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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIOUE WELL NO.
CountyName WELL RECORD 5 613 5 8
�'��=�''"'''3� Minnesota Statutes Chapter f031
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
n.
:,� + i^ ��. �. �. '` - 1: -
Numerical Street Address and City of Well Location or Fire Number DRILUNG METHOD
t _ ❑ Cable Tool ❑ Driven ❑ Dug
:.{ � � i_C�ii"i�'_i v'r 3�:t:: �Ji. �`f. 1i7�'i ,r,C-� t,i i. ❑ Auger ❑ Rotary ❑Jetted
Show exact location of well in section grid with"X". Sketch map of well location. ❑
Shoy+mg property lines,
N /roads and buildings. DRILLING FLUID
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_'r"y_ _1 _1_
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i � � i � ,USE q Domestic ❑ Monitoring � Heating/Cooling
�-�- --- - �- ❑ Industry/Commercial
yy � ; i , E ❑ Irriga[ion ❑ Public
' T ❑ Test Well ❑ Dewatering � Remedial
_1_ _1_ _'_ S' I ❑
I ! ' �
� , f"""� ``L CASING Drive Shoe? ❑ Yes � No HOLE DIAM.
--;- �' - -�' I y�� kk ❑ Steel ❑ Threaded ❑ Welded
1 ���'� �`Plastic ❑
�-I milr� -^'�
CASING DIAMETER WEIGHT
PROPEFTY OWNER'S NAME � '
' . � in.to 1`-'-%ft. :�-{.3�t..._.''� Ibs./R. � %ie�t -
o ��t.
;� '1\� 1,.1{. ::: .. in.to fl. Ibs./ft. �
-T��to�r�f.t.
Mailing address if different than property address indicated above. in.to ft. Ibs./ft. in.to ft.
� i� I �`I��,, : � L,, ;R`, .�, SCREEN OPEN HOLE
� y� � - Make lkii l_l Y� 7Y'+ ::.�;", from R.to tt.
f�. '�'l; .� , �.:. :. .. � . .
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TYPe .,1-��-t��-s�`--,—.k Diam. ;t3
SIOUGauze Length " �
Set between �:'�:�� � tt.and �j.� ft. FITTINGS:
HARDNESS OF STATIC WATER LEVEL
GEOLOGICAL MATERIALS COLOR FROM TO ?; `r ft. 0� elow ❑ above land surtace Date measured �'
MATERIAL � e- .-; ".
PUMPtNG LEVEL(below land surface)
� �.��.��.�'. c+ :��:ti�-�.i) �. ' ° ���. . t ft. after hrs.pumping g.p.m.
WELL HEAD COMPLETION
,,, .. i:�la� �� --,�_i":.- ��.
,'�,1^,�.i ��..(;� '��� �C] Pitlessadaptermanufacturer Model
❑ Casing Protection [] 12 in.above grade
GROUTING INFORMATION
Well grouted? ❑,Yes ❑ No
Grout Material ❑ Neat cement ❑ Bentonite
from � to ' ft. ❑ yds. Q,bags �
from to ft. ❑ yds. ❑ bags
from to ft. ❑ yds. ❑ bags
NEARE$.�KNOWN SOURCE OF CONTAMINATION
�-��) ° teet ��,�e'yJ��;' direclion ,,�zs"'Li T;l'ryPe
Well disinfected upon completion? �Yes ❑ No -�—T-��
" PUMP
❑ Not installed Date installed '�a�_��j__��.��-
Manufacturer'sname _��;.£,
Model number Z��r.�>� `7 HP�_ Volts L_�i-�
Length of drop pipe '�i� 4 ft. Capacity '�� g,p.m.
Pressure Tank Capacity �
Type: ❑ Submersible �]�L.�.�Turbine�❑ eciprocating ❑ Jet ❑
ABANDONED WELLS �
Dces property have any not in use and not sealed well(s)? O Yes C�,No
WELL CONTRACTOR CERTIFICATION
- � This well was drilled under my supervision and in accordance with Minnesota Fules,Chapter 4725. �
The information contained in this report is true to the best of my knowledge.
Useasecondsheet,iineeded i-z� t'� E .. . { �.�.-. t�s-,i�., i ...�.i�.,1 '{.; _ , � ..!iu:.`, ,. � � ,
REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name . Lic.or Reg.No.
� � i . � j ,Y- ._�'� -
••—/� � %J
y�� � � . e..-�'-� :
Authonzed Representahve Srgnature Date f
! ,...::,�... .� ,�, ,
� .1 . ,.`t.__ .. . . ..
Name of Driller Date
LOCAL COPY 5 613 5 8 HE-01205-04(Rev.5/92)
, �I'win City �Vater Clinic, Inc. �
, 61713th Ave So • Hopkins, Minnesota 55343 • (612)935-3556
07/21/1995
Stodola Well Drilling
1 5306 Hwy 7
Minnetonka MN 55345
938-21 1 1
REPORT OF WATER ANALYSIS
Lab�: 26642
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 07/19/1995 from the following (ocation:
263b Countryside Dr W
Orono,Mn
Unique#561358 .
Coliform Bacteria <1/100 ml
Nitrates Nitrogen 1.90 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 inciude analysis of Lead and other contaminants: (Unless
as specified by client).
\
i Water Clinic, Inc.
\
Bill a
nmlyiwl t,bowrory Co�u►w,s�
Water Amlyou Reagentr Boiler W�ter Chenuwlo
Lab Ccrtdication/027-033-119