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; WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UN/QUE WELL NO.
� County Name WELL AND BORING RECORD
P ( 2 � a33
� in Minnesota Statutes, Cha ter 103I
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
` 4cono 128 23 27 �� �� �� 185 `� 8-26-f)S
GPS DRILLING METHOD
� LOCATION: Latitude degrees minutes seconds
Longitude degrees minutes seconds �Cable Tool �'Driven .Dug
[;Auger �otary ❑Jetted
- House Number,Street Name,City,and Zip Code of Well Location or Fire Number �
' 1925 Lakeviev Tecrat:e O�OL� 553 b DRILLING FLUID WELL HYDROFRACTURED? _,Yes o
9
Show exact locatfon of well in section grid with"X". Sketch map of well location. �t�3t� FROM ft.TO ft.
�:a S�hoJw�pg property lines,
oads and buildings USE
N � � [J Monitoring j]Heating/Cooling
' I I ; I � ���� ,; �Domestic �,�'�Environ.Bore Hole �J IndusVy/Commercial -�
--'--- --J--- ---`-- ---`-- '
;]Noncommunity PWS �._�Irrigation `�..Remedial
�'Community PWS �_�Dewatering ❑
CASING . HOLE DIAM.
w e T ` ( Drive Shoe? �__�Yes �No
Ih�" j '��Steel {_=�Threaded 'L;Welded
'h nnlie �y+ ""'^"`�� �,rplastic � _
: ------ ------ --�-- ---:-- 1 �
CASING DIAMETER WEIGHT
: , , S , ,
�1 Mile—�{ —`'�in.to_._�ft. 4 Ibs./ft. �__in.to_lE/ft.
in.to ____.. ft. Ibs./ft �in.t�f7J ft. '
F
. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft.
� aillG iQCs SCREEN OPEN HOLE
Property owner's mailing address if different than well location address indicated above. Make FROM ft TO tt.
��y+� t1A�,c• �+ S�S�Ytt@913��—
n: alJlJ7 1 A1�RL76 JPu TYPe— - -- — Diam. � -- —
�3.l�LiV MN 55328 SlotlGauze_ �__ Length �f „t, )�!
s Set between ft.and ft. FITTINGS
STATIC WATE L �
1�� ft.I�ielow �._;above land surface Date measured U�Lv�tl� �
PUMPING LEVEL(below land surface)
: WELL OWNER'S NAME/COMPANY NAME �'
_ 1�,'r}_ _ft.after Z hrs.pumping 1,� g.p.m.
WELL HEAD COMPLETION
�� Well owner's mailing address if ditterent than property owners address indicated above. �pitless adapter manufacturer_ 1'�1��@ii$.�.@1' Model
�Casing Protection �2 in.above grade
�,Abgrade(Environmental Wells and Boring ONLY)
GROUTING INFORMATION
Well grouted ,1_,�'es �r]No
Grout material _Neat cement ❑Bentonite �. J Concrete ,�-ligh Solids Bentonite
from�to�ft. � ❑yds. [*6ags
from�__to ��S ft.j�_��c�. ��.,bags
� GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft [;yds. (]bags
� MATERIAL
NEAREST KNOWN SOURCE OF CONTAMINATION -
_. ,.� '"� l.�, �v_. • ,ryPE
� C� �'+� O �O Y✓'�✓ feet �� �► direction �
EaG'UJ.
' Well disinfected upon completion �Yes '�_�No ���.r.J i..,:_.�;., .y-�.�-
@�.ZOii
C � U7�iL� lO 1V17 PUMP T�S
,Not installed Date installed
� � e r�,� �t� �t� Manufacturer's name ����
iACRa.i OlJ � Model number _, HP � Volts �`�
� ��� �65 185 Length of drop pipe �f�� ft. Capacity g.p.m.
Type: -� ubmersible I���LS.Turbine [Reciprocating ❑Jet ❑
ABANDONED WELLS �
Does property have any not in use and not sealed well(s) `_]Yes o
VARIANCE
Was a variance granted from the MDH for this well? r]Yes o TN#__
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 sheet,if needed
� REMARKS,ELEVATION,SOURCE OF DATA,eta � Stodola 'Well Dciilfn,�.Ca�� I�IC zn7a
Licensee Business Name Lic.or Reg.No.
_r,."�
i1-9-05
ut rized Representative Signature Date
Ji� 1Coh2s
LOCAL COPY 7 2 � � � 3 Name ol Driuer
HE-01205-08(Rev.5/02)
. IC 140-0020
..�..
. � / /
WV C t�' 1Na.t"P�v' CLi�Vt�,c�, I v�,c�•
Tw y
617 13th Ave So Hopkins, Minnesota 55343 � (612) 935 - 3556
11/14/2005
Stodola Well Drilling
3841 Norrh Main
St. Bonifacius MN 55375
938-21 1 J
REPORT OF WATER ANALYSIS
Lab #: 6996N
Our Laboratory reports these analytical resufts, determined on a sample iaken
by CLIENT on 1 1/l0/2005 from the followrng locarion:
1925 Lakeview Terrace
Orono�Mn
Well#726433
Coliform Bacreria <1/J00 ml
Nitrates Nitrogen <].0 mg/1
The results of rhese tests indicate rhat this well is producing water that meets the
srandards for F.H.A., V.A., or conventional loans. This report is an analysis for
coliform and nitrate only and does noi include analysis of Lead and orher
contaminants. (Unless as specifred by clienr).
in Cicy Water Clink, lnc.
'.. �
Bilh Arsdale
Lnb CaRification fl 027-053-I 19