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STATE OF MINNESOTA DEPARTl�NT OF NEALTH --- � ABANDONED MELL RECORD 1. LOCATiON OF YEII _ M(�aE� blankNfvnoE known)N�• co��cr N... Hennepin Tawnship Nur Towishlp Nu�Wr R�ng� Nwiber S�ctlon No. Fraetlon ,� 4. YELL DEPTH (Cop1�L�d) D�t� s��l�d N E , .�4 ,4 ot. �OI10 117 Sr 23 Yr 17 �W �� /� tt. ///((��� Nunrtul Street Addnss and Lity of W11 Location or Dist�nc� frow Road 5. DRILLIN6 NETN00 (1f knwm) [ntersectton 1�Gbl• Woi 1[�R�wrs� 7[�Or1v�n 10(]Duy 2189 Shad�wood Road Wayzata, NII�i. 55391 zp iw�io., n,a 5[�Atr ep ao,�.a i�p Show exact ix�tlon of 4e11 3❑�L�rY 60 Jett�d �Powtr Aug�� � (in settton grid ritA •X") Sk�tch ap of wtll loutlon � N -t 6. OBSiRUCTI0N5 ��� � Mel l obstrucqd Q 1'ts No _ � _ _ - ._ ._. �- • Obstructtons n�owd Y�s []No If obstructlons c�nnot b� � ' p n�ov�d. contut MDH � � � �de�✓s `3�, �tors suliny. M - - -- -I- - E • � ('��t.,.�e u fi (``''� 7. USE , � ` y w. 1 I a 1�(Do�es'tit �Monitor/ng �Heat I.00p , , � •� �--- `�- Tc �_ . _.,.. _.,.. ..... I 2[�Irrigatton 5�Public 9� Industry � ' ' ' ' 1 3p r.:e ►k» �►w,���ia+� iap co.�...nt,i � ►--1 .iL-a 7[]Atr CondiNonteg 110 � 2. PROPERTY OYNER'S NAME Ma111nq Addr�ss if dlffer�nt ihan 8. LASlN6(5) M property addnss tndlut�d abow 1[�Bluk IQ Thry�d�d � t�� 1 � Scott Eaton SAME ��''�• '�'"1did � �]Plastic ED Stainl�ss St�el � � HARDNESS OF E 3. FORMATION l06 COLON FOkINTION FROM TO ��• � 1 5 ft. It not known, indlc�te fonytion log irwi n�w wil or n�arDy w�ll, in, to ft. - Dr if t 0 19' 9. scr�� �s�r..n.a r.11 rro. 1'S tc. co 1 9 rc. � - (If known) � ❑Op�n Npl• fra�_ft. to ft. 10. STAT(C WTER LEVEL � i � ft.�b�low [�aDow � /� �� I l�nd suMau Datt IM�sur�d ; � 11. YELLHEAD COMVlETION f 1�P1tl�ss Adapt�r �Found Buried � 2Q Bas�nt off��t 50 � �Wll P1t � 16. REMARKS, ELEVATION, SOURCE Of DATA - CJISINGS IIEMDYED. CASIN65 PERfORATED, ETC. 12. 6ROUT2N6 INFORINTION l�Nt�t Cpent �B�nWnit� � ; i Grout 5" Well Approx. 19' deep c��c..a�,,� t►o. /7 co�` rc. ��. ya: � 4 Bags Cement — --- � 6 LI�S. �I1tOT-11Ce 13. MEIlREST SOURCES OF CONTAN[►�ATIOM { 2 Men, Labor, Rig and Cement Grout P�np — r�•t a,�c,� c,�, � 1b11 disinf�ettd b�fon tuli�f �Y�s j E • � 14. PUIIY �flpwwd �Not ►ns�nt { � Typ�: 1�SubMrslbl� ��,s, Turbin� �R�efprouting f � 2Q J�t {�GntMfugal 60 � , �15. EIISTINB MELLS (Pl��s� sic�tch loc�ttons of abandon�d and � atttw w�ll• ta rw�rks NCLton or on b�ck.) F Oth�r unut�d w�ll(s) on prop�rtyT �Y�s �,No Abandon�d: �►�nyntnt �TNporary �Not s��l�d E i 17. WATER YELL CONTMCTORS CERTIFIGTION This w�ii ws stal�d under q �uNsdiction and tMs roport �f`�ru � '1 �„gv'�. 1S Lrllf to th� b�st of qy knowiedy� and W11ef. .,.,.., DON STODOLA WELL DRILLING CO. , INC. � lleens�� 9usin�is NaM Ltc�es� No. 1 Addr�ss 15 06 . 7 Minnetonka I�V. 5 345 � s,y�.e -- , o.e. 1-�6-92 � Mark G. St� o a Ta�. 1-16- 2 FFICIAL ABANDONEO MELL RECORD (N�y h� us�d for Prop�rty Tnnsftr) Nw o1 Dr/11�� ZJ�Td/Ts llld IIIITd Q3dD