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STATE OF MINNESOTA DEPARTI�NT OF HEALTH <br /> ABANDONED MELL RECORD <br /> 1. LOCATION OF NEII M(.,E• Olaak NfQnot know�)NO. <br /> County Nase Hennepin <br /> Townshlp Maw� Townshlp Nwber Rang� NuwDer S�ctton No, Frattton �. YEIL DEPTH (co�plat�d) Wt� s�aled <br /> N <br /> QY'OT10 117 or 23 y� 2.� �4 S�' o�y � �� ft. �a � � ' I � � <br /> S <br /> Nuwrlul Str�tt Addr�ss ind C1ty of IN11 loutton or Otst�ne• frow Ro�d 5. DW(L�IN6 METHO� (11 knwm) <br /> Int�rsectlon ' If�Cabl� tool 1�qtv�rs� 7[�Driv�n 10(]Duq <br /> 2693 Kelly Ave. Orono, Mn. �p Hoiio.� Roa 5[lA1r �Borod iip <br /> Show exact locatlon of w�il <br /> �Rot�ry 6�J�tted �power Auy�r <br /> (in sectlon qrid rlth "%•) Sk�tch wp of wll locatlon 6. OBSTRUCTIONS <br /> N � Yelt ob:sevct�d� : ❑ No <br /> _ � . _ . ._ _. (1 Obstruettons n�o�Y�s []No If oEstrvcttons cannot be <br /> � • � — ►ywovW. contut MOH <br /> ►+ - - - ' -I- ' - E �` �:..,,�9. <br /> .. <br /> . � �► <br /> � � � = T � 7. USE <br /> - - -� y.�, �' ' � �Dwrstic �MonitoMng �Neat Loop <br /> ' ' , ' I �e � 2[]Irrigattoe 50 Publlt �lndustry <br /> ..�. . .�. _.,.. _ . � F <br /> ' S ' � ` 3p T.:c wll bp 1M,etcip.l lf�co...rct.t <br /> �----1 .iL--� 7[]A1r Conditloninq ll[� <br /> 2. PRO�ERTY OMNER'S NAlff Mailing Addrexs it dtfferont than @. SIN6(5) <br /> property addnss Tndluted abov� �Black �Thnad�d 7[] <br /> Kate Perry 110 Bank Street S.E. �CI�+��• SC1 w��a <br /> Minneapol is, MN. 55414 3p Pi+:c+� 6p sa��i.:s sa.i <br /> HAitONESS OF <br /> 3. FORMATION �06 COLOR FOiGNTION FROl1 TO in. Lo 1 46 ft. <br /> If not known, 1ndlcat� fonwtion loq fro� n�w w�ll or ntarCy w�ll. 1n, to ft. <br /> Ilrift 0 150� 9. SCREEN 1(}(j 150 <br /> �sen.ew r.tt rro._rs. w_ rc. <br /> (If known) <br /> �Op�n Hol� fro�_ft. to__ ft. <br /> 10. STATI�MATER LEYE� <br /> �� ft. b�low []�bow <br /> land su u OaU Measund � � <br /> I1. LIHEAD COlpLETIpN . <br /> 1 pltl�ss Adapt�r �foued Buri�d <br /> ?Q Bas�nt offs�t '� <br /> 3[]IM11 Pit <br /> 16. REMARKS. ELEVATION, SOURCE OF DATA - CASIN6S RENOVEO, WISiNGS VENf01iAiED. ETC. <br /> 12.Y�AOyTIN6 INFORlMTION <br /> �� � �;4`tN�t Cu�nt 2[]B�ntoMt� � <br /> Grout 4 Wel l Approx. 150 Deep 6rout ..aMal �.o.�`.�bwQ ft. tu. yds <br /> 12 Bags Cement — <br /> 14 Lbs. Bentonite — — <br /> 2 Mer�, Labor, Rig and Cement Grout Pump 1�. �►�sr souacu oF coNru�i�ur�o� <br /> _ fqt dir�etton LYp� <br /> Mell dlslet�ctW i�fon swllnqt [J Y�s <br /> • 14. PUMP Ruiowd (�Not Pns�nt <br /> TYM: u]I��ub�rsibl• �l.S. TurDin� �R�ctprouting <br /> r-- � <br /> ' 2Q det �GntNfugal 6� <br /> � � � ' 15. EXISTIN6 NELLS (Pi�as� sk�tch loeattons of aEandoned �nd <br /> actire w�lls in n�arks s�c ton o� on b�ck.) <br /> Oth�r ueu t(s) on prop�rtyT �Y�s No <br /> Abandon�d��rs�e�nt �Tuporary ���t�d <br /> 17. WTER WELL CONTRAGTORS CERTIFIGT(ON <br /> ��knJ 2 4 .�.v`vM Th�= �+e>> ws suled undar sy Jurlsdictton and tMs report <br /> 1s true to the b�st of sy knorl�dge and beltef. <br /> � - DON STODOLA WELL..DRILLIDIG C0. INC. <br /> u�.��. a�:i�.,: n,.. �t�.�:. rro. 2 1 <br /> aaerys:15306 7 M' 45 <br /> � siyn•a— _ ' � au 1 _1 �- <br /> Mark G. Stodo`la aa�12-1i- <br /> FFICIAL ABANOONEO YEII RECORD (May be us�d for Prop�rty Tr�nsl�r) Nwe o1 pr411t� <br /> IIQKRTIII�'s PIId MITd �iD <br />