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J STR DOCUMENT VIEW - - Page 1 of 1 Document Name: Demo Permit #03-1220 CITY 0' PRIOR LAKE INSPECTION NOTICI CATIi TIll! 8CHEOUU!D ADOREI8 OWNE!R: PHONE fie. 31420 / S4- '7"H- s;: ~ "" <1ttiL- PERMIT NO. 03. IZ.Z. 0 CON"I'R. C FOCTINO C FOUNDATtON [] I'fU.MIHG D INlULATlON [] FINAL [] BITE INSPECTION C PWMllMGi Rl D MECH fill C ~TER HOaKUP C IEWlR HCCI<UP C PWIIIING FINAL o M!CH ....NAL Cl !XIGAADlFlLUNQ C COIIPLA1NT C IItJU!PLACIIU o ~REPL.ACE FINAL o GA.SUNE AIR TIT [J COMMENTS: D6no F/~L- III~"'<P'I"V -" ~AK SATISFACTORY, P"QaED C CORR.!CT ...mON AND ""OCIID C CORRECT LL P'OR RE:INIPECTlON I.FOR! COV!AING In.pector: 0wntI11Cr:mlr: TI CODB RBQtllUMBNrB.4.U ~ YOU. ,~ 1fBAL'1II. SdPBTYJ lJGIl'Im -------... --- - - ,-........- .- ...- .., ..... -....- --..,- -'.. .. ---- http://lfserv /weblinklDoc View .asp ?DocumentID=25 8 85 &F older ID=5 2 73&SearchHandle=... 2/1312006 From: 02/14/2008 18:12 1415 P.001/003 M~NLEY Brothers CGftstnlctlon,.lnc:. 211 a Cliff Drive Eagan. MN 55122 J ...I J ..J J ..J fAX COVER SHEET J J J ..J .J :.J .J .J ..J TO: EaN I E.. FE.) t5I FROM: .' ~'( A'SlF~ DATE: 2-/ I 14 6lo \lUMBER OF P AGES INCLUDING COVER: FAX NUMBER: PHONE N~MBER: 651.4S4.4yJG (PSi '155-71 eE\ FAX NUMBER: 651.454.9371 . RE: NOTES! COMMENTS: W.t: ~ ~ .TWo V\1;ISSJr-!k,"wEAL b~lrJro QE.~ 'Ct:><) wBU:- LOO;!JN1o ~. If;r ""IS ~bLV \ f= '-leu N~ "~.J '1'f1fH'J 6 ELS e-, - 1~~ (pS1_1SS-i1eB From: 02/14/2008 18:12 1415 P.002/003 02/1~/OB 03:~B PH CST HUH-EH 651-201-~572 via VSI-FAX Page 2 of 3 .16212 ilE MINNESOTA DEPARTMENT 01' HEAlTli WELL AND BORING SEALING RECORD AfimesOIB SlaIUlllS, C1IfII*r 1031 I" f 201057 , , -r' w -<t- "t. ~ T ...~ 1 s ~,-----t -.t- ..~. o -~-- -+- N&JI ClMler". tniIiI~1J 8dCres if dIIl!lrenI h1rI property ownl!l"s lId*ea ind"lCIttd.... QEClI.OQIl:Al MI:JERW. &;MAliK&, .cURCI: Of: DA~ D1~CUl.TlQ Iff _AlING t.4inne~la WeD and Bortng SealirJg No. Mlnn95llta Uniqul Well No. DI W-stries Na. II................ 0&.. Well or Boring ~ 4 If, OrigimJ Deplh STATIC WATER LEVEL ~ l\Iea..red 0 EsliJnat8d 1ft) lI, 0 b8btf It o abOve land &llI1ace o 111. 0 Cllher o~e: 0 Wel HD..... o PIte!lo::AdI;IUIU..t ~UP~ 1- k,....1NInl 0lIIs1 o Well PlI D90ried DBuriDd CA8IN~ , in. from-L:LZ2tt Selin "_ hoJel1 An.....,1JIIa! inltialJy g".,.d? o Ves 0 lib 0 UrlkrxMII D"". DNa ~ In. from_ to_ft. DYw OND o Yea 0 Nil 0 U,*_ in.1rom 10 It. DYe. ONe o "". 0 No 0 UrIulllW. BCIlI!ERIOPBlItOLE Screen fmm If.l t/. r ? It. Open Hale lrom 10 It. OlaTRUCTIOt/8 o RodlIIDrop P'lpe 0 ChRCk VaI....(,,) 0 O&blB 0 FiB 0 No Obslruclion Type of Obllnlllllans (Delcribe) 10 Obstruc:lIOftll r.mDW!ll1 0 Yes 0 No Ceecn~ .~ IJA T~f~#I'? Remo....d D Not Pr~lillnl D OtI'ler MmDD Ull!D TO IEALAIlNUUR IJII,CI! BETWEEN. CAtINCl", 01'1 CAIN: AND lORE HOu, D No M'-lllllllP_ Eli.. 0 Anrwllt.patIO gmullld IIIlh IN,," piJIII 0 CUInG PlllarellonlFl......' in.ll'Om to fl. D Pol'fDnJtBd 0 Rell1O'tllNl in. InltII to It. o PenQf8IIId [J fI.RIIY1!d Type ofperlollltclr _ o Other QIIOUTINO .A~J.J;:.:;. -. = M I"~an. b.. Of,.........'8 ..101118,1 GtoutinuU!lll~ frr1lflL!/:),o--L ft. _ l"'ldI ..5 bill" 1nlm~1O_1t._ 1'81l11 _!logo IIDIII_Irl_/I'_r<onll_"-ll' 0TIlEI'l 'ft\.\.li AHD 1OR1N118 OIh.,unMBllldanhn..ect....llI'aClll'lglll\pr1lJl8IIiIp D "'oA.N6 1tow'.IDI/ll!" L1CDiIIED OR IIl!BiBTEIII!D CClWI'RACl'OIl aJmIIICl1Il1N Thlo "lIllll' blll!nt - -'ad In -ll\DIwllh M1n..1lllIa flult*, C'-PtBr ~ Thllnfllrntion CO_Tnld In IhiIl'8jIlJn Ie ~!Db oI<<mwkl'l MINN. DEFT OF HeALTH COPY From: OZ/lq/06 03:~6 PH CST HDH~EH 651-201-Q572 02/14/2008 18:12 #415 P.003/003 Ifill V5I-FAX flE Page 3 of 3 '16212 10 Oll8lrucllclIII fIImQVetl.~ 0 Yes ONo Oesc~\)08 "UMP :;8iB~ 0 Not PnMnt 0 Othar M!TltOD UllEDTClllULMlt/ULAJlINCE 8ElWEEN:z CASIIG.., OR o NDAMula.llp_EDII 0 AM"-lp&CIIg_dwltlll_llipe In. t"om 10 fL Mlf'fI/ESO'TA DEPARTIlotBIT OF HEAl1li WELL AND BORING SEALING RECORD Mml9ot.I SIIIlIfe6. ChBpllr to:!! III , ....-- -.,-. w -t-- -y- -1-- --i-- E '-~- nr- T J_ -+- -t- 1 ~,~-+ ~ SlMI OPlatltie 0 1iJo 0 OIl", WELUfEAD COIiI~N (l~blde: 0 Wolf Ho..... o PI_ AdoptooUtll .... PlI DBnletl CASlNlICSI 0Ia_ DeIlGt ,,~ --L in, from~ 1D~1l _ in. trom__ 10_ It in. 11'01II- to n, Nfll......'... m.finlllldnl. H dillBr...lt\a. _rty """1Rfs .._lndicllO<!._ ICRI!EJtIllPEN HOLE Screen fmm 1'1' ~ Ic -C> I It, CJ881'RUtT'ioNa o RDdslDrop Pipe 0 Clleck VllVe(s) ~Illl of OllalrucliOlll /OlIIcrl~) GI!OLOOICAL MATERIAL In.~ MImluoIB. ~lllII1d Baring I H SeelIng No, . NInn8Iolil. Unique WIlli No. or Vi-sllriH No, --...- DlII8 NaIlor Boring C..._.<t ':f7)~ ~ 207056 It OJIglnllllqllll STATIC WlQmI LEVa n. MIIIlIftld 0 &timatIII IY() II. 0 boI", D BIDIIImId iii"" ..Ida: ~i1Sem8111 0II5et o We" Pit DINri8d SIll in -... halo? linn. Ill..,..... ""U;Il1y gmulect1 0"'- DND OlU ONu o Unlcnown OVal DNa OVal DNa DUnknown OYM DNa 0\'100 o No o ~own Op811 Hale fIDnI to It.. o Debris D AU o ilia ObIttucIion III II UD IIOflE HOlE: o Ceeln:l__... o Perflll8flCl 0 Rtmav.d o PlIrlorallKt 0 RemOYed ft. Type al' pIIrtarnr o Olher OJlOl.ll1M.'lllATERl3 /fOJJ ~ CIl cemant a IN IIBIo., _ ... !!MBllIft1ll = SO 1".1 GroLiIllllMlfoti81 ~~"'~I_ti)IO-L-",- yanIe 3- bag, 1ftl"'_"'_1l. - y..... -"lIB Ol1IER waul AND BDAlNG! t!MAAKG, llOu"Ct: lll" ~ DIFFICUL'llU IIf HALJIIG Inlm_Io_1l. _ \18~ _ b8g. OlIlIlrll-.ledlhlurwuctwIOG7bOl\JlCcnp..,pefly'l 0 v.. ND HOoP,,*"f'I UCENIEDOII "'TEREDeoI'fTlUClUIt CERllRCA1'10tl T1IIo will 01 bcmg _ ...11d In ~ with MInn_<lIi. AuI.., C~.,.., 4725. TItllrlormeaan lllIIlIainod In IhIe 11IpD/l11 lnIolllllle _ al my .....W1 MINN.DEP'T' OFI<IcAL'fIoCCOPV' H 207056 Feb. 14. 2006 10:14AM chaska bUilding center i ,,' \ i,,;;;;r;;;~;--~ MINNESOTA O!JIIAAT"lENT OF WI,m"l ~'" wtU..... WELL AND BORING SEALING RECORD : ~VV(, " " _ /,f1nf1t101~ SI.NI.., eMpler 1001 I(J: '''''1.1'~I''''''.'''' \111 .1'l"0"'1Ii~ r~"'I~r\);' l.~"~ I ~~ I!F,.~l.Jft__o'l!~_ .,_ 1\1'1111.1"" .." 1,1Q1r:rm __.,fWtl"IIIlll. _.............eon"'. !" ~ III' L'I",'II'~IIlIP'~~. ;11 ':'I;'~N~;';;A: ;"l1'J 1I>>~1 ~;i;-;'.n~ 147'. ,}L \ Q /,..... ~ .~. ., ".'",_.. "_ I ~,i' : 'II" ! ""'I.~f~r/~ It~l!'l" '~_p r'il ~~ nr .,~,~ , '" ,'~' ..,,', ~: I......II'./'. ""Iwi~U'Irt'l'I~ 11i'~"'>"~(IJ,>fo, ~ ..,'" ~I 11I11, "I!',' ~ , f L ,( , rl , I I . ~'w. . , l. I I t, I , j , I .. :1if':'It!(I' ......_ ",1"lUll. _..... No. 7319 P.3 fH,., -~'O 7 cJ5b' I.,._,.~,-", \AIM'1Ol1 W,! "nd 1I(lf,rc .Ullnt Ng M1'W.'1011 unlq~1 Well '-Ie t... ~~(\tl!i~ 0I1r. WII' ql hM, "'~\Il"""1 0"1'.11 ClI~1h_____. ...." :n l\UIII ~ II/I~ OoA..IUII. r:~ ,"IN'qrl -i!/12... q. 0 1lO'~~ ::1 .~'... :,,,,, ,,".F' o Or"fr_____.~__.._..._.I...,...__ '......... ': : , o PilAU 4~r.Ic,JU'1 ;av.. 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VIIV'('j 0 Dill/IS L1 Fill 0 N(I O~llI,.'atlon 'j"~'H'\', I , ':'::';'~'~'~.~~~~~I'L r.Cl\.O~ ;~~~~:~~~AII'llOM I rl.l OIjfl".olIQ~.,.moVQd? c:I Vel, D No OUC/lb~__.__..__, "''''\l~'''''''I~".I'OI:'''''''-:::'";;;;;rt,;.-..io;';::;:;;;';II.-",..J-.-- PLifM' . n f -"AA - .. T ., '.''1'-' '--i-"r r~p.et~~~..._~ _ I., . ,.!-',_.... -~--+- ~mll.,.d 0 No! PrO!lI"~ Cl O'Nt. ~__.__._. ,_. _._.,,~ ' . ~ . '-:- ..-.. ._,--' ~--f..' UI'!'1l0D UIIII '0. ~ NN~I:' 1''lW'IN IllA'INOi. 011 CA,,~~~g ioIls HOIo'E:-- ! I ' I -L Cl NOM...... 5~_ct h.14 Ci -M.',r.,eaa ,'."MId IN.'I""," DI~. ." QUi"\l ~.Nr,~'lt!""iFl..r~..~, . '''1 '" '-'" ,- . I" trom ___ 10 _.__.__.., II, t.l P,"Q'"IIO n A~11i",I" " '''I ...' ..... t-"T"- ---- In 'rom -- 10 '''.'___ II. :1 PfJl1~IIi'~tf ., A.mcw~~ ". .,-."t- -.. -.., '.'.-ro-'", I TVllf 01 perin/Rlor .__.____..__.._____'''_. _..., ... .._...._. ~.:.~,. :......,._3t.,~- ~.:::-::-----::::.::::::;:.::::; r .. f rJ/O"t"'; 1I.1.,le "nML!/:)'n _L " ,~I~I. ,. ~.,~. I 1~",_Lu_..". ,Nt".' /).41." . . I ,'--' , . -r- . Ir)nl__ '0 ____, n. .___ ,lI/'lI OA~ liij'm tou~e( Of 6rrJ~I~',~:LTI..~~h~:'~~~--. '-'" - TYQll 0' Otllltl~c'lon. (C.tOli~;l__._,...____..__ _.______"._ "_" "_,,".' _ ._~ ! .-......___.. .~.h" " -, 207057 , , I I i '1 .~-;;.~-:;;~-! H I ~ I.B~~N/"'" .--J~,l__...._.. Oil' .......-... .......... . .,......... .... \ ',1 '"' '~:Il '<1" .r.-.u ~ 'kr,. CITY OF PRIOR LAKE DEMOLITION PERMIT 1. White - File 2, Blue - City 3. Yellow - Applicant Perm~ No. 0'2..- 0 ZllCJ DIRECTIONS 1, DATE SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN BEFORE PERMIT ISSUED (Please print or type and sign at bottom). .? /, .-f .~--'/~~ /C.2--, BUILDING INFORMATION 7. SIZE OF STRUCTURE ;;""'/' 7' V c- 8. NO. 0 STORIES 2, SITE ADDRESS /ScP II O.B-l1 j::".& /l1I6jV (/ (; N IV 3, LEGAL DESCRIPTION LOT>CZ:-r];/--' BLOCK pvp it;:-- PID 2~5-tJ34- 0/1-0 9, TYPE OF CO~TRUCTION ,/p(,..."('" .,,":,;./ 10. COMPLETION DATE ADDITION /-..-,", / -./" .... /..~,".~-- /.-;":'.L /': . /. 5c / (Address) :1 .:yO (Address) 6,' ~iAC;~N~me) '/; I,', ' /~I' (Address) . i . J//. (Tel. No,) L..t{'" 1',/. ".J" )(--"'~\i hh'V-flt~) ~4.gI///b ~/t/4 I hereby certif~'1 'ave furnished information which is to the be'st of my Knowledge true and correct. I also certify that I am the owner or aut riz d agent for the a mentioned property and that all construction will c.o, nform, to all existing state and local laws and will pr ee in accordance wi ubm' ed plans. I am aware that the building official can revoke this permit for just cause. Furth m e, ereby a.flree that t e cit official or a designee may enter upon the property JO perform needed inspections. / ~// X I < -)/:.J._\ / .,: Date FOR ADMINISTRATIVE USE 1Cef!;' 0 1. O. c.. METRO SAC UNIT DETERMINATION co MATERIAL FILED WITH APPLICATION o Site Restoration Plan w~ c:J-.~ o Utility Abandonment Plan o Sewer Abandonment USE OF BUILDING SITE RESTORATION PLAN o Water Abandonment Occupancy Group A B E Accepted by Rejected by II III IV Q H ~ M 2 cY 4 o Electrical Abandonment o Other Division CREDITS Park Oed. Credit ................................................ $ SAC Credit ......................................................... $ Sewer & Water Connec, Fee Cred~ ........,......... $ Water Tower Fee Credit .....................................$ Other ...........,...................................................... $ TOTAL CREDITS ..,..,.................. $ --'J TYPE OF CONSTRUCTION: Date /- / -02 Issued by I1K/U::--P A ~ Z, -rJ z.-- Date This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and m~a~ Ceed~qUested. '-I:i ~?~~ tilt /02- ity Planner ,- Date Special Conditions if any White - Building Canary - Engineering Pink - Planning Tht" Cf'nft"r of the tlb Countf'}' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT 611ft, DENNIS 3/2-8/ () Z-- APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit apPliCaj 5z:ni'7tioo~~;~ pror;"(;;:N (/6 Ai MI Accepted Accepted With Corrections Denied Reviewed By: Comments: Date: "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." 7\ White - Building Canary - Engineering Pink - Planning Thf' ('rn'rr of the' Lakr ('ounlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED (' /f!..1j STA G fAy DE vi. I ( - 2-q - 0 I The Building, Engineering, and Planning Departments have reviewed the building;permit application for construction activity which is proposed at: /5540 DeA/C6 AVe;,. N{;J Accepted y Accepted With Corrections Denied Reviewed By: I'VlifS Date: {- q -_0<. Comments: See Reverse Side for Additional Information! f)e.l"lvl,'<.J~ on Iv Rx/~{.;itJ s+,u<.I(/r'c. . v See Attachments: 1) Grading Plan, 2) Erosion Control Measures 3) Erosion Control Plan IThe issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." House Moving in Prior Lake · A demolition permit is required. · $5000.00 Non revocable Letter of Credit is required · Site restoration plan is required, or an approved building permit application for a new house. · Damaged sidewalks, street or curb shall be repaired in an approved manor with all costs to be paid by the permit holder. · The structure to be moved shall not be stored on the street or other public property · The permit holder shall control erosion on the property. · Open foundations or other hazards shall be protected with an approved safety fence. · The permit holder shall comply with the Tree Preservation Ordinance. All work shall be done outside the drip line of all protected trees. ( (I Complete the following: Iu (t....J 0 b~r,r-\'t,() {. "VI. .s 1, Proposed house move date. 5 (24 hour Police notice required) 2. Scott County Highway permits Yes No _ (For County roads) 3. Site restoration plan Yes -;?'" No 4. Utilities shut off notification: Electric Yes-i..L No Water Yes No Natural Gas Yes No Telephone Co. Yes No 5, Tree removal or cutting Yes No V 6, Proposed route diagram Yes No_ (locate on a city map) Moving Co.: Name ofCo.~tf- f~ ~J~ c:l /nt) U~,/ S Address i/'~ C'~~ j r 2. ?~+A \1':. City/State/Zip -"tz'" '(g ,-" f ~. J<{~( Contact person ~--=:.,: _( _,~_,'~ Phone No. 91'>- 4'v, - :r"L-~\ State House mover's License No. /'~ v'-I t:u - 13"', Date of expieration: .S' - ) 0 - c) z_ Property Owner: Name '[~, \ (1 0 {j-,"----.:J phone# '7 ') 2: - f.( L I - J z cr Property address: /' ',. , f House to be moved L:?v..;; '-"C ~ ':;; +0 yj- =-----. ~ Signature of Applicant: tf ~ ____ J;11 0 u.: -:J F" " ~~ - IS-&" If o V~<A le~fk,~ b/lO I/--\-~ r'/-lu L ! --\(: C<.,;', , i 'V\<..,. I j, f--i )_,. ;/7-7-L- , I '\'.,-, , ._"" I. v' .. 1/_'" \ ,t :;1.(\ (I j\ r': r yV' ,:;' r..^ "'l'" , .,..:J. ;- \1 I \ 1 /z. 2 lo~ d ':::> 01'--] -:.t, c. 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';t- F'o /~.-v) I' 1""';' ..' ~,-J , To N 5!A\~".__ "'","' toO (~ ,~--; vV'\ Q V c:: )~j \ i~ Lolli) ,~) i L... t r'" t" ,-t CA':> r" D CA/"! )/'l-.< r~-i'-' FEB-I0-03 MON 01:20 PM FIRST MORTGAGE CORP FAX NO. 9529479183 .-.."...'..--, -...,--, --.,,-.-t' MINtiCS/)fAC>EPI\I'IWI:NTOr,' HF.ALTI, '~I~lf\ ~~ ('.1','1 uor',n~r; lnr.:.\. flCI'J i::~ci7~i,,',;;;;-~""" .-----, ,- WELL AND aOHING SEALING RECORD ,I .,,'~' Mlnmxw/,) :';/JIlJliJJ, CJUI'/,~f 70JI ;~j~~tl~~~~::;'Ii:;:~'i~h'';_~T-]'r<'~~G:':;I;-1 :"'3,"UII N,} 1t::tl"~. '7 ~_~ O~I;;' ~;f5,:~}j:o,/o; U ;tl,"~L/,-((,4:.. )jj ..,.. .,.,.,~<JL ,. __~, ,;:':"'_w,L_ _' , ,.....2 ... f. t 'If.. " / NI(t'i'I'"'-';'~ :;.~~~~'I/'J;":"'" m r,,(~~'t,'" ",,';t"1 "/l 1>, "~""7QJ Le-.r.:~ I,.'fl I:" I c;, {) h ( ~ (:.~l () i:::.1. Iii!! (./ =c: . 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" ~~k Hnmi)\/t~ n Nn1 Prl~:;ufll 0 (J1Mrr li~;;U;:;(D TO SFA~ Ar_I~Uu.R SPAC:; BeTWEEN 2 CASlrlGS, Oil CASING AND 1101'110 1lOLE: n t~D t....(il'p'ar Sj:;-:JC'I) E:"!..jl:1. l.ll"l\nl,;:l~~' '~r'\nCI' '1rcu~t.,t! wllh tl '11'''lia pip~ U C~"I.,in9 1ii:lr10!JTiorv'Rr:.'T1wv;"lj 1(1 fram_~ ._ ta_,_~.,__~. In !(1~1(1 _."''''__ ~, n, 'fyi'':!': (,;./ F"~,f'J(u!(:r --.... nOli"" .. o P.nerolo" o Romo,.d o Porforated o Ro'MVOd c.1'i"urIN'~ MATERIAI.I:;) (One ba!) of eemO~1 ~ !)4lb..o on6 bail of /)8nlonll.. ~ 50 Ib~.) r.."'Ullr~I'~i'!lIfi"IW~lrom lli.- t" ~ yOM -i- rrG.n"i 10 ___ n, 10 __ n, _ ynrd. ___ DaQ~ YQT":; _",_ tOll" from frO/n .......,........._ tf.l __.._ 'I. _._ YArd~ __....._ ~i bn~" orliC~1 WELLS "IJD DOnlNCS On-lor ur.",i):~lrliJ ;J.f1d u')IJ~i.1d ,,.00 Qr boring 011 ProD9f1Y? 0 YI3~ ~ N., HDW mlJMy? L1CCtJo:.E\:I OR IlEGISTl:I1EO CONTRACTOR CERnnCATION "rl:l. ''''111 ur lOIJ(1a Wil:) ".oulad In R,;cord=afl~ WIl(l Mjrf'le~Q Hulu::. CJ\{lpl~r .72'5 "':7;1:'''' ~ _ ife_~-:: _ "'kU LrlePj . ..-- ~W':;7.'1t;'O': Num" rAPiIL --J/~ ' ~'~"2E;:"~'~ N.oll'Hl::"r f'lJ.f'f4?" StJullf'lg WfI>Il <if Tho lolo""'lioo <ontai~lld In 11\1:; r-pOI1 is -- /6/1-> L""",.. Of Regi.lf/lllOfl (';Q, ~~/aL. , /0... tjsz -'IL/3-ZS?2- ,,/ / FEB-I0-03 MON 01:19 PM FIRST MORTGAGE CORP FAX ~IO. 9529479183 Po 05/06 ,.,.....-..--....,-.-....--.-..'---- MINNeSOTA Df'I'Ann..1t ~lT Oi' IjFAL Ti I l.AiMp.sot" W~II and Soring Se"ling No. Minnro$o~a Unique WolI No. or W-sflrir:s 1-10 t".l'''' b1i'M.'q,I!rI'W'\III'ij t --lBS03'g--- ..-....-.--. -- .-_. --- I"U_L (jt1IlC;'IN'~ U1C,~ nuN ;;''f/~;'.:t~:-- --. . --. WELL AN~"~~~~~,,~~:',:~:~~, RECORD 1(' .,,{ ~ .J.~r 1''''l.,..J'"''' /'I",,~-n ~;;;,~-\-r:,:;~;,I,~~r;;:~~~:~ ~,u' ; fl': I'~.o"~ '~~ Ow.~F~ ~ ovi- {) )~- J. -"'Il2!~ ,I/~.......", ' ,-_. 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I"_.~..- 5fjt 1('1 ('jvl~r~lle hOln? ^Mcl~r ~pO\.' loHi~lly grouted? o Yo:; 0110 o Yo" o No o Un.oo.,,, o y,,,, DNa D'ro' Ol.jc o U'-',MwO CJ v,," o No o YM U/;o o Url~l'O'HI'i .__..I~tlr~)!ll_- \/:.1__._ tt ,...--.... $(;I'ICC\~OI'i:~ IIOLF. ~"(Qr.n "0'" -1-1. 7-_ 'Q -Lj-,f....... n, Opiln I i~16 ',~m _, __ 10 ---,- " OI1~Tf;;JCilON:; U n"-'CIO'DD p;~c [J Cl'o<:K V.llv"I,) 0 DC.~II, 0 Fill 0 NO Ob"lruC110n ~);:a'~':'~j~~-;;:il';~oJ .,.;;':;~"7f;r'~~~~~-:T~'~~:::;:;:;;;;;~J ~t"~I;~Ji;';^~ JL1)VO Typl) cf Or.-a'uLIIOill; ID,,::O,IN! -,,- OL!JrlIC!illll:,l fI)ii,ovr~d? 0 "'i.'~. 0 Nl> D\.l~r..rIOe -:-..'~... ..-..,-- .'LiMP fvr" .,..~~L_...-.-,- ~, . . :. . ..,--.."'-,--,.---..,,-'-:-:-T---..--~-~ .. c~~~:,~~~I,: ~~~~t'U~~...I,:. ~~~~:(j_~,_:,lt:?~::J1~~,\~~~ ._.~~ ~~~:.~,v:~~~::'~~'.~'I:!~.~~~!l,.1 flu.~~~I~~ ~~~':~;..~~'y ',mn 0!.\~~~~~rJ ~:~'._ ___. j.YJ..F1l.:"\O\I(.1 0 r.L~j. fJrr:~tHlt [I OrlLlH -....... r.I~mu,o U;;,;O TO S:;,\I"."\JNULAR $P,\CE BETWe~N:L CASINOS, OR C"'SII'lG AND BORE HOLE, U ~II' 1\"I'l\II(\r SrHlr'IJ E.,";lrJt~j\'~' .' .,--- ..' '..__......-'.. -...., .--..........'-.-. n AJ1('l:llilf ~P,~lCI) n~NIII,d ,v,li!~ lr~rniu "ipe ("l C~\~:r'I!' Pn~r"I;jll,'I1/Pf\lno"'.JI .---,. -- .', ..--- ,- In,lrt1rn _._......._ to _........_ h. o POMIDI"d :J Removord W"l. '10m .,__,.....- I\:! __.".,,_ rt. o P.~~'eloll o ne<<ovQd ......_-...\.,....._.,. -_....~..._--..,..,....--- ,- 1V;';u of ,"l"rf\lIJ!t1r .---.', .--....-.-.,.... _..... ._..___'.....-___.. .." .. .__t.,....'.. --.......".....- --.,.......- [] 011,0( __,,--,,--'-"'''' ~OUTINC :JA T:OAIAL(S) (One bog or C<JlilG,\1 . ~ Ib".o OM nag Qr benlonllO . GO Il.JC.) ~), ,- I ~ - c;,culi"Q M,,'ollill 4~, :,_Ct(,,'f(j J..53, 10 _t!..- n, - yord. ~~ MQA .,.,...--.--...."",---.-..-."".' ..-...-.., ...- .,--.-........,.---. ~......--- -......',..--- .--....-- Irem 10 _ ~. _,_ yord. _ b~Q' ''''11' \0 _..,_ tl. _ .,.1art1~ _._ h"9~ ----,...----...'-,-...-. -....--.-.-.. ..--....- !rom _._ In _.___ ft, _ y,...:l> _ bag~ ...-..---....--..-- _..._......~-_. .",I.IAn:,:,.. SOUilC\; OF D^T~, DI~FI.~lJ<,:nr~ IN ~.EAUIIC .,.-.'....... OTH1-.A WIOLLS AND OOnlNCS Olt'lj~r unw~lor1.lC1rJ U(1UI'.(.1('! wI,ll1"r borlJ1!J on pt"',:.,erry? 0 Vet LIC~N;;C(l Ol~ R~,;ISTEIlF.D CONTRACTOR elORnnCATIOI'l ,No How m~ny1 _,_ ;r~ir'c~fi~:7"~Of.€"'I'" i '-188038 l"At>it:R$-iilliel.:1o- C\l'1fiJa> (:;OPV N -."".------- -.. TM \'Iuil ", tlUrlno Vi"" "".Ied ii' ~CC'lrojn""& wiL~ Mlnnt>';cU rM6&. ChAplnr 4725. ;;;:.~::.:I~:~~~,~ c'''';7~.;~''.~o'-'mQ ~ u_."l~g~- , '~ii~::~)~~ N.,ftllJ 6' POf'!'..ot'l 5IJ~JinlJ Wnil 01 Ii;rlflg Th~ i"fom,.lIon conl~lnlld ,n I1\,Q rIlpan '. I ()J L L LIcI,,~ 01 ~ r;o 0(!/b~ OBI. FEB-l0-03 MON 01'19 PM FIRST ~ORTGAGE CORP P. 04/06 FAX NO. 9529479183 WELL AND BORING ScALING RECORD Mir>ncsot;J Well al1d 50r\ng SCJllng No, MinnB~O\.:l UniquO Well No. or W '$Or1e~ No r._..l'lnlr'o"JI",llrM-l"lj \H -f8-8-0~-1 r'-"'-"-'-- 1_. .._-,'-- ,.-..' V,lrj L Con (j,WI:.,Ir. 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D::\tljo \,N,.II 1)( 8c,Ino Cc'n.;;I'~_Ir.ll:1.l ~~ Oriijl!\OII)rplh ~- ---.-" ST",l'IC WATf.R LEVEL W[LU13I')~--" j,fi~ W,lll':f ~.1.:PP y W('l\ (J Mnnil. Weir o E:>>h(T'\'l!I:'<J Mi~a:;Ur ~" J./ftLh. Cl tl~l"w o abr.lvn \:wu '-.l:1~rr. Cl f il'J ~(Hr'J I\(]II': n Qln", _". "--' ,- C^,~Hlc.; TYr::(::>1 Y~;I,...1 [] l'1.oIlC n Tile 0 011":1 -, ...---.-...-,-...,.--...-..- -,.',--____""'~ CA~JNCI':;I $n! In o":Br';'ll.'-' r'I"I",? ^ntlul~r ,paco Initially 9rcule,~1 IJ YQS o NO o \'~" o No o U")cnr~\lfl' o I'u, o Ilo O'1'l' o NO o Vn""'~n o Y~r, o NO o 'i., o No o Unknown Dli.I{~,.:.lul ,..,,~~,n r-' 0'_111 IL r-- J_ ,~-/..QJ, r, rr"I" ~ ..._ In IJ!~I."'_ 101 u. h. .'_ In. lr"n' __ In_._ ~. SCRCI::NlOI'"N HOL.F. S-;;!CGf'\trCJI'l ..1-6_~1\" ~..12~._ n. OPI.." l-\ole rm", _._ tu --..,- /1. o~u~'- o l'u,l:.IDrcp Pii'" 0 Chc-ck Vol",,=-) 0 0""",, 0 1',11 0 NO Ob,lrucliOI1 T',.~~ Cif Oh:{iUCW'1'l:i {DW~I~flo(.l -- Ot,~>I.rllc~;i.in::. rOm.,v(:~'? [J '(1.:<:. 0 t',ln OGtcrlPo _..___._M"_"" PUMP T\'~a_-,~--'-'- TO ~.ncl'''lr\v('d n N{)tPrt.l!;U/l1 (J Of!'lM..-,. .--'-- .---...- ~jET:WD1J$:::1) TO Sr.J\L ANNULAR SPACE BETWEEN 2 CASINGS. OR CASIIolG AHO 1l0AI: HOLE: (J No Iql{1t.iLlr ~;rt;lC~ Exl;;t~ (1 Anml!!':r :;~,~\,~ 'Jr.:;url.,;1.l \\,rl1I' IrtJrTI 6 pipri ~! C...r~(\q 1'>9rfcrlJ\ioJn/Hl1fTh.;.,,,~1 1i'l,lmm__o,_ 10_......-_ f\ o PertQra\O~ o RtlmQvcoQ in. Ir.l,fn __...._ to o PdrtorAlod o Aerno,fld Typo w' >~~cr.'!M _ "..._~-,." C1 O'I,ur ---.,,,,-,,,,---" ----- C,flOU liNG MA T("AJAL(S) (One bOa of t.monl ~ 1)4 Ib~" on.. bOa of bonlonlltl ~ !ioO lb..) (iP'"''''(< Mol",i..1 aJljA~rro --/;i?J-r,' ~..- 1\, -' yarIX ~- Il~O^ Imm 10_,_"' y~rd. _ ~"\j' Irom 10 __~ ". _._ )RrU' _ bOil' fr"'fi"l _ 10 __ n _ V:,"'d~ _..'_ btlO:; OTHLR WE\.~S AND BORJllGS Oll\t:lf IJ,I"1:;na\tJ ond IlrlJ:;\,eJ 'NIJII nr bctit\Q on Ilro;)tJflyi 0 '(t,1~ ~ No How,."any? l.JG(NSEO OflIlEGIS11'.f\LO COtlTRIII;TOR CERTIfiCATION Tlll~ Willi Of rx,/'ij"l1] WiS~ t(!UIC1(J \!"l,lCCt.'/denco wUn Mlnneoo18 AIJI":;, Chdp'e, ~?:!S 'M' 'il)<,..l 0' 'nv " owltw.J~" ._7i:{~ t~:cldL~-k- CO"" ;(,1,', llil<'oltor-< Nu"'" - -0- - 4 2J~&-~ :'~~d N;';rl/u of f-JQ~AI' SoRuno W"lt Of Ben"" TIle tnrOfl'Tlillion c:or'1lalned In Inl:: ItJ()Of11, /olJ-~- L..,;;;H.'" Aff!1;.tra/l()ll r.;o sj.20/6.J- ;v'I. ~.,. I II.J II. J~() A n ..- 260 ....-... 1 k.I\IM..&h pRo ~~I1_ ~ ".. ~ 3SP1 3"00 1 R. KOi-tOUT 152 - 528 en v N PPr~"- ii'\ In !!' :3ip '2. 0 en q- 62-3 OTTO 'OM8URG 161 - 513 cD. "Z ~ 2s :-:)~ '-- <t <::::!. 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