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I. lOUIIM or HIU i <br />STATE OF HIUMESOTA DEPAATICMT OF HtALTH <br />ABANDONED NELL RECONO <br />CORRECTED COPY <br />COMAtjr Hennepin <br />fmmthip Si <br />Orono <br />roMtMp Nuabtr <br />N <br />or <br />S117N <br />NINNCSOTA UNIQUf MU NO <br />(!••«# lURk If not Inom ) <br />Ningt Nuaktr <br />C <br />23W <br />StcUoA N o. <br />10 <br />FrtctiM <br />SW NW ME <br />NuatHcil SCrttt AdNrfii ba 4 CUy of Nfll locttlon or OlttOACt fro« toid <br />lAUrttcttOfi <br />940 South Brown Road Wayzata, IlN 55391 <br />Show tlNCt lociUoo of Vfll <br />(lo ifCtlON prU vltn *1*)SkfCCh MP of Mfll lOCBtlOA <br />1 • <br />- k R • a •• a V • w <br />«•Xi • <br />1 1 1 p <br />«••• <br />•R •f <br />• » •- r ■ • • <br />1 i 0 1 <br />••• <br />••• <br />1 » <br />r <br />S mi. <br />I miu <br />4. UCll OIPTN (CQNpIttPd) <br />ft.120 <br />Dot# mipd <br />06/19/91 <br />S. OliUIM ICTNOO (If kfiM) <br />iQ C bd Io tool 4Ott«0rM iQOrlvoo lOQ <br />CD Mollov lod IQ___ <br />d iociry fQ Jiltoi d ^**9*'’ <br />6. OISTRUCnONS <br />Moll okitructodQ Til Q No <br />OOstructlOAi roflovfd Q Yfs Q Nt If ooitrvotlooi COAAOt Of <br />roflovtd. COAUct NON <br />fctfort tiillNg. <br />f. use <br />iBOOMitU <br />d ^9UIOOlOf Id — <br />2. MOfCiTT QNNCS'S fUMf <br />Carol Senn <br />NAlIfng Addrtsi If tfifffrtnt thin <br />proptrty idOrotl InOiCAltd Abovt <br />940 South Brewn Road <br />Wayzata, MN 55391 <br />naroncss Of <br />fotwrioa 106 coio* formiioii from <br />If not knovA. inOtCAtt fonMlion log freo nt« Mill or ntirOy «ifll. <br />II. aCNklkS. CICVATION. SOUkCf OF DATA . CASINOS ICHOVCO. CASINGS PtNFONATfO, CTC. <br />8. CAStNO(S) <br />iQ llAck 40 YNrfAdod <br />3 lA. to <br />lA. to <br />,fl. <br />ft. <br />9. SCRCCN <br />(S ScroontO tool I froa <br />Q OpoA Nolo <br />ft. U <br />ft. to <br />ft. <br />ft. <br />(If kAOvA) <br />10. STATIC UAfCR LfVIl <br />30 ft. ffll OtIOM QkNONt <br />IkAd lurfACO Otto NBAtyrod 06/19/91 <br />II. UCLLHCAO CONPLCTION <br />d PItItlS Adiptor <br />d 94kN"N"T OffSOt <br />d Ntll Pit <br />d ^NoAd lorfod <br />a- - - <br />12. G80UTIN6 INPORIIAriON <br />iQNAAtCtAdnt d^AAtOAlto d <br />Grout AAtirtAl 4 baCjS froa Q tpl^Qlt.cu. jdt, 2^ <br />13. NEARCST SOUiCiS 0^ CONTAIIINATION <br />fttt __________ dIroctlOA <br />ucll dlkiAftctid kdforo idillAff Q Yoi <br />14 ?UHP QktAONtd □NotPrtkOAl <br />l/pf d Sut«niOlt d‘►•i- d <br />d Jit d ^ <br />IS. UISTING MCUS (PIdkM fkttcN locdtlOAt Of tNAAdOAdd AAd <br />•ctlvA »oIIb Ia rtMrki itctlOA or oa kick.) <br />Othtr uAuttd AAll(s) OA proportyl O Q No <br />Ac*n<iontO; pi PoraiAAnt Q TiOipAriry Q Not ttiltd <br />IT. WATCN NCLl CONTNACTOaS CCaTIPICATIOi <br />Tau rra II mi tMifd uAdtr a/ jurtidIctlOA OAd tkii rtport <br />n iruf to lAi bolt of ajr kAoaltdgt AAd btliff. <br />Stevens Well Drilling_ _ _27194 <br />pfPIClAi AIANNONCO yCLL ICCQ8D (Nky kt ultd for Propdrty Triiufor) <br />I rii# mn om <br />•attcTWaav 12 westICdAld No. <br />1»®1 55359 <br />Dick Stevens <br />n.f 06/19/91 <br />’#RU ”o?7I575T <br />Noao of IHIIor <br />I