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HomeMy WebLinkAboutWell info STATE OF MINNESOTA DEPARTMENT OF HEALTN ABANDONED WELL RECORD • 1. �ot�TloN of w[ll MINNESOTA UN[QUE MELL N0. 1 (leave bL ok 1/ not known) � � c�°°`Y "•�` Heruze in Tovns�l0 Nae�t� To�nsAlp Number Aange Number S�ctlon No. Fr�ctten �. MELI UEVTN (�ospleted) Oate sealed M E ti � ot y �r�fl..--.--�. _ Sr Mr 05 rc. 9-24-90 Nmneric�l Stnet ddreis nd C1ty of Nell Lou tton or OtsUnct /ron Road 5. ORILU NG METH00 (/I knowe) �r fntersectlon 1�Cable tool �Rev�rst 7(]Driven I[Q Dug 2824 Casco Poi.ntl Road� ��Jayzata, r�1bl 55391 zp Hoiio� Rod S[�Mr ep eo�.e >>p _ 3�Rat�ry 60 J�tted �Porer Auger Sho� exact loutton of rrll (in sectton qrtd vitn "lt") Sk�tch e�p of �elt loc�N on 6. OBSTRUCifONS �___ _- N Well oDstructed�Yes � No � ._ ` Obstructlons nmov�d Q Yes ❑No If obstrucN ons cannot De . . � removed, contaCC MOH M _ � - • + -I- ` - E before sealing. ; : , ; T �. �sE — ,_ , . _ y� 1�Domestit �]Monitoriny �Heat Loap _' ; ; ; : � 2[] Irrlqallon 50�ubI1C 9[] lndustry �[]Test 4e11 6�Munlclpal 1CQ Commerctal S 70 Mr Condttiontng 110 r--1 +i L — 2. PROPERTY OWNER'S NAME Mailing Address I! 0lfferent th�n 8. CAS(NG(5) proDerty address indlc�ted above 1�Bleck /�Thr��ded 70 � Miriam Johnson �Galv. 50 4elded JQ V1asNc 6[]St�tnless Ste�l MARONESS OF 3 J, FORMATION LOG COLOR FORWITION fROM TO �^• t� ft. If not known, 1ndlute fornutton log lrom new rell or n�arby vell. 1n. ta ft. 9. SCNEEN �Scre�ned w�ll from_ it. to _ ft. (If known) �ODen Hole fro�n_ it. to _ (t. 10. STATIC M�I�R LEVEL ��-S tt.�j] Dalow ��Dove l�nd sur/�ce D+te Meesured 9-24-9 0 11. uEILHEAD COMVLETION l� Pltless Rd+pt�r �Founa Burted 20 Basement oNset 5Q l�Hell Dtt t6. NEIMRKS, ELEVATION, SOURCE OF OATA - CASINGS NEMOVED. CAS[NGS PERFORATED, ETC. t2. GNOUTING INFONMATION 1�Ne�t Ce�nt 2[]Btntoett� � House has been sold. ��o�c �,�.�,.� 3 bagi�r�o�Qco85 +�. ��. Y�= 1 I7. NEAREST SOURCES OF CONTAMINATION /tet dlrecN on CyDe � /� 4e11 dlsinfect�d D�fore se�ling7 ❑ Yes � � � � IC. �UNV �Reenved �Not Present n- Type: t[� SubnarslDle �L.S. Tur�ine � Reclprocating 'V 2�Jet �]Centrlfuqal fi0 � >� 15. EXlSTING �ELLS (ile�s� sk�tcA loutlons ot abanGoned and �ctive w�lls tn remarks s�ctlon or an uack.) Oth�r unus�d wll(�) on propertyt �Yes � No Ilbandoned: �V�r�an�nt �Tampan ry �Not sealed V. MATER WELL CONTRACTORS CEATIFfCATION Thts well was s�+l�d und�r my Jurlsdictlon and tnis re0ort I: crue to th� Dest of my knowled9e end belle�. Stevens Well Drillinq 27194 "�•��240�H��qhwa� 12 we�te�s• N�. _ Addreis I1 � Siqn�d � �✓ Oate 9-24-90 Dick o,�. 9-24-90 OFfICi�l A6A1100NED �ELL AECOQD (May b� us�a !o rooertY Trans/�r) N�iw of Drtll�r IJIPCRTANr r !I Ld MI1'S DdED .