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Jfp^.. < . - M. » . <br />t.»* 1 <br />, A STATE OF MINNESOTA DEPARTMENT OF HEALTH <br />ABANDONED HELL RECORD <br />■. . <br />. (3 <br />U lOCATtO* Of fCLL <br />CotiAty «•»• <br />To^sntp ««•€ <br />MINNESOTA unique well NO. <br />(Ita«t blank If not known) <br />iennepin <br />Towntntp N <br />Long Lake <br />■© <br />117 or <br />S <br />lanot Ryaotr <br />C <br />22 <br />Stction Mo. <br />6 <br />fractloM <br />% % of H <br />4. UCLL OCPTH (coapltlto) <br />ft.115 <br />OaCt italtO <br />4/14/92 <br />Htll LoetHon or Olsunc* fro. to*« <br />845 Old Long Lake Road, Wayzata, MN 55391 <br />Rwatrtcal Strttt Addrtti and City of <br />tntfrttction <br />Show taact location of wtll <br />(In tedtiofi fHd with ’i*) <br />N <br />Uj <br />SktUN M9 «f «•<) locttia* <br />S. OtUING WTMOO (tf knoiM) <br />IQ C«b1# tool 40Uv#rfo TQOrtvtii IcQ 0«9 <br />;Q Hollow Hod SQAlr b Q Sor*d llQ------- <br />iQUotiry (Q Jolttd Cl <br />1 0 <br />a •1 1 <br />9 •a a <br />* • «« 4» • <br />••.• <br />••a a <br />• m • • •B « « <br />0 a 4 I <br />0 <br />•* •• ••aw <br />1 0 •• <br />I -kU <br />6. OBSTRUCTIOMS <br />Vtll obatniclfd Q Toi Ro <br />Obitniclicni rwowtd Q Yts □ R® If Obstnictlons cannot bf <br />rt«0«fd. contact KOH <br />be^orf leal(np. <br />2. PR0P£»n 0«ICR*S HA«£ <br />Joan Sweetser <br />Mailing Addrtii if difftrtne man <br />proptfty addrtfi indicattd aoevt <br />HARONCSS or <br />3, rORMATlON t06 COLOR FORMATlOli <br />If not kno%m, inoicatt foriMtion log fro« nt- wpll or ntarpy wtll. <br />•’‘sH ut -'S <br />i <br />. atWRtS. tUVOllON. sounck'of CAT* - CASIHtS «EW»tO. CASIKSS mfOAATW. ETC <br />I <br />Im <br />mmm <br />fe. <br />1.2 <br />* . <br />v^’'- <br />. ■'{ <br />0 •• <br />^nCUl AiAMDOKlO VUl tfC0«0 (May bt w»tO for rroptrly Tra«»far) <br />7. use <br />l^Oo-fftic C3 «o«<tor(ng BQ <br />:□ Irrigation SQ FubllC O <br />3Q Tfst Util 60 Hunic'loal IcQ Coointrcial <br />TQ Air Conditioning UQ , ___ <br />a. CASINC(S) <br />iQ Black 4Q Thnadfd O <br />rj^alv. SQWoIdtd <br />iQ Flattie {QStainlttt Stftl <br />2 115la. to <br />In. to <br />/t. <br />ft. <br />9. SCRCCR <br />)QJ Scrotnod wall fro* <br />n Open Wolf <br />ft. W <br />ft. to <br />ft. <br />ft. <br />(If known) <br />10. STATIC WATER UVCL <br />63 ft. f^oolow □ »0OY« / /I / /QO <br />land lurfact Cata htisurfd 4/ <br />U. weiLHCAO CCmplCTICM <br />iQ Fitleti Adaptor <br />2Q Basoi«tnt offltt <br />SS3-*" <br />Found Burlod <br />G------------- <br />12. CA0UTIN6 iNFOAMTIOH <br />JjJJ) N««t Ct<MOt 20 »«"toi*ltt Q <br />Grout •atonal Portland froM 0_toll5ft. cu. ydi^ <br />13. MEAfltST SOURCES OF CON TAM I RAT IQJI <br />2Q ftti south diroction sewer typt <br />Util dlslnftcttd bofort toiltng? X3 <br />14. FW# □ R o«>h #4 Rdt Froatnt <br />Typo: O Subiwrflblt Q ^-5- C «tc1procatlng <br />Jot QCantrlfugal fiQ ----------------------------------- <br />IS. EXISTING WELLS (Fltaio laotcn locatloni of iPandontd ano <br />•ctivo wolli In roourks faction or on back.) <br />Omor «miitd waU(i) on proparty? jJJ&at □ "• <br />Abandoaod: □ Famanoat □ Tawrary )Qj Rot kaaltd <br />17. WATER WELL CORTRAaORS CERTIFICATICR <br />Thii wall wai taalad wndar ay Jurisdiction and tMf raport <br />n trua to ma boat of wf knowladga and ballaf. <br />Bergerson-"Casvell t Inc> >27058 <br />Liconsoa luitnais RAO* LicoMa Mo. <br />Addrotf >ins Industrial btree^------- <br />............. <br />M«wa of Ori11 or <br />V