HomeMy WebLinkAboutWell info STATE OF MINNESOTA DEPARTMENT OF HEALTN
ABANDONED NELL RECORD
t. �oc�rtow aF wEu MINNESOTA UNIQUE WELL N0. H81772
County Name (leavt blank 1f not know�)
Henne in
To�nship M�or Townsntp HumDer Renge Number Sectton No. Fraction a, uELL DEPTH (to�pleted) Oate se�led
N E 4 4 of y
Orono 117N 5' 23W w� 20 NE NW NW 95 f`' 10/9/92
Numeritai Street Address and City of 4e11 Lota[1an or Distance fron Ro�d 5. DRILLIN6 METHOD (if knawn)
Incersection 1�Cable tool i0 Reverse 7[]Oriven 1�Dug
2665 Casco Poi nt Road Orono 55392 �S]Ho�,aM Roa `,�]Atr �]Bored ��p
Shor exact loc�tton of well 3Q Rot�ry 60 Jetted 9(]Power Auger
(in sectlon grid vttA "X') Sketch nep of wll loc�tlan
N 6. OBSTRUCTIONS
�ell obstruct�d Q Yes &] No
- �X - : •- -• ODstructtons rNov�d Q Yes []No If oDstructtons cannot Ce
. I
re�oved, conGct MOH
M _ : _ : � � _
. - ' 'I- � E btfore s��ling.
- _ :_ : : : T �. �sE
- -, y.ri. 1[H Donestic �Monitoring �He�t loop
.�_ _;, _ ' : � 20 Irrigatton 50 Public � Industry
3[]Test 11e11 6(]Municipal 1C[]Cosercial
$
�---l +iL 7[]Mr Condittoning 11[f
2. PROPERTY ONNER'S NAME Mailing Address if different than 8. CASING(5)
property address tndic�ted aDove 10 Black 40 Threaded 7[�
2665 Casco Poi nt Road 2�Galv. 5(]y�)d�a I
B. Chuck Downey Wayzata, MN 55392 3[]Plastic 6psu��i�:: Steel
HARDNE55 OF
3. FORMATION l06 COLOR FORlNTION FROM 7p 2 tn, to /�,
If not known, indlcate formation log froa new well or nearby well. 1n, to ft.
9. SCREEM
�Scrten�d wl l frw_ ft. tp ft.
(If known)
�Open Hole fro�_ ft. to_ ft. I
10. STATIC WATER LEVEI i
45 re. p o.iow ❑,oa�.
��na :urtace O�te Measurca 10/9/92
I1. YELLHEAD LOMVLETiON
10 Pltless Adapt�r �Faund Buried
2Q Basement offs�t �
30 Well Ptt
16. REMARKS, EIEYATIOX, SOURCE OF DATA - CASIN65 REMOVED, CASIN65 PERFORATED, ETC.
12. GROUTING INFOItMATTON
l�Neat Cenent 2�Btntoniq �
Graut wterlal j h�n s froo�to� ft, cu, yds.�
��^
_. — _�
13. NEAREST SOURCES OF CONTAMINATION
_ feat dtrection �y�
Mell disinfect�d befar� seallnyJ � Yes
14. VUMV (�Reoored �Not Present
TYDe: 1[� Subo�rstble �]L.S. Turbine �Reciprocating
20 J�t �Centrifugal fi[�
15. EXISTIN6 YELLS (P1��s• sketcA lacattons of abandon�d �nd
�ctiv� w�11s in rs�arks sectton or on back.)
Oth�r unus�d wtl(s) on prop�rty7 �Yes � No
Abandoned: []Farsan�nt �Te�porary �Not sealed
17. MATER MELI CONTRACTORS CERTIFiGTION
Thfs �+ell was sealed under uy Jurisdtction and this report
is true to th� best of my knowledge and Eeltef.
te en W 1 Drillin Co. 27194
Llcense� Bustn�ss Na�e Ltcens� No.
Address
Slgned _ � ��1�.,�� 2 Lti_, D�te
Ranriv ,lnhncnn o.0 1 n�
FFICIAL ABANppqEO YEIL fiECOitD (May be us�d for Property Transfer) Na�e of rill�r
I!@CRTAIi'r llLd MIT9 �6gp