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� MINNESOTA UNIQUE WELL
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO.
CountyName WELL AND B�RING RECORD � 6 ��.�.2_�.�
��i� Minnesota Sta#iites,Chapter 1037
Township Name Township No. Range No. Section No. Fraction WELY780RING DEPTH(completed) DATE WORK COMPLETED
t?tocio 32i 23 OS � ,� ,U '*�� � i8-(!S
GPS DRIL:LING METHOD
��� LOCATION: Latitude degrees minutes seconds _
Longitude degrees minutes seconds ._ Cable Tool '�J Driven � '�Dug
— - �Auger �Rotary ['Jetted
House Number,Street Name,City,and Zip Code of Well Location or Fire Number �,—_� ��
J4'iV C7�I� 1'�i�L� � vLVi� �Sb DRIL�fNG FLUID WELL HYDROFRACTURED? r'Yes ; o
Show exact location of well/boring in section grid with"X" Sketch map of well/boring location. ��?'�-� �t��l From ft.To ft.
-} Sho p perty lines, �_� ��
' .y .. r uil s direction. USE• �' � � ,
N '�..,,)� -.+..��.a..._.ha-%'---��� �� ���,�Domestic '�Monitonng �i Heating/Cooling
__.___ __._____L_ ___:_ �-����,_��.Noncommunity PWS ❑Environ.Bore Hole [�Industry/Comme'pcial -�
�' I Communiry PWS ']Irrigation r Remedial �
--'-----;-----`-- ---`-- i Elevator �'�Dewatering -� � �
W � � E MATERIAL Drive Shoe? [I Yes o HOLE DIAM. �
_ _
T � CASING � ;
�-- F- ---%-- � `. , , _. � � .
"'� �Steel _Threaded ❑Welded
, , � 'h Mile . lastiC '-
, , , , 1 � � _
--.-----,-- --.-- ---:- . -
v3$" _ , CASING
g � - iameter Weight Specifications
�1 Mlle� �� �,I �in.to_�ft. �.7bs./ft. , _�,,,�� �in.to�. .
��p �
PROPERTY OWNER'S NAME COMPANY NAME in.to _ it .___IbsJfL _. __ _ �in.to (.1/i7t.
B�•,Qt� /+•,��,t�ti� in.to ft. Ibs./ft. in.to ft.
� wu�a OPEN HOLE
Property owner's mailing address if differeN than well location address indicated above. SCREEN
22d15 � 7 Make a� ____._ From ft. To ft.
i7iI7[lct� � J��� TYPe ��aiii��,� �t-i Diam.----_—
! SbUGauze �$,�8 _____ Length� ,* ({�
Set behveen ft.and it. FITTINGS
STATIC WATER LE EL
/� Measured from
2V-7 ft.i elow n Above land surface Date measured ��
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)
37� ft.after ` hrs.pumping �7V g.p.m.
Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION },,• ���y�
[�,(`S itless/adapter manufacturer_t�����^�'�'*s'�'"�^�Model
�..J Casing Protection ��Q2 in.above grade
� ]At-grade(Environmental Well and Boring ONLY)
GROUTING INFORMATION
Well grouted '�Yes L�No
Grout materials �,.�Neat cement�entonite � -Concrete ❑Other.}
From To y�� . �7 � I Yds � ags
GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From � To I7ifit. �RL�����I�Bags
MATERIAL From__�To__ GlJ[.7f1. � ❑Yds. � ags
NEAREST KNOWN SOURCE OF CONTAMINATION
CIa bc�m aOft 1 )��
J 'Q�feet � direction � � type
t �y Well disinfected upon completion? ' es ❑No
Ct�l aQ,{,{, � PUMP
-� � � �i Not installed Date installed �'"� ` ��� �6✓
C�$ �'"""" ��t � Manufacturer's name �--a!� ��.."�..J`✓
Model Number HP .J Volts ��
cla bc�c�m aQft I 1 i,, '7
Length of drop pipe /Y / ft. Capacity g.p.m.
� L.� �A, � Type: Submersible ❑LS.Turbine ❑Reciprocating ❑Jet ❑
� l�� ABANDONED WELLS
� Does property have any not in use and not sealed well(s)? �-I Yes I o
VARIANCE
Was a variance granted from the MDH for this well? �'�Yes � o TNri
WELL CONTRACTOR CERTIFICATION
This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
. The information contained in this report is true to the best of my knowledge.
Use a second sheeG if needed. ���'�S• tL*1 � �r�e�s� "�a i�• a diviaion of
} REMARKS,ELEVATION,SOURCE OF DATA,etc. Y�C�1 i����1�
Dc�ei Stodols Weil Drfllfa� Co., Ix�c. 1691
__ - - __ _ __
Licensee Business Name Lic.or Reg.No.
��� 4C�
�ie resentative Sigrf�iture � Certified Rep.No. Date
LOCAL COPY 7 �O 6 C. V __._� �� _-
Name of Driller
IC 140-0020 HE-01205-11(Rev.3/07) �
r �
rw i�w C i,t�y W a��' C ' ' , I v�c�'i
617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556
06/20/2008
Stodola Well Drilling
3841 North Main
ST. Bonifacius MN 55375
938-21 1 1
REPORT OF WATER ANALYSIS
Lab #: 248BN
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 06/18/2008 from the following location:
3240 Graham Hili Rd
Orono,Mn
Well 760628
Coliform Bacteria Absent
Nitrares Nitrogen <1.0 mg/1
The results of these tests indicate that this well is producing water thar meets rhe
standards for F.H.A., V.A., or conventional loans. This report is an analysis for
coliform and nitrare only and does not include c�nalvsis of Lead and other
contaminants. (Unless as speci fied b;� client).
Twin City..�bt�a er linic, Inc.
Bill Va �rsdale
�-
Lab Cariit7catinn k ii�7-u;>-I 1'�