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WELL!_flCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
� CountyName ` . ' WELL AND BORING RECORD 5 � 7 %� 4 .��
Kenne�i n Minnesota Statutes Chapter 103/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed �
Orona I17 23 OS ,,. ,: ,. 105 k 9-21-98
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
3II 50 Bays i de R�� �.t�Z]� �5�� ❑ Cable Tool ❑ Driven ❑ Dug
❑ Auger ❑ Rotary ❑ 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? ❑YES ❑NO
N
_� � � �_ 41L`��' n�+ttiral FROM h.�o h.
; -,- -;- -,
USE ❑ Monitoring ❑ Hea�ing/Cooling
i i i i ❑ Domestic
_i_ _�_ _�_ _i_ X ❑ Community PWS ❑ Industry/Commercial
i i � i ❑ Irrigation ❑ Noncommunit PWS
w e� ❑ Test Well y ❑ Remedial
i i i i ❑ Dewatering ❑
i -, i r �/2M.ia CASING Drive Shoe? ❑ Yes ❑ No HOLE DIAM.
_i_ _ i_ _i_ _i_ � ❑ Steel ❑ Threaded ❑ Welded
i i i i
❑ Plastic ❑
s
"�"� �-1 Mile�
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME __ � in.to__gZ ft. ��� Ibs./ft. $in.to�JSJt.
Paul/Raren r�adsan in.to ft. Ibs./ft. (�iin.to��ft.
��
Property owner's mailing address if different than well location address indicated above. _in.to R. Ibs./ft. in.to tt.
320 Geor�i:. ��`tn!! SCREE OPEN HOLE
�: Golden V�2Iey, �IN 5S4Z7 Make o n�an from nto h.
Type sta3nless S�l�� Diam.
SIoUGauze ���� Length �� ; � t•
" Set between A�ft.and 9�►G ft. FITTINGS:
7 i�7�
STATIC��TER LEVEL
WELL OWNER'S NAME ft. ❑ below ❑ above land surface Date measured �'1;_g
PUMPING LEyF,�(below land surface) ry
Well owners mailing address if different than property owner's address indicated above. i�t-� k. after L hrs.pumping 40 g.p.m.
WELL HEAD COMPLETION i�
❑ Pitless adapter manufacturer Edi13 t Q WS t p[' Model .
❑ Casing Protection ❑ 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
GROUTING INFORMATION
Well grouted? ❑ Yes ❑ No �. � �-�
HARDNESS OF Grout Material ❑ Neat cem t ❑ Bent i e ❑ Concrete ❑ Hi h Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO �{' �� c 9
from V to ft. 2��7 ❑ yds. ❑ bags
��'. 1����1 lack $Qf[ � ,[4 from�to_g_Zft. �'j$�iJ.�r3Z_ ❑ yds. ❑ bags
, from to ft. ❑ yds. ❑ bags
1{a� dra� e�1�3� � �!y NEARE T NOWNS CEOFCONTAMINATI� l7r��
� // / t:
� et __L�3� direction�„�3rT_t���type
Well disinfected upon completion? ❑ Yes ❑ No w
1$Y k �;ray soft �� �0 PUMP t
❑ Not installed ate i stalle L������
a�+�.r.sand �ray oft 9� lE}S �ec� .�ac�;et
ManufactureYs qa
i Q
Model number HP � Volts
2 .�
Length of drop pipe ft. Capacity 4 '� g.p.m.
Type: C�Submersible ❑ LS.Turbine ❑ Reciprocating ❑ Jet ❑ "-
ABANDONED WEL�S
Does property have any not in use and not sealed well(s)? ❑ Yes C�'No
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes f�^No
WELL CONTRACTOR CERTIFICATION ��
Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. ��
REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge.
�)on St4dala We2I Drillin�, �o. , Inc . �7Z
� Licens Busine Name �, Lic.or Reg.No.
��-�=,f�L.i�� .���� .�_-...�.� I I-12— �s
'� Authonzed Representative Signature Date
'�, e�1i��$�`-�i O t'3��' ��1�."��3
Name ol Driller HE 01205-06(Rev.9/96)
LGCAL Cc�PY 5 9 7 2 41
- , Jcuin Litc� I/Vater C,�inic, J�rcc.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
09/18/1998
Stodola Well Drilling
15306 Hwy 7
Minnetonka MN 55345
938-2111
REPORT OF WATER ANALYSIS
Lab#: 35769
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 09/15/1998 from the following location:
Paul Madson
3850 Bayside Rd.
Orono,Mn
Unique Well#597241
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 mg/I
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).
i ate Clinic, Inc.
�
Bill Va a
�
Aotlyical laboratory Coneulting Etgineer
Water Analysie Reagenta Boiler Water Chemicals
Lab Cert�cationll 027-053-119