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617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556
09/13/2007
Stodola Well Drilling
3841 North Main
� Sr. Boni facius MN 55375
93 8-21 1 1
REPORT OF WATER ANALYSIS
Lab #: 424BN
Our Laboratovy reports these analytical results, determined on a sample taken
by CLIENT on 09/1 1/2007 from the following location:
Edward Conlin
1520 Fox St.
Orono,Mn
Well 750670
Coliform Bacreria Absent
Nitrates Nitrogen <1.0 mg/1
The results of these tests indicare that this well is producing water that meets the
standavds 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 speci fied by client).
-,
Twlh ity Water Clinic, lnc.
, �
Bill V��! sdale
j
i
Lab Cert�cation tt 027-053-119
�
WELL C>F BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„' �� /� ���
� County Name
WELL AND BORING SEALING RECORD Minnle9oNa Unique Well No. 't
{�{ Minnesota Statutes,Cha ter 1031 or W-series No.
� �i3i P [Leave blank i�no�knownl
Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Conshucted
� o,� ii� Zs o2 3�-cx�o2�� q�� ��
. _ .._,t i
GPS Latitude degrees minutes seconds Depth Before Sealing_ o�� ft. Original Depth ft.
LOCATION: Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL
Numerical Street Address or Fire Number and Ciry of Well or Boring Location Single Aquifer (_J Multiaquifer ,�f� /� /�
1520 Fox St, V� ,75.77� �W/ELUBORING �easured ❑Estimated Date Measured r'',��l�iF iJ17
�y-Water-Supply Well ❑Monit.Well �^ �
Show exact location of well or boring Sketch`rCap of wel�'�r boring �Env.Bore Hole ❑Other ��``�6�(;J ft. �below �- 1 above land surface
in section grid with"X" y�qc�aSjjprl,s 'n I �rty —� ;�,,_,,.,.�. ��
N � " � 9S� CASING TYPE(S)
, �
. _''___ __�'_ ___`__'__'__ ' .
� � �I ❑Plastic ❑Tile ❑Other
--'--- --+-- ---`-- ---'-- � � WELLHEAD COMPLETION
W E
�� � � � � �- �� � � Outside: '�"�Well House 3rade Inside: �;Basement Offset
'h Miie � � _ �itless Adapter/Unit ���uried L]Well Pit
-- --- - I j .^ ]Buried
_L � � ❑Well Pit
S ]otner
�--1 Mile--{ �I L_Othef
PROPEATY OW/�1 ER'S NAME/CO^M�PA,,�N�Y{j E � CASING(S)
���/J�e 1�.�1J.J.n / /� r De�'� � Set in oversize hole? Annular space initially grouted?
-� Properry owner's mailing address if diflerent than well location address indicated above �1 `� rOm `� t0�� _ J Yes �No ❑Yes ❑No ❑Unknown
.�
881� �8 !1�'1QVe
.,� in.from to __ ft. ❑Yes [�No ❑Yes ❑No ❑Unknown
� in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown
WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE �
Well owner's mailing atld�ess if diNerent than property owner's address indicated above SCreen frorr��_to���f ft. Open Hole from to R.
OBSTRUCTIONS
❑Rods/Drop Pipe ❑Check Valve(s) I]Debris '_��Fili � �bstruction
Type of Obstructions(Describe) __ . , .
GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe
FORMATION
PUMP
If not known,indicate estimated formation log from nearby well or boring. -
_.��` / TyPe
� `� •��� ❑Removed �1'!ot Present ❑Other _._
i l
� METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE:
[�Jo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal -
in.from to ft. ❑Perforated � �Removed
in.from to ft. ❑Perforeted []Removed
� Type of Perforator
❑Other
GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.)
Grouting Materi�/*/ C.r/��F��from � r ��� �. yard�_�� bags
from to ft. yards _ bags
___ from to ___ ft. yards bags
OTHER WELLS AND BORINGS
�, REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes � No How many?
��� LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report
is true to the best of my knowledge.
D� Stodoia iiSll Dcillin� +Co,. Inc. l�91
Licensee Business Name License or Registration No.
/ �� - �/ .�7
d epresentative Signatu�e Certified Rep.No. Date
_c�;;,�^o�v H ��,-.� �,�.... ..���,...�
2 6 4 3�6 Name ol Person Sealing Well or Boring
HE-01434-10 IC#140-0423 5/o�a .:.;