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41RIC Ur nlmw.*WIA WrAKIMRI Ur 11CALln <br /> ABANDONED HELL RECORD <br /> 1. LOCATION Of TELL MINNESOTA UNIQUE WELL N0. <br /> (tea" blank if not known) <br /> Canty N'me Hennepin <br /> Township Rem Township Number Relive Number I Section No. Fractionof y a. WELL DEPTN (completed) Date sealed <br /> N <br /> Orono 11811 i 23W Wr 33 SW sillS11 168 1t. 06/17/91 <br /> Numerical Street Address and City of Rall Location or Distance from Read S. DRILLING METHOD (if known) <br /> lateroactlon 10 Cable tool 4[3 averse 713 Driven 1013 Dug <br /> 3140 Watertown Road Orono 20 Mallow Rod E]Air 113 Rend 1113 <br /> Show exact location of wall 313 notary 613 jetted 113 Power Auger <br /> (in section grid with •X•) Sketch map Of well location <br /> 6. OBSTRUCTIONS <br /> We11 obstructed 13 yes ® Me <br /> If obstructions cannot be <br /> -; Obstructions removed p yes 0 Ne <br /> i removed. contact NDN <br /> M - -•- •�- - E before.1a1109. <br /> • 7. USE <br /> T <br /> - •- y,�. 129 Domestic C1 Monitoring 43 Neat Lamp <br /> x4 - _ go Irrigation '.13 Public 90 Industry L <br /> 30 Test No" 10 memitipal uO Commerciai <br /> 70 Air Conditioning 130 <br /> 2. PROPERTT OWNER's NAME ailing Address if different than G. CASING(S) <br /> property address indicated oho" 10 Black 4M Threaded 713 <br /> 20 Cygnet Place 2C7 aim• IO Welded <br /> Harold Panuska Long Lake, I.V 55356 30 Plastic 40 Stainless steel <br /> HARDNESS OF 4 in, to 1t. <br /> 3. FOWTION LOG COLOR FORMATION FROM TO <br /> if net bow, indicate formation leg from new well or nearby well. in. to ft. <br /> 9. SCREEN <br /> ®Screened vat from_ft. to_ft. <br /> (it Rnown) <br /> 0 Open mole from_ft. to_ ft. <br /> 10. STATIC WTEN LEM <br /> 86 jt.®below 13 above <br /> lead value a0617te measured / /91 <br /> 11. WELLNEAD COMPLETION <br /> 10 Pitless Adapter 40 Found Buried <br /> 213 Basement Offset 'n <br /> 313 Weil Pit <br /> 16. M ARKS. ELEVATION. SOMNICE OF DATA - CASINGS ROWED. CASINGS IERfOIIAM. ETC. <br /> House has been sold. 12. OWING INFORMATION <br /> 1®eat Comsat 213 aatomite 313 <br /> Grout material 13 bags from 0 168.t. ea. yds:54 <br /> 13. NEAREST SOURCES OF CONTANINATION <br /> feet direction type <br /> Well disinfected before smaling7 13 Yes <br /> 14. PUMP ®Removed 13 at Present <br /> Type: Ila Submersible 313 L.S. Turbine go Reciprocating <br /> 20 jet 40 Centrifugal 10 <br /> 1S. EXISTING KLLS (Please sketch locations of abandoned and <br /> active wells to remarks faction or em back.) <br /> Other unused welI(a) on property? 0 us 0 No <br /> Abandoned: 13 Permanent 0 Temporary 0 But mled <br /> 17. PATER WELL CONTRACTORS CERTIFICATION <br /> This wall was sealed under my Jurisdiction and this report <br /> is true to the best of my knowledge ad belief. <br /> oma 271 <br /> 94 <br /> 622"I riWa"ass � West "can" a. <br /> Address L4agle P I-V .55359 <br /> stgaed pat, <br /> 06/18/91 <br /> Tan Stevens Data 06 <br /> DFFICM ANNNINED WELL RECON (Ney be used for.Property Transfer) Name of Driller <br /> LR>PNImrs ISLE Mss!I7RlD <br />