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" � ` Laboratory Test Report
Engel Water Testing, Inc.
9300 County Rd. 15 * Minnetrista, MN 55359
Phone: (952) 955-1800 Fax: (952)955-1806
Minnesota State Certified Laboratory#027-003-105 * Wisconsin State Certified Laboratory#105-10115
Don Stodola Well Drilling Co., Inc.
3841 North Main Street
St. Bonifacius, MN 55375
Water Test Location: Report Issue Date: January 7, 2010
Chris Kosek Year: 2009
3060 County Rd. 6 Date/Time: Sample Collection: 12/31 9am
Orono, MN Date/Time: Sample Recd.in Lab: 12/31 2pm
<:
Well Unique Number: 770045
Laboratory Test Number(s): 09-7574 &09-7574A
�Required when critical to the validity and upplicution of the results
�1d�1bT� �A�1X ��1,G'/�lll(18 T)i1��1t11� ��5��@S�� ���tk�B���X�IE�
T�Sk l*Tc? . ;. ......... ��t31.�;. . ;:... ..A�n,a� sts; > ..C1t�f�1....... .; .
_
Coliform SM 9223 B 18�'ED
09-7574 Bacteria 12/31 2pm 1/1/10 2pm Negative Colisurem
09-7574 Nitrate 12/31 2pm 12/31 2pm <1.0 mg/L per ISE Method�SM 4500-
NO3 D 18 ED
09-7574A **Arsenic 1/04/10 9:45am 1/7 9:45am 0.0036mg/L SM 3113 B-99
Allowable Limits:
➢ Nitrate Nitrogen,mg/L: Maximum allowable limit is 10.0 mg/L or Less
➢ Coliform Bacteria: Allowable Limit is NEGATIVE
➢ Lead,mg/L:Maxunum allowable limit is 0.015 mg/L or Less
➢ Arsenic,mg/L: 0.010 mg/L or Less—(0.010 mg/L or more exceeds the MDH-recommended health limit for long-ternl
consutnption of arsenic in druiknig water.
Subcontracted test results:
O/No samples were subcontracted;or
Gd� The above test result(s)with"**"designation were produced by Steams DHIA Laboratories,825 12�'St.S.,Sauk Center,
MN 56378(MN Cert.No.027-145-378).The subcontracted laboratory maintains MDH certification for the field(s)of
testing perfornted.
Discussion/Notes: These test results are within the allowable limits.
Report authorized by: � Date: January 7, 2010
Kathryn M. Engel, Laboratory Dir tor
�
The results listed within the report relate only to the samples received on the dates indicated.
This report must not be reproduced,except in full,without the written approval from Engel Water Testing,Inc.
Created by Engel Water Testing,Inc.October,2008 Page 1 of 1
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I ��c�O�{
C�inty Na����
WELL AND 60RING SEALING RECORD Mnnesoa�UniqueWellNo. J 1'
KEN��pIN Minnesota Statutes,Chapter 103/ or W-series No.
(Laeve blank�i�not known)
Township Name Township No. Range No. Section No. Fraction(sm.—�Ig.) Date Sealed Date Well or Boring Constructed
OROAiO I18N 23W 28S SE N� �i+i ��'2, �i�N /Q
r
GPS Latitude degrees__ minutes_ seconds Depth Before Sealing ft. Original Depth ft.
LOCATION: Longitude__ degrees___ minutes seconds �FER(S) STATIC WATER LEVEL
Numerical Street Address or Fire Number and Ciry of Well or Boring Location Single Aquifer ❑Multiaquifer
W LL/BORING Measured ❑Estimated Date Measured���j��
Y RD � 6 ORON�i. MN• Water-Supply Well ❑nnona.wen ,, ,
Show exact location of well or boring 55�.356Sketch map of well or boring i Em.Bore Hole
in section grid with"X." location,showing property ��� ❑Other_ �`"__�__ft. �elow ❑above land surface
N lines,roads,and buildings. CASING TYPE(S)
.. --'---—`-- ---`-- ---'-- �.
\ Steel ❑Plastic ❑Tile ❑Other
-- --------- - - ------ '�"j WELLHEAD COMPLETION
, .. ..
; W � � � �
�� ' ' ' ' � �"'��� Outside: ❑Well House ���
__,_____,___ __,_____,_ ❑At Grade Inside: ❑Basement Offset
, , , , , nniie dless A p r/Urnt U Buried �Well Pit
��
, , , � �P' da te
--�--- --�------�----�--
[�Well Pit ❑Buried
S
' i nniie� � ❑Other ❑Other
i
PROPERTY OWNER'S NAME/COMPANY NAME CASING(S)
� Diame(((eee�� � Depth � Set in oversize hole? Annular space initially grouted?
Property owner's mailin ere n ation address indicated above � / ?/ � � � �No ❑Unknown
�in.from to��_�ft. Yes No Yes
$$m@ in.from to ft. ❑Yes ❑No ❑Yes ❑Na ❑Unknown �
c612-840-9470
in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown
WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE /// ,
Well owner's mailing address if tlifferent than property owner's address indicated above Scfeen from�,��_to�h Open Hole from to ft.
OBSTRUCTIONS
y ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill �No Obstruction
i
Type of Obstructions(Describe)
GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No'����Describe
FORMATION
If not nown,indicate estimated formation log from nearby well or boring. PUMP �� �
/"� Type
�✓ �Q ❑Removed �Not Present ❑Other
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE:
�No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal
in.from to ft. ❑Perforated ❑Removed
in.from to�ft. ❑Perforated ❑Removed
Type of Perforator
i�
�
❑Other
'i GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.)
t � �
Grouting Material^,����f���/from� to��ft. yards�� bags
from to ft. yards bags
�_
from to ft. yards bags
i'
�` OTHER WELLS AND BORINGS
REMAHKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes ' No How many?
i
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION "
f 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 fiTELL D1t T r.L T NG ��.�^� � �^-
Licensee Busmess f �--. . ,. L�cens trahon No. �..
f _
i �. ,,. , f� 558
1 C rtifie Representative Signature� Certilied Rep.No. Date
�� Fi /�/� . �,'"�,,,'`r'-'
LOCAL COPY /y(��0� Name o/Person Sealing We/l or Boring
f�V i
� HE-01434-11 IC#140-0423 f 2/OBR
`
� ._.,
WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH
MINNESOTA UNIQUE WELL NO.
CountyName , . WELL RECORD - �}
1:':'�lftG%i3i1 �� `'° �' �] /�
Minnesota Statutes Chapter 1031 '/ �— s�J"Y �i �
Township Name Township No. � Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
fl.
:..;zf.;�r, � ��: µ :..
. �. �. ��,
Numerical Street Address and City of Well Location or Fire Number DRILLING METHOD
❑ Cable Tool ❑ Driven ❑ Dug
�`��;{� (,-Cil,;yj�.1 li(��ii.. �', i.,l�ii'.-i Lc?,�S`�� �°1. ❑ Auger ❑ Rotary ❑ Jetted
Show exact location of well in section grid with"X". ~ Sketch map of well location. ❑
Showing property lines,
N roads and buildings. DRILLING FLUID
I i _1 _1_ y�:n�it,�;;i.i.��._.
--r--ti- � i
� � � � .USE ❑ Heating/Cooling
_a_ ___ �_ �_ q Domestic ❑ Monitoring _; Indust /Commercial
W � � E ❑ Irrigation ❑ Public � ry
' T ❑ Test Well ❑ Dewatering O Remedial
_1_ _1_ __ _' I
I ; '
2-mi. CASING Drive Shoe?
� , .. q•Yes ❑ No HOLE DIAM.
--;' �' - —�' j �f L n�j�.� ❑'$teel C Threaded � ❑ Welded
� �' �d ❑ Plastic ❑
� 1 mili� �
C�
CASING DIAMETER WEIGHT
�.:.�; 1i, , ' i:�
PROPERTY OWNER'S NAME in.to ft. ��" Ibs./ft. � "/��in.to ��� ft.
�_�)`t .�x?4:.:".
in.to ft. Ibs./ft. � in,to'�-�- ft.
Mailing address if different than property address indicated above. in.to ft. Ibs./fl. in.to ft.
SCREEN _7��__T_ OPEN HOLE
. E> i c . .'} r L�<t,. k• _
,.
`. ' Make �.• � ... ....� from , ft.to ft.
�4.i:(; _: :�, t .,. ' :i.:i: TYPe .`� -�. ..+7,.a ,... .,a —�-=---
I �•• � �� Diam.
SIoUGauze � Length
� Setbetween ��.��- ft.and �,"f.i�, ft. FITTINGS:
HARDNESS OF STATIC WATER LEVEL
GEOLOGICAL MATERIALS COLOR FROM TO ��+_` ft.�1 below ❑ above land surface Date measured � - —�'�':
MATERIAL
PUMPING LEVEL(below land surface)
f l�'���r� ��y �-��`� ft. atter hrs.pumping g.p.m.
i�.....:. . .
WELL HEAD COMPLETION
�i'��' �='�.�i �:.�;�; CN;Pitless adapter manufacturer ;;,���,•1������>,� Model
❑ Casing Protection C�12 in.above grade
GROUTING INFORMATION
Well grouted? ❑ Yes []+,"No
Grout Material ❑ Neat cement ❑ Bentonite
from to ft. ❑ yds. ❑ bags
from to ft. ❑ yds. ❑ bags
trom to ft. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
feet direction type
Well disinfected upon completion? �`Yes ❑ No
PUMP !"!.,i"`_<.,`
❑ Not installed Date installed r
� —�.���iC�!.+�.
Manufacturer's name
Model number ��� HP -- Volts `'"" -
i Length of drop pipe � c� 1t.;., apaei m.
-`�7`s�`3.'.f.�_1� ,..� ., 9'P'
Pressure Tank Capacity
Type: Cf�Submersible ❑ L.S.Turbine ❑ Reciprocating L-1 Jet ❑
ABANDONED WELLS
; Does property have any not in use and not sealed well(s)? ❑ Yes �No
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.
L�.ia >�.t..�i.Y .1.�. �4'tI:��1� i.t1,.��,,#�.;.:,1_ �4. r i,� �'�:
Use a second sheet,if needed "' '"' ' '
REMARKS,ELEVATION,SOURCE OF DATA,eta Licensee Business Name Lic.or Reg.No.
r �r-"�� .�..�;x•�= ;' �—t�--_ti
' � Authorized Representative Signature � ' Date
.v .. . i;C..`�r'.�:.;Z�C:i; V—�'�--�t�,
t
Name ol Driller Date
LOCAL �OPY � � � 4 4 � HE-01205-04(Rev.5/92)
�
� ' ` '
TWIN CITY WATER CLINIC, INC.
� 617 13th Ave. So.
Hopkins, Minnesota 55343
(612) 935-3556
06/26/93 ' -
Stodola Well Drillin�
15306 Hwy 7
Minnetonka, MN 55345
938-2111
Lab #: 20160
I2TPOR`1' OF WATFsR ANALYSI S
Our laboratory reports these analytical results, determined on a
sample taken by YOU on 46/24/93 from the followin� loeation:
�
Greg Malik
� � 2060 Cty Rd 6
Long Lake, Mn
Coliform Bacteria <1/100 ml
NitrateB Nitrogen <1_0 ffig/1
The results of these testa indicate that this well is producin8 water
that meets the atandards for F.H.A. , V.A. , or conventional loans.
\.,\
y Water Clinic, Inc.
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Bill � e
Brian ai
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