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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD 68897 -1
Hennepin Minnesota Statutes Chapter 1031
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
Orono 11? 23 07 ,, ,A 246 � 6-3-0
GPS DRILLING METHOD
LOCATION: Latitude degrees minutes seconds
Longitude degrees minutes seconds ❑I Cable Tool L]Driven ❑Dug
❑AugerS�Rotary ❑Jetted
House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑ /
4535 It Shore Dc Orono 5536 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes XNo
Shop exact location of well in section grid with"X". Sketch map of well location. benoonite FROM ft.TO ft.
Showing property lines,
N roads and buildings USE ❑Monitoring ❑Heating/Cooling
Domestic ❑Environ.Bore Hole ❑Industry/Commercial
❑Noncommunity PWS ❑irrigation ❑Remedial
Community PWS ❑Dewatering
7� ❑Comm ❑
CASING Yes )(No
HOLE DIAM.
W � � � E T Drive Shoe?
e ❑Steel ❑Threaded ❑Welded
$Mile Plastic El
CASING DIAMETER WEIGHT
S Ni t _ A in.to_218 ft. ?.()I lbs./ft. in.to_34ft.
-1 Mile-� �.; +\_1� it,
in.to ft. lbs./ft. in.teff.
PROPERTY OWNER'S NAME/COMPANY NAME * in.to ft. lbs./ft. in.to ft.
Tonevood Deei Build SCREEY OPEN HOLE
Property owner's mailing address if different than well location address indicated above. Make_-" 0 FROM ft. TO ft.
4420 Shoreline Dr Type Diam.
Spring Park, MN 55384 Slot/Gauze •010 Length 49 * 41
Set betweenft.and ft. FITTINGS
STATIC WATER LEVEL ]
65 ft. 6
below ❑above land surface Date measured 6-3-03
PUMPING LEVEL(below land surface)
WELL OWNER'S NAME/COMPANY NAME 235
ft.after 1.5 hrs.pumping40 __g p.m.
WELL HEAD COMPLETION �2
Well owner's mailing address if different than property owners address indicated above. Pitless adapter manufacturer waif tealltlr Model _
❑Casing Protection >f12 in.above grade
IR=CSVEp ❑At-grade(Environmental Wells and Boring ONLY)
GROUTING INFORMATION�j
Well grouted !�'-- Yes ❑No
6 2004 Grout material ❑Neat cement ❑Bentonite ❑Concrete High Solids Bentonite
g"_ from .to_5ft. 3 ❑yds. )<bags
'YOv. -�'from 0 t-238 ftnat,r� f fj}❑bags
GEOLOGICAL MATERIALS
YL
HARDNESS OF FROM TO from to ft. ❑yds. ❑bags
MATERIAL
NEAREST KNOWN SOURCE OF CONTAMINATION
feet
�" direction pe
topsoil black soft 0 3 d -1 =�- ty
Well disinfected upon completion 9Yes ❑No
clay brown soft 3 181
PUMP 6-22-03
'❑Not installed Date installed_
clay ra soft 18 84 Manufacturer's name AervDtor
Model number HP 105 Volts Zia
*and gray Soft 80 110 Length of drop pipe NQS ft. Capacity g.p.m.
Type:, Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
clay/sand Rray Soft 10 230 ABANDONED WELLS
Does property have any not in use and not sealed well(s) _.Yes XNo
Ater sand t C8 soft
4
0 2fL VARIANCE
1 't Was a variance granted from the MDH for this well? 7 YesNo TN#
WELL CONTRACTOR CERTIFICATION rX
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 Drilling
REMARKS,ELEVATION,SOURCE OF DATA,etc. Son Stodola Well Drilling Co., Inc. 27, 72
Licensee Business 00ame _- Lic.or Reg.No.
uthoriz presentative Signature- Date
Chuck Moore---6-3-03--
Name
o Ire -_-3-03__
9 7. Name of Driller Date
LOCAL COPY HE-01205-08(Rev.5/02)
IC 140-0020
riv*v C Xy W aot-e-or c nAC1.
617 13th Ave So Hopkins, Minnesota 55343 (612) 935 - 3556
06/06/2003
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-2111
REPORT OF WATER ANALYSIS
Lab#: 458
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 06/04/2003 from the following location:
4515 N.Shore Dr.
Orono,Mn
Unique Well#688976
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).
I I Water Clinic, Inc.
Bill
Lab Certification#027-053-119