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STATE OF MINNESOTA DEPARTi�ENT OF HEALTN <br /> ABANDONED MELL RECORD <br /> i. �au►itaM or rEu MINNESOTA UNIQUE MELL N0. <br /> � (luw Dl�nk 1f not known) <br /> County Naar ��e � <br /> TownshiD Nawe Township Numbe� Nanye NuaDer Section No. Fryett`o' y 1. 11ELL OEPTH (ewpl�t�d) D�te s��l�d <br /> N <br /> ���n� 117 S� 23 yr �S E' � � 1� ft. /�/���/ �� <br /> J <br /> Nwaarlcal Street Aadress end Ctty o/ Y�I1 Loc�tton or DisNnce froa Rpad 5. ONILLING METNOD (if known) <br /> (ntersettton �Caple tool 1�Wv�rf� 7❑Or1wn 1�Oug <br /> 175 Landmark Drive Orono , �"°��°"' p�a 5OA1r ep eorya ►ip <br /> 3�Ibt�ry 6�J�tt�d �]Vowr Auq�r <br /> Shor exut locatton o1 rell <br /> (tn stttton 9rid wlt� "%"J Stetch eyp of wetl locatton 6. 08STNUG7ION5 <br /> N r � Vkll ODstrutt�d�Y�s No <br /> _ � _ . ,_ _� Obstructtons n�ored Y�s ❑No If oCstructlons cannot be <br /> ' i n�ovld, COnNtt MDH <br /> fore s��11nq. <br /> M - - - � • -I- - E � <br /> . . ' � �� � <br /> ._ , . , T �� 7. U�SE <br /> • �� y,R. 4 � 1DCiDowestic �Monitorinq �Xe�t loop <br /> � ,�y �-{• <br /> ' ' ' I V[ Q/ 2�Irriq�tlon 50 Vubltc � Industry <br /> ..�. . �.�. _.� . 1 � � ap re:c w.ii ep M,��c�p.i iap ca..�c�.i <br /> r.____�.1 Sv— � � 7[]A1r Coeditlontny 11[j <br /> I <br /> 2. PRODERTY OYNER'S NAME . Mailing Address if different tnan 8. CASING(5) <br /> property addnss indicated aDove 1�Black �Thr��d�d 7[] <br /> z�j w��. ep w�aa <br /> Lee Harren 205 Lindawood Iane, Wa zata �P��=�+� �7 se.,��.:: sc..i <br /> 3. fORMATION �OG COLON �FONINTIpNF iROM TO r� tn, to�ft. <br /> If not known, fndtc�te forallon loy troo n�w wtl or nearby r�ll. 1n, to ft. <br /> ��� 9. SC EEN . <br /> �Scrt�nW wll f►o� 'y��1t. WJ.��,tt. <br /> ([t known) <br /> �Op�n HO1� fro�_ft. t0_ ft. <br /> 10. STATlC WiER LEYEL <br /> -'!� — ft. D�lor �a0ov� <br /> l�nd u f�ce D�q IMisund, .1 -/�-� <br /> 11. MELLMEAD COMVLEI(ON <br /> iQ V1tl�ss AMPtt� �found Buritd <br /> 2[]8as�wnt offstt � ' <br /> �]WI1 P1t <br /> 16. aEMAit[5, EIEYATION, SOUNCE OF OAtA - CASINGS aEM0YE0. CASIN65 PERFORATEO, ETC. <br /> 12. G�iING INfORINTiON <br /> N��t C�nt 20 pntoMt� �] <br /> � Grout Well at 175 Landmark Drive,DY'OTl�O Grout aut�rl�1 froe�ot tt. cu. yds <br /> , Grout 2" Well Approx 35' <br /> 3 Hours Labor — — <br /> 3 Bags �IT�Llt iJ. NEAfiE5T SOURCES OF CONTAMINAT20N <br /> 1 Bao Bentonite _ ra.e a,ncc,ue ��.c.�iv�-� ,t!cro. <br /> M�I1 disinf�cted Defore s�aling} []Y�s <br /> 1�. DUMY �Reeov�d IA Not ins��t <br /> /��� <br /> ' iype: 1[I Suhrrsf0l� �l.S. TurEine �RecSprouting <br /> � 2Q J�t �Gntrlfuy�l 6[] <br /> IS. EXISTIN6 YELLS (Pl��s� skete� locatlons of abandon�d and <br /> �ttiv� M�llf in rwres 1�CN On 0� 0� Datk.) <br /> Oth�r unused NI1(s) on prop�rty? �Y�a No <br /> AOanAon�a: �P�nwMnt �Twpora�y � t se�ltd <br /> 11. MATER MEII CWITRACTOIIS CERTIFiCATION <br /> Thts welt ws ualed und�r�y Jurisdtctton and t�is report <br /> Is tru� to CM best of ey knoritdye and Delt�f. <br /> DON STODOLA WELL I�ILLI�IG C0. INC. <br /> Litenf�� Wttn�ff Nur 1 72 Ltttns� No. <br /> Addr�st 1 5 Mt <br /> Stqn�d D�t� <br /> ct o a o,�. �,- 1`f <br /> FFICIAI AWIOOMED YEIL ItECORO (1Yy Ot uftd for /roplrty Tr�nfftr) N�� of DH11�r <br /> ZI1Q171Ii's llli NITS ARSD <br />