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HomeMy WebLinkAboutWell info STATE OF MINNESOTA �PARTMENT OF HEALTN ABANDOMED WELL RECORD l, LOCATIOM OF �EILI MINNESOTA UNIQUE MELL N0. � -- (l��v� Dl�nk 1f not knovm) co��tY N�.» Hennepin Tornznip Nanr Townshtp Nunber Range NunDer Section No: fractton 1. MELL DEPTH (co�pleted) Dite sealed N E 4 � of 4 �TOriO . � 11� s� 23 w� 2� � � � ���� ft. � ��� � � t Numerical Street AdEress anG Ctty of Mell Loution or Dlstance fron Road 5. DRILLIN6 METH00 (if knorn) 3 c. -� Intersectton 1(3 Cable tool 1(]Rev�rs tien 1�Oug , � 2755 �thel Ave. Navarre, i'1n. zp Hoiiw, aoa spA,� ap e,�.e iip �0.otary 6�J�tted 90 Power Aug�r Snow exact toca[ton ot wll (in sactton grid rlth •S') Sk�tc� map of wil loutioe 6. OBSTNUCTIONS [� M Yell obstructe�Y�s � No�'`� � ��.�nJ� _ � _ _ _ ,_ _� 1� OOst►ucttons vW�Wf T�s �No If obstructlons cannot be . . _ � )t' `� \ rewoved. contact MDN N - � - • • -I- ' - E •4 \` J\ �`��2• /ons��llny. � ' � T J Y 7. SE , J^ _`I�e. '�,� - - - y,.; � �� � 1 �Uy Oorstte �MonitoHnq �FNac Loop ' ' • r r0 2[]irNgatloe 50 Publtt S� (ndustry -- -'- - • - j J 30 T�st Wll 5�MuMctpal 1L0 Ca�erclal �----1 SL--r 7[]Atr Londtttoetny 11[J 2. PKOPERTT OMNER'S NAME Matllnq Address 1f different than B..CASiN6(5) property �ddrus 1ndluted abon 1�Black �Thrytded 7C1 ���.� 2�6alv. 5[]Wlded Ken Larson 161U west 63rd Street �p,,,t,� �sc.��i.:: sc..i HARONE55 OF �_,�. �, 65 re. 3. FORMIITIOM lOG COLON FONMATION FROM TO ]f not known. tndtcate forwattan l09 1ro� n�w rtil or n�aror �wtl. 1n. to /t. IJrif t 0 69' 9• scae� g)s«..�w w.t� rro. 65 rs. u 69 re. c�� r�o��� p ov.� uot. �ro._ ts. w_ rs. 10. STATIC TER LEV �t�b�lor �aEovt � land sur ce Dat� lYuund � �� � 11�EA0 CONPLETION 1 Pitl�ss Adapttr �Found luried 20 Bas�wnt olfs�t � �W11 iit 16. REMARKS, ELEVATION, SOURCE Oi DATA - CASINGS REMOVED. GISINGS PERFOMTED. ETC. 12..FROUT I M6 1 Ni01UMT I ON �ClN�t C�ent �J B�ntontt� �q Grout 4" Wel1 Approx. 69' Ikkep ' ro�t „u�,,, rro.�,��0 0 ft. ��. Ya: 8 Bags Cement 10 Lbs. Bentonite — — 13. NEAREST SOURCES OF CONTAMINATiON 2 ML�T1, Labor s Ri��, and Cemet?t Grol?t �?!?'p _ re.e directton cype Yell dlsinf�cqd befon sulinqt �Y�s 14. VUIIP Re�ovM �Not Pres�nt• Type:�Suhrnibl� �l.S. TurEin� �Reciprocating - 2�J�t �C�ntNtuyal 60 15. EYISTINC YELLS (P1��s� skeccA locattons of abanAon�d and uttv� wells in r�warks s 10� or on back.) Other unus�d w�ll(s) on propertyt �Ttf No Abandon�d: C1 P�nrn�nt �Ta�porary � t���led . 1). W1TER YELL CONTRALTORS CERTIFICATION TMs rNll ws s��l�d und�r ay �urisdtciton and thls report � is trut to tAe b�ft of my knowledge and beltef. DON STODOLA WELL DRILLING CO. , INC. Licens�� Busln�ss Naw Ltcens� No.2 7 1 7 2 ,w,n�, 15306 . 7 Minnetonka, NII�t. 345 � . s�ynea- ,-� ac. — — o.c. FFICIAL ABANDONED �ELI QECOIiO (!4y be us�d for Proptrty Trans/er) Na� of Drtll�r txpaer�vr: rzrs rzra v�o