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MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD
Herne vi 655066
Minnesota Statutes Chapter 103/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
tt.
Orono 117 22-23-01
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
L 17
El Cable Tool F1 Driven E, Dug
64 To k R ❑ Auger 1-4 Rotary C Jetted
Show exact location of well in section grid with"X". Sketch map of well location. ❑ __-_... __ _ __ _
Showing property lines, -
roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? El YES I*NO
" super gel-s
FROM _-ft.to ft.
USE ❑ Monitoring ❑ Heating/Cooling
i Q Domestic ❑ CommunityPWS
❑ Industry/Commercial
t7 Irrigation
i ❑ Noncommunity PWS ❑ Remedial
w eT El Environ.Bore Hole ❑ Dewatering ❑
� i i r ? , �� CASING Drive Shoe? ❑ Yes >il'No HOLE DIAM.
-i i i i_ ,ti•�. ❑ Steel ❑ Threaded ❑ Welded
- - - - -� I/Plastic 11g 1
E1 Mile
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME 4 in.to 138 ft _2dr 21 lbs./ft. 7 7/8 }
Diversified Cons t rpet inn in.to ft. — _—----.__- lbs./ft. V '�.to 5
Property owner's mailing address if different than well location address indicated above. -. ...- __ in.to ft. lbs./ft. in.to ft.
7010 fiwy 7 SCREEN OPEN HOLE
St Louis Park, TIN 55426 Make Johnson from _ ft.to ft.
YPest.,�r.ainless st! Diam. - 311
Slot/Gauze fil n Length
Set between* tj ft.and ff. FITTIN S'
STATIC WATER LEVEL I V1w/f
WELL OWNER'S NAME ft. 1(below ❑ above land surface Date measured kp 8
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. _ ft. after—_--__- hrs.pumping---4-5-g p.m
WELL HEAD COMPLETION
Di Pitless adapter manufactureryh Vodel
'❑ Casing Protection k 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? Q Yes ❑ No
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material /❑ Neat cement ❑ Bentonite ❑ Concrete V High Solids Bentonite
MATERIAL from_()_to a. 3 ❑ yds. 1�,bags
from to �8�Jt atura ❑� bags
clay yellow soft 0 22 from—to__ h n 11yds.Pbags
1 �f NEA.jEJT KNOWN SOURCE OF CONTAMINATION
Cloy gray soft 22 55 -.(K) feet � 1-�4 direction / _type
Well disinfected upon completion? y Yes ❑ No
sand/clay gray soft 55 110 PUMP !
❑ Not installed Date installed 6-26-01
sand brown soft 110 150 Manufacturer's name Ae rmo A P
Model number HP 5 volts
Length of drop pipe Itos ft. Capacity g.p.in
Type: Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes lyNo
VARIANCE 7
Was a variance granted from the MDH for this well? ❑ Yes No TN#
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 report is true to the best of my knowledge.
Don Stodola Well Drilling Co., Inc. 27172
Licensee Business N e Lc.or Reg.No.
,►v
s
uthonzed Representative Signature ate
Duane Mathews 2-23-01
6 5 5 0 6 6 Name of Driller Date
LOCAL COPY HE-01205-07(Rev.2/99)
7�wwv C cry W a er C U*t4u, I n ci.
617 13th Ave So - Hopkins, Minnesota 55343 (612) 935 - 3556
02/27/2001
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-2111
REPORT OF WATER ANALYSIS
Lab #: 150
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 02/26/2001 from the following location:
DIVERSIFIED CON
645 TONKAWA RD
ORONO,MN
UNIQUE#655066
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 report is an analysis for
coliform and nitrate only and does not include analysis of Lead and other
contaminants. (Unless as specified by client).
Twin City Water Clinic, Inc.
Bill Van Arsdale
Lab Certification#027-053-119