HomeMy WebLinkAbout1991-06-19 Abandoned Well Record (corrected)I. lOUIIM or HIU i
STATE OF HIUMESOTA DEPAATICMT OF HtALTH
ABANDONED NELL RECONO
CORRECTED COPY
COMAtjr Hennepin
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or
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NINNCSOTA UNIQUf MU NO
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SW NW ME
NuatHcil SCrttt AdNrfii ba 4 CUy of Nfll locttlon or OlttOACt fro« toid
lAUrttcttOfi
940 South Brown Road Wayzata, IlN 55391
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06/19/91
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6. OISTRUCnONS
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roflovtd. COAUct NON
fctfort tiillNg.
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2. MOfCiTT QNNCS'S fUMf
Carol Senn
NAlIfng Addrtsi If tfifffrtnt thin
proptrty idOrotl InOiCAltd Abovt
940 South Brewn Road
Wayzata, MN 55391
naroncss Of
fotwrioa 106 coio* formiioii from
If not knovA. inOtCAtt fonMlion log freo nt« Mill or ntirOy «ifll.
II. aCNklkS. CICVATION. SOUkCf OF DATA . CASINOS ICHOVCO. CASINGS PtNFONATfO, CTC.
8. CAStNO(S)
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9. SCRCCN
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ft. to
ft.
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(If kAOvA)
10. STATIC UAfCR LfVIl
30 ft. ffll OtIOM QkNONt
IkAd lurfACO Otto NBAtyrod 06/19/91
II. UCLLHCAO CONPLCTION
d PItItlS Adiptor
d 94kN"N"T OffSOt
d Ntll Pit
d ^NoAd lorfod
a- - -
12. G80UTIN6 INPORIIAriON
iQNAAtCtAdnt d^AAtOAlto d
Grout AAtirtAl 4 baCjS froa Q tpl^Qlt.cu. jdt, 2^
13. NEARCST SOUiCiS 0^ CONTAIIINATION
fttt __________ dIroctlOA
ucll dlkiAftctid kdforo idillAff Q Yoi
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IS. UISTING MCUS (PIdkM fkttcN locdtlOAt Of tNAAdOAdd AAd
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Othtr uAuttd AAll(s) OA proportyl O Q No
Ac*n<iontO; pi PoraiAAnt Q TiOipAriry Q Not ttiltd
IT. WATCN NCLl CONTNACTOaS CCaTIPICATIOi
Tau rra II mi tMifd uAdtr a/ jurtidIctlOA OAd tkii rtport
n iruf to lAi bolt of ajr kAoaltdgt AAd btliff.
Stevens Well Drilling_ _ _27194
pfPIClAi AIANNONCO yCLL ICCQ8D (Nky kt ultd for Propdrty Triiufor)
I rii# mn om
•attcTWaav 12 westICdAld No.
1»®1 55359
Dick Stevens
n.f 06/19/91
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Noao of IHIIor
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