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— �.,�— <br /> STATE OF MINNESOTA DEPARTMENT OF HEALTH <br /> ABANDONED IiELL RECORD <br /> 1. LOCATiON OF YEII MINNESOTA UNIQUE WELL N0. HH1�99 <br /> Count Name (�eave blank 1f not knorn) <br /> Y Henne in <br /> Tow�ship M�ne Townzhtp NumDer Range Number Section No. Fraction 4. HELL DEPTH (co�pleted) Date sealed <br /> n E k �, of y <br /> or �� ft. <br /> 0 s � 115 10/9/92 <br /> , <br /> umertcal Street Address and C1ty af Well loca[ion or Distance from Road 5. DRILLING METH00 (1f known) I <br /> Intersection 1�Cable tool 4�Reverst 7(]Orlven !�Oug � <br /> 2470 Dunwood Avenue Orono �"°„°" Rod �a,� �a°��a ��O � <br /> Show exact locatlan of well 3❑Rotary 60,letted 9[]Power Auger <br /> (in zectlon grid r1tA "X•) Sk�tch map of wll locatton <br /> N 6. OBSTRUCTIONS <br /> x � Hell oEstructed Q Y�s 9(��-+ No <br /> - � - ,- •- -` Obstructtons reaqved�7es []No If oEstructlons cannot Ce <br /> i <br /> M _ : _ _ ; � , - reaoved, cont�ct MOH <br /> , . -�- ' E before se�ling. <br /> - _ ; ; . : T �. �sE <br /> - ' y�. 1�Domesttc 40 Monitoring �Heat loop <br /> .�_ _,. _ ' , I 2[] Irrigatton 5�Publtc S� Inaustry i <br /> 1 <br /> � 3[]Test Well 6�Municlp�l 1C(]Caaerct�l � <br /> % 1 ..iL )[]Mr Condltioning I1(] I <br /> 2. PROPERTY OWNER'S NAME Na111ng Address tf dlfferent th�n 8. CASING(S) <br /> property addrezs lndtcated above 1[�Black �Thrt�ded 7(� i <br /> 2470 Dunwoody Avenue 2Q Galv. 5[]Yelded <br /> Loren Ri chards Wayzata, MN 55392 3p v,.:t,� ep s�.,��e5, Steel � <br /> HARONESS OF I <br /> 3. FOW�ATION I.OG COLOR FORMATION FROM TO 4 �O' L0 ft• I <br /> If not known, indit�[e formatton log fron new well or nearby well. ��. Lo f� � <br /> 9. SCREEN <br /> �Stre�ned w�ll fro�_ ft. to _ (t, I <br /> (if known) <br /> �Op�n Hol� (rp� ft. to ft. <br /> 10. STAT[C YATER LEYEL <br /> Ei5 rt. �ator p,00�e <br /> land surfaca O�te Measured lO f 9 f q7 <br /> � <br /> 11. WELLHEAD COMPLETION <br /> 10 Pltless Adapter �Found Buried � <br /> 2�] Basement offset � i <br /> 3[]Mell Pit ' <br /> 16. REMARKS, ELEVA7ION, SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC. <br /> 12. GROUTiN6 lNFORMIITION � <br /> 1�Neat Cement 2[]Bentonit� � � <br /> HOUS2 hdS been S0�C� Grout atertal q h�_tro��toj„�jtt. cu. yas <br /> I ' -- — — <br /> 13. NEAREST SOURCES OF CONTAMINATION <br /> _ fett direciton LYD� <br /> Mell dlsinf�ct�d befor� se�ling7 � Yez <br /> 14. DUMP �Reooved �Not Pr�sent I <br /> TYpr. 1[I Sub�rstbl� �LS. Turbina �Reciprocating I <br /> 2[]J�t �Centrifugal 50 I <br /> 15. EXISTIN6 YELIS (►l�as� sk�tcA locatlons of abandoned and <br /> �ct1v� w�lls tn raarks s�ctlan or on back,) <br /> Othar unus�d wll(s) on prop�rtyt �Yes �t10 <br /> , ACandoned: [�Pernanent �Teaporary �Not seeled <br /> U. 4ATER MELL CONTRACTORS CERi1FICATION <br /> This well wai sealed under my j�risdiction and this report <br /> is true to the Dest of my knowledge and belte(. <br /> t 194 <br /> Llcens�� Buslness N�ee Lfcense No. <br /> Addreis 5 g <br /> Sfyned C �ti1-.� Oate �� <br /> R�nri�/ �lnhntnn n,c. 10/12 g2 <br /> FFiCIAI ABANppNED 4ELL RECURO (May b� used for Grop�rty Transfer} NaM of Or111�r <br /> L�CRTA/7't lZLB MZTS DdBD <br />