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Home My WebLink AboutWell and Boring Construction Record ' MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 8 27810 Henilep fL Minnesota Statutes,Chapter 1031 hp Township Name Township No. Range No. Section No. Fraction(sm.-.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 HO6 SE SE SWi _ 151 t 6-15-18 _ GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger %Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other_ DRILLING FLUID WELL HYDROFRACTURED? ❑Yesio 650 Pinehurst Crt, Orono 55364 Show exact location of well/boring in section grid with'X." Sketch map of well/boring location. bentonite From ft.To ft. Showing property lines, N roads,buildings,and direction. USE .i Domestic ❑Monitoring ❑Heating/Cooling _____ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial '..4,< ❑Community PWS ❑Irrigation ❑Remedial ---l---.-- l ❑Elevator ❑Dewatering ❑ _ w E CASING MATERIAL Drive Shoe? ❑Yes �(No HOLE DIAM. T ❑Steel ❑Threaded ❑Welded '/Mile 'Plastic Cl 1 i _ CASING s1 41 Diameter Weight Specifications I___1 Mile--I (0 P 4" in.Ta 145 ft. lbs./ft. 86-1 _in.To 50 ft. -- PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6 4 in,To 15 3 ft. Norton Homes n.To ft. lbs./ft. in.To ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Johnson 18215 45th Ave N, Ste D Make From ft. To ft. Type stainless steel Diam.2" Plymouth, MN 55446 Slot/Gauze .010 Length 41 + 4' Set between 1'5 ft.and 153 ft. FITTINGS 2MX3I leader STATIC WATER LEVEL 70 ft.Xtelow❑Above land surface Measured fromtop of well ate measured 6-15-18 Dry hole ❑ Yes ]a'No — WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 140 ft.after 2 hrs.pumping 40 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer Whitewater Model ❑Casing protection 12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) MateriabentOnite From 0 To 50 ft. 3 ❑Yds. igtags Materiacut t ings From 50 To 145 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags = One bag94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION topsoil black medium 0 2 Well is /4./,`-',f-) feet •— direction from 'b---`--" - type Well disinfected upon completion? Wes ❑No clay brown medium 2 , 25 PUMP ❑Not installed Date installed 8-2-ip clay gray soft 25 61 Manufacturer's name SehAPfer Model Number HP 1.5 Volts 230 sandy clay gray medium 61 74 Length of drop pipe 84 ft. Capacity g.p.m sand brown medium 74 7()98 TypeigSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ 98 ABANDONED WELLS fine sand gray solC t 120 Does property have any not in use and not sealed well(s)? ❑Yes PKflo VARIANCE gravel mix medium 120 134 Was a variance granted from the MDH for this well? ❑Yes,No TN# WELL CONTRACTOR CERTIFICATION 'r This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. sand medium 134 153 The information contained in this report is true to the best of my knowledge. Use a Seco til needed. 1 ^,, • Co REMARKS,ELEVATION,SOURCE OF DATA,etc. 1 Stodola well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. _2_7', �f��j._ _ z;;,,-- 9-20-18 Cer i �Repres n tive'Signa urs f Certified Rep.No. Date Rob Stodola LOCAL COPY 8 2 7 810 Name of Driller ID#52603 HE-01205-16 IRev.5/16) Minnesota State Laboratory ID#027-053-119 Twin City Water Clinic Laboratory Test Report Wisconsin State Laboratory ID#105-10117 Wisconsin DNR Lab ID#399073400 Client: Don Stodola Well Drilling Report Number: 18-07574 Twin City Water Clinic Inc. Sample Collection Date: 06/17/18 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 14:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 06/18/18 Phone:(952)935-3556 Report Issue Date: 06/19/18 Fax:(952)935-5077 Laboratory :Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 18-07574 Coliform Drinking Water 06/18/18 13:03 Absent 18-07574 Nitrate/N Drinking Water 06/18/18 12:46 <1.0 mg/L 18-07574 Arsenic Drinking Water 06/18/18 8:00 06/19/18 12:02 <2.0 µg/L Lead Drinking Water µg/L Well No.: 827810 X No samples were subcontracted;or the above test result(s) Sample pt: well with**'designation were produced by a subcontracted laboratory. [Laboratory name;address;MDH Lab IDM. The Well Adr: 650 Pinehurst Court;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Norton Homes field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 14'C Discussion: Notes: Approvedmethods usedin analyzing the samples listed above have the following reporting levels: Maximum contaminant levels: SM9222B Coliform,1 cfu/100 ml Coliform-<1 cfu/100 ml Nitrate EPA 353.2-Nitrate Nitrogen expressed as No3+NO2,1.0 mg/L Nitrogen 10.0.mg/L Arsenic,10.0 SM3113B-Arsenic,2.0 pg/I,Lead,2.0 µg/L µg,/L Lead,15.0µg/L EPA 353.2-Nitrite Nitrogen,1.0 mg/L Nitrite,1 mg/L Sample Collected by: X Client _TCWC Approved By: Bill Van Arsdale Laboratory Manager The results listed in this report apply only to the above listed samples.All routine quality:asurance procedures were followed,unless otherwise noted.This analytical report must be reported in its entirety.All methods are certified by the Minnesota Department of Health,unless otherwise noted. TCWD Rev 4.0 Page 1 of 1