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