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PID No. <br />Abandoned Well Sealing Cost Share Agreement <br />Contract No. <br />Well Depth <br />Well Diameter <br />THIS AGREEMENT is between Elk River Municipal Utilities, 13069 Orono Parkway <br />NW, Elk River, Minnesota, 55330, ("ERMU") and <br />("GRANTEE"): (Name of GRANTEE) <br />The parties agree as follows: <br />1. GRANTEE warrants that s/he is the lawful and sole owners of the property <br />located at ("Property") and that <br />the well to be sealed is located on the Property. <br />2. GRANTEE agrees that the well located on the Property will be sealed on or about <br />. GRANTEE shall submit proof of filing of the well <br />sealing report and an invoice from the well sealing contractor. <br />3. GRANTEE shall allow on-site inspection of the well by ERMU or by the <br />Minnesota Department of Health staff ("MDH"). Inspection by ERMU does not <br />constitute approval or a guarantee as to workmanship. <br />4. GRANTEE shall be solely responsible for contracting directly with a licensed <br />well-sealing contractor and for paying the contractor. <br />5. ERMU will reimburse GRANTEE the lesser of the following: a) fifty percent <br />(50%o) of the actual cost of the well sealing; or b) $400. The cost to ERMU shall <br />not exceed a total of four hundred dollars ($400.00). The cost of any work <br />performed by the GRANTEE'S contractor in excess of this Grant will be the sole <br />responsibility of the GRANTEE. <br />6. ERMU will reimburse GRANTEE after completion of the work and after <br />GRANTEE'S contractor files a sealed well report and a copy of the well record <br />with ERMU and the MDH upon completion of the well sealing. Payment will be <br />made within (30) working days after GRANTEE provides proof of the filing of <br />the sealed well report to ERMU and an invoice from the GRANTEE'S contractor <br />documenting the costs of the well sealing. <br />