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WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO.
County Name WELL AND BORING RECORD 677 8 6
Hennepin Minnesota Statutes Chapter 103/
Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed
n.
Orono 118 23 31 335 9-30-02
House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD
420 Orchard Park R4, Orono 55356 CI Aug Tool 0 Driven 0 Dug
111 Auger Rotary 0 Jetted
Show exact location of well in sectio\ nd
Sketch map of well location. El
Showing property lines,
roads abuildings. DRILLING FLUID - WELL HYDROFRACTURED? ❑YES OHIO
N ' .. bentonite FROM ft.to ft.
{ USE ❑ Commung ❑ I dust /Comm(/ omestic ❑ Community PWS ❑ Indust /Commercial
❑ Irrigation ❑ Noncommunity PWS ❑ Remedial
w I E ❑ Environ.Bore Hole ❑ Dewatering ❑
YI CASING Drive Shoe? es 0 No HOLE DIAM.
/
KSteel ?threaded 0 Welded
/ ❑ Plastic 0
S
I—I M,Iei
CASING DIAMETER WEIGHT
PROPERTY OWNERS NAME 4 in.to_252_ft. 31 lbs./ft. 8 in.to.30 ft.
LDK Builders ZInc. in.to ft. lbs./ft. 63/4_in.t ft.
Property owner's mailing address if different than well location address indicated above. ____._ _ in.to ft. lbs./ft. 3 7 ti8to..33.5.
21370 John Mills Dr, Ste 101 SCREEN ___ OPEN HOLE (! OJ
P.O. Box 67 Make from 252 ft.to 335 ft.
Type Diam.
Rogers, MN 55374
1 SloUoUGauze Length
Set between ft.and ft. FITTINGS:
STATIC WATER LEVEL
WELL OWNER'S NAME 118 ft.Xbelow ❑ above land surface Date measured 9-3002
PUMPING LEVEL(below land surface)
Well owner's mailing address if different than property owner's address indicated above. 250 ft. after 3 hrs.pumping 35 g.p.m.
WELL HEAD COMPLETION
❑ Pitless adapter manufacturer 111h11 t eve t A r Model
❑ Casing Protection 0 12 in.above grade
❑ At-grade(Environmental Wells and Borings ONLY)
+ SGROUTING INFORMATION
Well grouted? ? Yes ❑ No
HARDNESS OF Grout Material ❑ Neat cement 0 Bentonite 0 Concrete Hi h Solids Bentonite
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO 30g
* from to [
ft. 3 ❑ yds. bags
clayyellow hard 28 from 30-_to 252 ft. na�fi4s1❑ bags
from to ft. 0 yds. ❑ bags
NEAREST KNOWN SOURCE OF CONTAMINATION
clay gray soft 28 110 f•'J feet direction j`•.1a•-�. type
Well disinfected upon completion? 'res 0 No
sandigravel gray soft 110 160 PUMP
O Not installed Date installed 10-18-02
clay/rocks gray medium 160 252 Manufacturer's name Aermotor
sandstone gray hard 252 335 Model number HP 1.5 Volts 230
Length of drop pipe 147 ft. Capacity g.p.m.
Type: ❑ Submersible 0 L.S.Turbine ❑ Reciprocating 0 Jet 0
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? 0 Yes o
- • VARIANCE
Was a variance granted from the MDH for this well? 0 Yes ,o TN#
WELL CONTRACTOR CERTIFICATION
Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725.
REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge.
t • • • • • - Dril -27172
• Li - see Busin ss Name lc.or Re .No.
/ AzedRepresat,-Sigfl.
LV re `� ' 12-4-02—02
Chuck Moore 9-30-02
°..A 77870 Name of Driller Date
g/�
ro
LOCAL COPY HE-01205-07(Rev.2/99)
IC#140-0020
Tw£ / C Ity W cat-ex C , I vc/.
617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556
10/03/2002
Stodola Well Drilling
3841 North Main
St. Bonifacius MN 55375
938-2111
REPORT OF WATER ANALYSIS
Lab #: 1024
Our Laboratory reports these analytical results, determined on a sample taken
by CLIENT on 10/01/2002 from the following location:
420 Orchard Park Rd.
Orono,Mn
Unique Well #677870
Coliform Bacteria <1/100 ml
Nitrates Nitrogen <1.0 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 include analysis of Lead and other
contaminants. (Unless as specified by client).
w.. Cit Water Clinic, Inc.
Bill ` • •ale
Lab Certification#027-053-119