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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD6 6 8 O O 2
Hennepin Minnesota Statutes Chapter 103/
Township Name Township No. Range No. I Section No. Fraction WELL DEPTH(completed) Date Work Completed
Orono 118 23 1 36 y. 200 11- '8-Ol
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
360 Wakefield Rd Orono 5 391 El Cable Tool El Driven El Dug
❑ Auger Rotary ❑ Jetted
Show exact location of well in section grid wit Sketch map of well location. ❑
Showing property lines,
roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? ❑YES O
N super 8411-s
FROM ft.to ft.
USE ❑ Monitoring ❑ Heating/Cooling
❑ Domestic ❑ CommunityPWS
-- - - -+- -- QNrrigation ❑ Industry/Commercial
❑ Noncommunity PWS 11 Remedial
W i E ❑ Environ.Bore Hole ❑ Dewatering ❑
CASING Drive Shoe? ❑ Yes No HOLE DIAM.
�/ZMile
❑ Steel ❑ Threaded ❑ Welded
XPlastic 171
s
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME �+ in.to 292_ft. ad 21 lbs./ft.
Wayne Le Neave in.to ft. _lbs./ft. in.to 10 0
Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft. in.to ft.
same as above SCREEN OPEN HOLE
Make jr from fLto ft.
Type stainless steel Diam. IV — —
SloVGauzewoso Length_ 9 +
Set betweenft.and ft. FITTINGS:-
STATI�fy�1TER LEVEL e
WELL OWNER'S NAME 77 ft. below ❑ above land surface Date measuredpn U— - v1
PUMPING LEVEL(below land surface) q t �f
Well owner's mailing address if different than property owner's address indicated above. 180 ft. after 2 hrs.pumping 32 g.p.m.
WELL HEAD COMPLETION
❑ Pitless adapter manufacturer�--� Model
❑ Casing Protection �a�i wry sea ❑ 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INF RMATION
Well grouted? XY.s ❑ No
HARDNESS OF Grout Material ❑ Neat ce nt ❑ Bentonite EI Concrete High Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO
from to 30 It. 3 ❑ yds. bags
topsoil black soft ol from_30 to 192 ft. natal fjj(j.r bags
from to ft. ❑ yds. ❑ bags
NEA OWN SOURCE OF CONTAMINATION_ SE T I type
gravel gray soft 1 feet G<,/ES / direction
Well disinfected upon completion? ❑ Yes ❑ No
clay gray soft is 10PUMP
LI Not installed Date installed 11-23-01
gravel/rocks colored medium 10 10 Manufacturers name A etuotor
clay pray medium 105 161
Model number t HP_2 Volts 730
Length of drop pipe 105 ft. Capacity g.p.m.
clay/gravel, gray soft 161 19 fdy
Type: 1TSubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
sand gray soft 190 200
Does property have any not in use and not sealed well(s)? ❑ Yes ,)<ho
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes �4 TN#
WELL CONTRACTOR CERTIFICATION
Use a second sheet,i/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 ea._ Inc_ -27172
Liceirsee.6usiness,Name 7Ic.00r Regi
12-6-)l
Authorized Representative S' a urs Date
Daane 'Nathevs 11-8-01
Name of Driller Date
LOCAL COPY � 668002 HE-01205-07(Rev.2/99)
IC#140-0020
riv Lo'lnl c t"Orly w at-r c U , I ncl.
617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556
11/12/2001
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-2111
REPORT OF WATER ANALYSIS
Lab M 1258
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 1110812001 from the following location:
Wayne LeNeave
360 Wakefield Rd
Orono,Mn
Unique Well#668002
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).
City Water Clinic, Inc.
Bill s e
Lab Catilication#027-053-119