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Home My WebLink Aboutwell info � MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. �County Name � � ' WELL AND BORING CONSTRUCTION RECORD g 18 01� Minnesota Statutes,Chapier 103I Towns ip e Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 118 23 26 S� 5�,,,SF ,,, 231 n 4-13-16 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude �J Cable Tool ❑Driven �J Auger �Rotary House Number,Sireet Name,City,aruf"ZIP Code of Well Location _ �]pther 725 Si.cih AVe ,�IJrOI�O 55391 DRILLING FLUID WELL HYDROFRACTURED? �;Yes [�Mo Show exact location of well/boring in section grid with"X" Sketch map of well/boring location. �ntonite From ft.To ` h. Showing property lines, ; N 1 - i�� (_'r adq s,buildings�ar�i di:ection. USE �No cosmmunity PWS O Monitoring ❑Heating/Cooling ' ; � , _��--�.... /lJ , � Environ.Bore Hole ❑Industry/Commercial [�Community PWS n Irrigation �''�.�Remedial � --J--- ' _�---_:_ �,Elevator ❑Dewatering ❑ ` �`-� w ; ; ; ; e T CASING MATERIAL Drive Shoe? �Yes ❑No HOLE DIAM. � � ' --+--- ' ' -'-%-- hreaded elded . --,-----�-- I �teel �T ❑W ; , � �� ile StiC M a , � ❑Pla ❑ --�--- --;-- ---�----�— • CASING ' ' S ' � Diameter Weight Specifications �1 Mile� � �in.To__�2__ft. Ibs./ft. _�__in.To��`jft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. Ibs./ft. �J��p.To_��ft. Spring Tiill �aolf Cc�ur�e in.To ft. Ibs�fOPEN HOLE in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN 1 725 Sixth Ave N Make Fro�2� ft. To �31 ft. Type Diam. �r�� MN SS391 SIoUGauze Length Set belween tt.and tt. FITTINGS STATIC WATER LEVEL Measured from 1L1V ft. Below ❑Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME RECEIV�� PUMPING LEVEL(be w land surface) �99 ft.after � hrs.pumping 1}� g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION J1�� (1 �7 �� Pitless/adaptermanufacturer��e�t�� Model u �� Casing protection `�f 12 in.above grade ❑At-grade ❑Well House ❑Hand Pump �� `�►TY OF ORONO GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) � Material � rom�_To��_ft. _�__ j]Yds. ags - Matenal��_€��i��_To_'�'�'�ft ❑Yds. �Bags HARDNESS OF Material _From To ft. ❑Yda [J Bags ; GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Dnven casing seal From To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION C1.$y C�WI'1 1T1@��LilM1 n 1� � feet ,f+� direction _ ��.X..-c type �$ y Cl$� Cay �� 1P �4 Well disinfected upon completion? Yes ❑No ; �-,°CaVf.'IICZA� COWCl flf��tII}I Z�F �7 PUMP 3 }7 CISy bl'S�'1 cedist► b oim snerli 7 �Z J�Not installed Date installed � �" clay �ray ��1� �� (,� Manufacturer's name C a� �r�'Ve eL� ��1' �J 1� Model Number HP 1T�.:� Volts �;ravellrlay Sra� medi►.�n 108 142 �y 7 . —""�� Length of drop pipe ft. Capacity g.p.m , ine sa racan sa.f t 1 2 149 clay •rzy T1Ca�.ti� �(�C� '!(77 Type: Submersible ❑LS.Turbine ❑Reciprocating ❑Jet ❑ ABA DONED WELLS c sy ray eeft 197 213 gt lttle erJish br aii t i�rC! 213 22� Does property have any not in use and not sealed well(s)? ❑Yes No VARIANCE sa stone ahite harc� 22� 2 Was a variance granted from the MDH for this well? ❑Yes - No TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,il needed. REMARKS,ELEVATION.SOURCE OF DATA,etc. -I�.lA—�J��GI�s W�-��T1E��A-��Reg�'o. Licensee Business Name i rr � ,� II�7��[) .�L+`� ' .�� "sr-' .._ ,�ert�e'd pres�nta ive Signature � Certified Rep.No. Date ROtJ StOcj0�.8 LOCAL COPY 818 013 Name o,o,��e� -- — - ID#52603 HE-01205-15(Rev.8/13) ►, e �. :' i - �.. ,y�z+, �cf y,. r'-"3e� � '�� 4 rs'�t} 7 2v � �� .. �: � � �...� ryl . ��_�� ` � y� .��n� ��,t'�� ,�4Q.��`M�l��`e�'+'r 1�9. Twirr��it�W��+��`��Ll�ni�La�,+��a�,�a�'�'�t��.�1��.�� -�� .� s_ � ��!f ��p��4�'j�o�� .��* , . = ' � ��.��a �t� ,�;�.�,. r,� � ,..�.x� ,,�..:,�. '. �,�;�.}._��k��IVi c'o 5ir NRxL�ali'�'f�#399073400�r'�=�Y. 5 ':... ; Cllellt: Don Stodola Well Drilling Report Number: 16-05398 Twin City Water Clinic Inc. Sample Collection Date: 04/13/16 61713th Avenue South Address: 3841 North Main Street Sample Collection Time: 10:3o Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 04/14/16 Phone: (952)935-3556 Report Issue Date: 04/15/16 Fax: (952)935-5077 L'.. � � e ,�-�� E c w.' k s� �5 h �.�t�"�,.� ��"�,� , , �;. �,' �� , � �. ; , _t4_. 14. �� =F.�4i.�ui. .� �,��:' u- 4 �"��" � �} n Sam�,le."�I,IrI� d a� �.. +,� r � ' �� i �.�w�� a:` `�' � . F g i c w "�a ��. . � 8 � �`�I�,_�.�� So.,..�.K-.�..A , i^ .'?�� sx�.�1^ ��E-k &P.' �.� 16-05398 Coliform Drinking Water 04/14/16 14:16 Absent 16-05398 Nitrate/N Drinking Water 04/14/16 12:52 <3.0 mg/L 16-05398 Arsenic Drinking Water 04/14/16 12:00 04/15/16 1324 7.14 µg/L Lead Drinking Water µg/L Nitrite/N Drinking Water mg/L Drinking Water Drinking Water � a ECEIVED � � � � � � , 4r�Well No.: 818013 x=No sarr�� `' �,,t�act�sl,o t�e��,b��r,�.u�;�s,��k ' with•'"desig� tic�n '�u��tl rb''�r�'�qiaCoptr��kec� � =Sample pt: Well �UL Q 2��6 Iab�oraiQt�;��a��or�wr�+�� ' rFes,s��Rk�wla�i�#� TheE F Well Adr: 725 Sixth Avenue N;Orono,MN s�l�;�ont�c�e.d��ia�o .�� n ��y�,�",f��"�on�f,�octfi�,,i� C�'�QF RONO � �,�, s� t �, � �;, Owner: Spring Hill Gulf Course fjelcl�s��f test�p��f� �� ;�' i � � '� `a '��w ��,�;��e��,�'��4��"g��.�ii �'�F'�'OwnerAdr: Sample Conditions: Sample Temp: 18°C Discussion: Notes: �,:�v � �� ,Y� � �d�r��r-�r..}�Mn3�,�m�� e� .:r� 7 r�,��' ��a»}�r f�i !r�P �. {-. .i ,�- � 1 �� 3�a� Sa �1+�:,t l�c#s�� l �t5�� '"�:��* ��. ApRrouec��,��- ��n „ _ ��m'�,c��p� ��'�"�,��1�;� Bb,OVE I�8��1 t� �� 1�e� I �� i f�e. M �� '�' :. .ax5 Y�' S'i �{ .� �" ,� '*. - nA q�r �', �(`SY� �� I�' €a �� '� 'f� � t�� r ,i 1 1 3 M �+F � �� 3�'�V;�y'ka�{�h S1r'9�!-� �i � "� � �+�`�.�.��_� +�� I � �uu�� .. _ ' �� ` � , �& : � + # d i _ ' � n`'� r,� 7•r�� , a , , c.•.'�`. " �� J e�... i� � - ''� +� � - .,'. � X .� ��v ��'��'�� - � _� � �,�.� � � -w� ,� �C_��` � '� � s,m� �zy.��r, 13�'�r'^w.� �� a� � ': 4f�+.'f�' ' '*��7'��t�0�� '�Lai �;;4��yy �p ,_�:�,�� "�F�� S e3s , � �• .�� •'r x.�. ��. x�r,4,�,n�,�..x��,.� . vy:� . 5fl�� rw:- � �„a Ai�f�;�� .y�,� .,k�i�Urr.f�r�.r.�.::4 Sam le Collected b X Client TCWC A roved B � ''`�""� p Y� — pp Y� r�i`�� , Bill Van Arsdale Alan Senechal Laboratory Manager Senior Analyst r cef�lt��t�� a� ,��•` ti � �- �,r a a��it � � 't��'� r a� ' t �. �;a E y' . �� r�,�' �4v' r� ,r��9 .:.�. �+' fi'�^ '��' � �.�7m. '%� f-��s i� �� '*- j�,�.r t?.- �,k N'R Gh�.,��`a4^�� , o- � -�� k g�6#'�'. �.� -.. :. .el.� � .�t1¢.� �.�:.� , `�� i , { b+;ft��r`� �'t,�*"�-.��...��u . � �,.. -6'� � Ks�� .y;. � �i u�� ,_ ,..� r ,. � a, � , �.. . �. TCW D Rev 2.0 Page 1 of 1 �. MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 'Z �`� WELL OR BORING LOCATION WELL AND BORING SEALING RECORD Minnle9oNa Unique Well No. H � "M��` ��` � County Nar►e � � Minnesota Statutes, Cha ter 1031 or W-series No. P (Leave blank I�not kn wn) � Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed `�. 7 ( � � Tn (!/v l< GPS LOCATION- decimal degrees(to four decimal places) ) � Depth Before Sealing /��/ ft. Original Depth fl. Latitude Longitude A UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer r�I,M J��► /�- 72�j �i!t�}Z A V� P,T� f}r��(� �j��!11 WELUBORING �Measured ❑Estimated Date Measured�ri/71�' !.rC/ Water-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring / in section grid with"X" location,showing property ❑Env.Bore Hole ❑Other /l.f�/�l_ ft. �elow ❑above land surface �` in s,roadS; nd build [y N ..-}. �....._.. :,��,tiR �7 CASINGTYPE(S) '-'-'--'y----`-- --'-- ' --�-��-��--��`-----�-- ELLHEADCOMPLETIONIIe th � ❑S el P ❑T' ❑O er 1'�C(��,��U�� , ' W W � � � � E � N _� � � � T Outside: ❑Well House At Grade Inside: ❑Basement OffseA I I f O � ?0 I� • - ;--- --�--- -�----�-- 'hMile� Pitless Ada ter/Unit ❑Buried ❑Well Pit ��UL : ; ; : 1 � P --�-----;-----�-----�- ❑Buried ^ .. ' S ' ❑Well Pit �Other v'��ORO'vo F-1 Mile-{ ❑Other PROPERTY OWNER'S NAME/COMPANV NAME CASING(S) �� ' F7 DiameJe�� r Depth / Set in oversize hole? Annular space initially grouted7 Prope ty owner� ailing address if different than well location address indicated above c,J � / in.from d to�ft. ❑Yes �No ❑Yes ❑No ❑Unknown �� `tt� A�� in.from to R. ❑Yes ❑No ❑Yes ❑No ❑Unknown �rorx�, t�1 55�91 in.from ta ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE I A Well owner's mailing address if different than property owner's address indicated above Screen from�to_J_�,�_ft. Open Hole from to ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill �o Obstruction �� Type ot Obsiructions(Describe) GEOLOGICAL MATERIAI COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP -� If not known,indicate estimated formation log from nearby well or boring. ,r .� Type �`�` � ��Removed �Not Present ❑Other - MEJHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: ' BNo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal /� in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated [f Removed Type of Perforator VARIANCE Was a variance granted from the MDH for this well? ❑Yes No TNti_ GROUTING MATERIAL(S) (One bag of cement-94 Ibs.,one bag of bentonite=50 Ibs.) M '�' r Grouting Material�� F//��/V�from U to�_�"�� R. yards /� bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes � No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report � is true ro the best of my knowledge. '-kkan "todola t�Tell T�ri].lic�; �o,. Inc. 1Czn1 Licensee Business Name License or Registration No. i /` �_ ;; � �,, "..��`j,,,�" � r- - � �.- ...P�- i � �ettiKed Aepresenta6ve Sign twe Certilied Fep.No. Date r-� u Q F' � �Y`'. ��} :�'Y� LOCAL COPY n � � („j,<�,�l�J Name ol Person Sealing Well or Boring HE-01434-14 ID#53159 v 5/13R •-,�,'�'�� ,� ..� ' t k'-�q� MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. - WELL LOCATION � � ��,<,��Vame WELL AND BORING RECORD Henne in ti��, , _ ,,,;;;��vs Minnesota Statutes Chapter 103/ 5 910 8 2 - Township Name Township No. Range Na Section No. Fraction WELL DEPTH(completed) Date Work Completed rc L�n La?ce 1 I$ 2 3 �� • �� Number et me,C ,and Zi C de of Well Loca6on or Fire Number DRILLING METHOD � J y�� ❑ Cable Tool ❑ Driven ❑ Dug � �'- . ❑ Auger f}Rotary ❑ Jetted Show exact loca6on of well in section grid v�"- ' Sketch map of well location. ❑ 11 _____ _ _ �,,,,J Showing property lines, roads and buildings. DRILLING FLUID N � �entonit� � � � � � _�- ' � � _�- -�� USE C] Moni�orin i � � i ':;` }t❑ Domestic 9 ❑ Heating/Cooling -�- -�- -�- -�- t ❑ Irrigation O Community PWS ❑ Industry/Commercial i i i i ❑ Noncommunity PWS ❑ Remedial w i l e� � ❑ Test Well ❑ Dewatering ❑ _ - ' , r i '/zM e . -�+ CASING Drive Shoe? ❑ Yes}�❑ No HOLE DIAM. _� � _L_ _�_ I � ❑ Steel ❑ Threaded ❑ Weltled � �- � � 1 � ,X�1/ � Plastic ❑ �1 il� S ��, b �-,M.,a-� �.� CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME ,4 _�_ in.to 1 �z R. �_i� Ibs./ft. in.to317 n. _ Spr�nC� H�1� Golf CLL�� ___in.to______tt. __________._. Ibs./tt. ! in.toZ��it. Property owner's mailing address i�different than well location address indicated above. in.to ft. __ Ibs./ft. in.to fl. �St.c�'�Z Structures, TIi�• SCREEN OPENHOLE �8IIt11S Char�iaad• Make,JO�'IIIS�ri from e.to ft. 8 2 Z 9th AvS. SE Type C�a i p� Ac�__C�_�oo��Diam. 'f� C SIoUGauze �n� Length n� '�i i n n e a p�1 i s, M's1. 'rJ J 4�.� Set between��_fl.and_��_fl. FITTINGS: STATIC WATER LEVEL WELL OWNER'S NAME ?�S2 t�❑ below ❑ above land surface Date measured 1_=.�i_��8 ' PUMPING LEVEL(below land surface) s, Well owner's mailing address if diflerent than property owner's address indicated above. . ft. afler hrs.pumping.�� g.p.m. WELL HEAD COMPLETION �] Pitless adapter manufacturer ��;��a�.�� Model CJ Casing Protection _�J 12 in.above grade � ❑ At-grade(Environmental Wells and Borings ONLY) GROUTING INFORMATION Well grouted? }�] Yes ❑ No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Giout Materia� ❑ Neat cemem ❑ eentonite ❑ Concrete�O High So�ids Bentonite MATERIAL from_Q_to_3II_tt. �__ ❑ yds�] bags from __to____ft. ❑ yds. ❑ bags C�.c1 Gre � 1 from to ft. ❑ yds. � bags NEARE T N L[J�SOURCE OF CONTAMINATION_ / �� feet directi��type Sand Gravet � � Well disinfected upon completion9 �] Yes ❑ No Brown C 1 a � �PUMP ❑ Not installed Date installed_ = i o� T8 Manufacturer'sname �AC3 TcICkP4' `SanC� � �Modelnumber ��(�('ri�tCl _f'NC9 1 �� Volts77� Length of drop pipe �� ft. Capacity _ i�g.p.m. ? Pressure Tank Capacity Type:�] Submersible O L. .Turbine ❑ Reciprocating ❑ Jet ❑ _ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes ,�{7 No VAFIANCE Was a variance granted from the MDH for this well? ❑ Yes .�l No WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this repon is true to the best of my knowledge. DON sT�r��r.n, w�r.r. nRILLIN�. C9. �N�. .;. L�cens Busmess Name L�c.or Reg.� a 271�2 j�;,� I-29-99 _ --r . ,. /� - ± l / ''. � �Authonzed Repie ative rgnature " Date < C�uck �Ioore 1-25-98 Name ol Driller Date LOCAL COPY 5 910 S 2 HE-01205-05(Rev.t/95) , .i J� �U/6�Z �6�1.� V V�l�N �Lb/26C� JrLC. 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 03/29/1999 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT QF WATER ANALYSI5 Lab#: 36763 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 03/25l1999 from the following location: Spring Hill Golf Course 700 Spring Hill Rd. Wayzata,Mn Coliform Bacteria <1/100 ml Nitrates Nitrogen <1 . 0 mg/1 The results of these tests indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This repoR is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). � �,\ T\ i ate Clinic, Inc. \� �� Bill �( e� , � .a�.tri�.i w>oncory ca��u+a�� WuerAmlyeia Ro+6� Boiler Wa[er Chamicsls Lab Certifioation q 027-033-119 w �. WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 12�6 Q� County Name WELL AND BORING SEALING RECORD MinnlesoNa Unique No. x�IIlle �n Minnesota Statutes,Chapter f031 or W-series No. � (Leave blank if not known) Township Name Township No. Range No. Section No. Fradion(sm.�Ig.) Date Sealed Date Well or Boring Construded flrono I18 23 26 , � � �, - � }� � Numerical Street Address or Fire Number and City of Well or Boring Location � � .^.; F -�fl 5pring Iii�l Rd, �rOn� Depth Before Sealing Z'�` � ft. Original Depth �� ft. d_ ' Show exact location of well or boring Sketch map of well or Goring AOUIFER(S) STATIC WATER LEVEL in section grid with"X". � , wing property Single Aquifer ❑ Multiaquifer µlines,roads,,aP uildings. N �tF a�^�: l WELUBORING Measured ❑ Estimated �� :� l.�.. 3 Water Supply Well ❑Monit Well � --�- -T- --i-- --�-- � ! _...,_ .__. t � �- ❑ Env.Bore Hole ❑Other {�� tt. �below ❑ above land sucface i W -�-- -i-- -;-- --;-- E � � .._.._.._______..�..._.� CASING TYPE(S) � i i i � { --�- '�" "�-' -'�" � Steel ❑ Plastic ❑Tile ❑Other '/.mile ¢ —`- -.�-- -�-- --�-- � j CASING � Diamet�/ Depth � Set in oversize hole? Annualar space initially grouted? S """��,''' (t/ h �i mi�e--�e ��: "�'��.'. '� _, � in.from r-/ to - �� ft. ❑Yes �No ❑Yes ❑No ❑ Unknown � V� PROPERTY OWNER'S NAME in.from to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown Property owner's mailing address if different than II location address indicated above. in.from to ft. ❑ Yes �No ❑ Yes ❑No ❑ UnKnown 3335 P�nnsylvania A�$ � SCREEWOPENHOLE ` ` Cr3T.4t$1� 111v 5.7�27 Screenfrom to ft. OpenHolefiom �^�� to ?S` R. 09STRUCTIO WDEBRIS/FILL WELL OWNER'S NAME Obstruction ❑ Debris ❑ Fill ❑ No Obstruction Well owner's mailing atldress if different than property owner's address indicated above. Type of Obstruction/Debns/Fill �/�^'�'�f-��'� /��°" � /"'P=J�I'� Obstruction/Debris/Fill removed? �Yes ❑ No PUMP Type ;t..�:> �:%,.ry�p� GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO 1�� Removed ❑ Not Present ❑ Other FORMATION � It not known,indicate estimated tormation log from nearby well or borinq. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HO�E: No Annular Space Exits +� ❑ Annular space grouted with tremie pipe p 1 a t vi i 1 e �� G S ❑ Casing Pertoration/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to R. ❑ PeAorated ❑ Removed Type of perloraror �� ❑ Other GROUTING MATERIAL(S) � �� / � '7 f Grouting Material J�1'f t� 'r C�-'��E/�`irom � to�._,2 ft. yards �— bags from to ft. yards bags from to ft. yards bags from to tt. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑ Yes �No LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Don STodola �de11 Drilling Co. , Inc. 27172 Contracfor Business Name License or Registrallon No. _ .�'.• i {�2�'47 ori RepreS`entative Signature ' Date Jim �intonson LOCAL COPY H 12 4 6 0 7 Name of Person Sealing Well or Boring HE-01434-02 10/95F