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