />