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STATE OF MINNESOTA DEPARTMENT OF HEALTH <br /> ABANDONED MELL RECORD � <br /> 1. LOCATION OF WELL M��::Ee blankNf iWiot known)N�• � <br /> County Nur henne 1T1 <br /> Township MaM Township Nwb�r qange Nu�b�r S�ction No, Fractton 4. WEIL OEPTH (co�pt�ted) pat� s��ltd <br /> �-�r'C f�C\ �Nr or 4 � of 4 <br /> li� s 23 � oa ti'csc:s�: I oa ,t. �{1 �s ��� <br /> Nwrrical Street Addnss �nd City of Melt Loc�tion or Dtstanct frow Ro�C 5. IL IN6 METH00 (1f known) <br /> Intersection Cabl� tool 1�p�vtrs� 1(]Dr/r�n lq]Duy <br /> 3458 North Shore Drive Wayzata, MN 55391 �"°"°" �od '�"'� ��°�'a "� <br /> Show ex�ct lotatton of wll <br /> 30 RoCarY 60�ttt�d �Powr Aug�r <br /> (Tn section grtd rtEh •X`) Sketch �yp of wll loutlon 6. 08STRUCTIONS <br /> � wlt obstruct�a❑ 110 <br /> - � - - •- -. Obstructlons n�owd T� []No If obstructions unnot b� <br /> � . _ � . ' - r�oved. contact NOM <br /> i � <br /> w - - - • -- -I- - - E o�►� ��OM :..,,�9. <br /> _ :_ : : � T �. �E, <br /> �� y.�:. 1IZq Dowestic �MoniLoNnq �il�at LooD <br /> � � r1 <br /> � 2[�Irrlyation 50 Publtt �Industry <br /> ` / <br /> .•.�. . .. � <br /> -•,.• - • �_ , <br /> ' S ' )n�/� )��//(�2!„�'1.�t�t� 3�T�st Wll fi�Munlelp�l 1C0 Co�rrc1�1 <br /> �---� riL---� 7[]Air co�a�e���� i�___y__��� <br /> 2. PROVERTY OMNER'S NAME Mailtnq Addrtss if dlffer�nt than 8. 5 N6(S) '�J <br /> property addrtss lndit�ted abov� �Blatk 1[�Thry�ded 7� <br /> >'� 7� <br /> 2[]6alr. 50W�7dW <br /> A1 Seran SAN� 3p vi.:c�c �sai�i.:: ss..t � <br /> MARDNESS OF �� in. Lo 98 1t. <br /> 3. fOWMTION L06 COLOB FORK4TtON FROM TO <br /> !f not known. 1ndlute forqtlon loy /ro� n�w wll or ntarEy wll. tn. to ft. <br /> Drift 0 1�2 9• SCREEN <br /> ��r..�w M.t� rro. 98 rs. w 102 rc. <br /> (tr w,o�� <br /> ❑op.n xot• rro._re, co_ �c. <br /> 10. STATIC WTER LEYEL� <br /> �n .t. �.,� ❑���. <br /> land u c� D�t� lNasur�d � � <br /> . 11. YELLHEAD COlilETION <br /> 2 1�Pltltss Adapt�r �found Buried <br /> BasNeent oftstt � <br /> Mell P1t <br /> 16. RENARKS, ELEVATION, SOURCE OF DATA - CASINGS RE)IOVEO, CASINfiT VERfORATED, ETC. <br /> lY. R UTIN6 INFORlNTION <br /> Grout 3" Well Approx. 102' Deep. �N.,c c...,�e sp e.�w�,a 3p <br /> 4 Bags Cement 6rout ..u�i.t rro. o�to� ft, tu. yds <br /> 6 lbs. Bentonite <br /> 2 Men, Rig, Labor and Cement Grout P�np. - - <br /> .3. +�EARE's' SL`L'CcC'c5 Oc CGNTRItTi'v:Ti01i <br /> _ rae atnccton trv <br /> Nell dlsinf�cttd b�fon s�alinyl �`fes <br /> 1�. PUMP �ppp�b Not Pns�nt <br /> Typ�: 1[]Sub�rslbt• �L.S. TurDin� �R�tiproutiny <br /> 2�J�t �]GntHfugal fi0 <br /> 15. EXISTIN6 YEILS (Vl�as� sk�tch loeattons of abandoned �nd <br /> j �ctiw w�lls in ruarks i�t n or on buk.) <br /> � Otb�r unus�' il(s) on prop�rty? �Y�s No <br /> � ADandontd: P�rNn�nt �TMpprary �Not s al�d <br /> �� 17. MATER MEIL CONTW1CTOitS CERTIFICATION <br /> Thts w�ll was s��l�d under oy �urisdictlon and this report <br /> ts true to CA� Mst of ory knorl�dg� end Deltef. <br /> DON STODOLA WELL DRILLING CO. , INC. <br /> ��r-b, ? .� �„ L1cen:�� 8uitn�ss Nuie 271�2 llcens� No. <br /> ' Addr�ss 15306 7 Minnetonka MN 5 345 <br /> S�9^ed;6�.���� o.t. 4 15 92 <br /> Mark Stodola o,u 4 15 92 <br /> iFiCIAL ABANDONEO YEIL RECORD (!4y b� us�d for Property Tnnst�r) Ma�e of ONll�r <br /> rrrcRrbsr: rzr.a �rrra�n <br />