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WELL LOCA�ION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name Henne in WELL AND BORING RECORD 6 2 4 9 0 8 ����
p Minnesota Statutes Chapter f031 '"��
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
Orono lls 23 32 �,, ,. ,,, 23Z' � 4-21-99
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
47b0 BS side Road Oroac� NN. 5356 � CableTool ❑ Driven ❑ Dug
Y � ❑ 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
, , , , Bentonite FROM n.�o h.
-,- -,- -,-- -,- - ;
/ � . ; USE ❑ Monitoring ❑ Heating/Cooling
i i i i ._i,��i � -. i-� <'� f��� i�. i �,Domestic ❑ Communit PWS "
_i_ _�_ _�._ _i_ � ❑ Irrigation Y ❑ Indusiry/Commercial
i i i i --. ❑ Noncommunity PWS ❑ Remedial
w i I I I E T l7 Environ.Bore Hole ❑ Dewatering ❑
i i i i �/2IM.ia 'J''�� CASING Drive Shoe? �Yes ❑ No HOLE DIAM.
_i i _i_ _i_ � ( � �Steel �Threaded ❑ Welded
� _�_ � � �,�,_,. x � ❑ Plastic ❑
�—,Mae—� jU' ��
CASING DIAMETER WEIGHT
PROPERTY OWNER'S NAME __�in.to__��tt. l� Ibs./ft. in.to ft.
Diversified Con�truction ��.�o n. �bs.�h. �;�.,o��.
Property owner's mailing address if diNerent than well location address indicated above. in.to ft. Ibs./ft. ����,
7O 1 O AXy 7 SCREEN OPEN�fHO�fL�Ef �f9 9 F
3�r• L�uls Parl�/ 17t�.�✓al�6t7 Make��r1 from LLI ft.toLJi ft.
Type Diam.
SIoUGauze Length
Set between ft.and ft. FITTINGS:
ST4T1G�p//�TER LEVEL ���1�n
WELL OWNER'S NAME 1�'� h� below ❑ above land surtace Date measured �
PU�P�f�yG LEVEL(below land surface� � 30 a i r
Well owner's mailing address if different than property owner's address indicated above. �� ft. after � hrs.pumping g.p.m. ���:s+
�LL HEAD COMPLETION
Pitless adapter manufacturer Whi tewater Model
❑ Casing Protection L�12 in.above grade
. ��tiAt-grade(Environmental Wells and Borings ONLY)
�GROUTING INFORMATION
Well grouted? �Yes ❑ No
HARDNESS OF Grout Material ❑ Neat cement ❑ Bentonite ❑ Concrete �(1 High Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO from Q to 3O ft. 3 ❑ yds. �bags
trom to ft. ❑ yds. ❑ bags
C18 7@Il M 3 0• 2? r�om �o x. ❑ yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
Cla Gre S `� 1 3� `—` � feet y;'�% �� direction - ' ' /*.. rype
Well disinfected upon completion? Ll►Yes ❑ No
Sand Gre S 35• 190 PUMP
❑ Not installed Date installed 6�Z���7
Cl$ S$n(� BrQ'Kn [K 90� Z 1 5 Manufacturer's name ��d Jacket
Model number HP��Vfolts 230
Shale sa�f�8�+0 @ �ed B ��n M 1 5� ZZS Length of drop pipe �'��* R. Capacity 1` g.p.m.
�f� Type: C'rSubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet O
Sandstone Cir� ite H i�� ��Z qgANDONEDWELLS P
Does property have any not in use and not sealed well(s)? ❑ Yes LPNo
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes C�'No TN#
W�LL 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.
D�N S'PODULA WBLL DRILLZAtG CO3 , IAte.
Licen e Busines am ic.or Reg.No. 2?1 7 Z
�,�,,,� 9-13-99
\ Authorized Representative Signature Date
C�iuck Maor� 4-21-99
Name of Driller Date
LOCAL COPY 6 2 4 9 0 8 „E_o,2o5_�,Re�.,,�8,
l � ' .
Jcuin �it� l/Vater ��i�cic, J�nc.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
04/23/1999
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-2111
REPORT OF WATER ANALYSIS
Lab#: 36889
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 04/21/1999 from the following location:
4760 Bayside Rd.
Orono,Mn
Unique Well#624908
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).
,
Twi� ' y Water Clinic, Inc.
�,� � `
Bill " � r��le
�
Analyical laboratory Coosultuig Engineer
Waler Malysis Reagenls Boiler Water Chenilcals
Lab CatliGcatiou k 027-053-119