HomeMy WebLinkAbout1988-11-03 Abandoned Well RecordSTATE OF RINNESDTA DEPARTMENT OF HEALTH
ABANDONED WELL RECORD
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MINNESOTA UNIQUE YELL ' -1 �._'
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(leew blank if net know
ew Cty Ilex
Township OuM
tows le A1aeer
sense Number
Section M.
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.. WILL OEPTh (consist 4)
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Orono
117 i
23 �r
17
SW SW SE
o1.70/-
boserJcel stnmt a asd City of well leteUN
or Olstance frm bee
S. ONILLING INITIO) (If know)
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Cable tat 41311everse 10 Drlyea to urg
3457 Crystal Plac
Sbr Butt location or we�11
� (1a NctIM grid f"1")
W
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)PENTT OWMN'S UK
:a, Mn. 55391
Swatch Yp or .ell locatloo
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TE
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to w. n
Malling Address if elf/eront than
oroporty addrass Indicated Aboyf
Jim Sampson I
KUMSS OF
T, FORMATION L06 COLON FOrMTION f%W TO
If not known. Indicate formation tog iron aew well or nearby wet
i❑wllow Add SUAir 10 Not - I1Q
30 burr 60 Jetted 10 power Aver
a. 06STNLKTI0"'
sell obtr.cted,gfe ❑ N.
0►ItructlNf reMpVN Ik Tef ❑ Re If obstrettlons Co-inot be
reMsved contact MON
t•.Ilq.
T. USE
1KDosopstic Q Nf.ltorl.E 40 most Loop
20 lr.lption 10 public 10 ledustry
30 Test Well Q Municipal IUD Co.u.rcial
20AJr Conditioning 110
i
A. CASINGS)
19 E14ck IM TMNAN 1❑
20 Galy. 10 Welded
10 Plastic ID stainless Steel
in. tn, —1d0 ft.
IN. to ft.
t. $CA[EN
❑ screened well from — It. to — ft.
(if thew)
1000n w1s f Wn, to" it.
10. STATIC WT[R LE141
/t.14 below 0 as*"
lend serf Ka We 14450red 11—F-fe
It. VNEAD cowuTION
T/FItIes. Adapter Q know Well ad
20 Easswent offset 10
20 wl I pit
RCMAARS. ELEVATION. BOUNCE OF DATA - CASIO" EEAMD, CASINGS KNFORATED. ETC.
IT. ZTINg INrONIMTION
Grout 4" Well Approx. 220' Deep Neat Combat 10 u.teNto 43
4 Hours Labor, 2 Men & Grout Pump Grewt Material ►0-9 ft. cu. yet
11 Bags Cement — —
3 Bags Bentonite 0. AEAAEST Sowers OF CONTAMINATION ✓
10,
FFICIAL AMIt WO WILL KCOAO (by he rood for Property Transfer)
IAAIa"Wro rZAR EQ!! iiiiiiiiiiiio
Nt dlrK.I@P . !X. type
well disinfected before seallepr 0 rr.
Is. ►w X NuWyed 0 rat Present
Typo: K Swho sable 20 L.S. Turbine C Reciprocating
10 Jet (3 cestrifupal 40
15. (11STI06 WELLS (please skatcA letatless of abandoned and
ettiwe wells 1. re "D settle or o. Dock. )
other roused wells) M Wesm►tyl ❑ its No
A aaddNd: 0 poreeaNt I1 Temper•ary ❑ t sealed
11. VAT(R WELL COIFYAACTM CERTIFICATION
This well was styled "Nor N Jurlsdlctles and this report
it us to the best of 4' knowled" and bettor.
James NeRe License
Address w'm
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