The URL can be used to link to this page

Home My WebLink Aboutwell info �� r—., MINNESOTA UNIQUE WELL WELL O�E�RI�,LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORWG NO. ;� County Name WELL AND BORING RECORD 7 919 9 7 Minnesota Statutes,Chapter 1037 Township Name Township No. Range No. Section No. Fraction WEWBORWG DEPTH(completed) DATE WORK COMPLETED � �� fl. ' GPS DRILLING METHOD ' LOCATION: Latitude degrees minutes ____ seconds ___ u� Longitude degrees minutes seconds f^CableTool I �Driven —— — — - — -- Auger �otary House Number,Street Name.City,and ZIP Code of Well Location Fire Number ❑Other I�� J.i,j'� �y l/f.V[1V �5.771 DRILLING FWID WELL HYDROFRACTURED? ❑Yes No Show exad location of well/boring in section grid with��X" Sketch map of well/boring loc ion. ��lit�' From ft.To ft. Showing property nes, N roads,buildings,and dir tion. USE r�Domestic ❑Monitoring �1 Heating/Cooling �,� __L__ ._�_. ___�__ ; ,` :.]Noncommunity PWS ❑Environ.Bore Hole U Industry/Commercial ---'-- : ; ; ; ; � �Community PWS [�Irrigation ❑Remedial ��' � --'--- --;------�-----'-- []Elevator ❑Dewatering ❑ '- < w ; � ; ; E T ASIN 0e a HOLE DIAM. , , ' r * Q 4y MATERIA Drve Sh Yes I�'No �;� s C G L i � :� ; ; ; � �r�v ri ❑Steel ❑Threade [�Welded � � , , , h_-M��le � �plastic ❑ � ------ ------ - � � 1 : CASING S � Diameter t Weight Specifications ��Mile� �1 ,.,�.�._.:a,,, `f-,..,J/�.. . � in.Ta iL7L ft. Ibs./ft. 8 in.To__ �It. PROPERTY OWNER'S NAME/COMPANY NAME � in.To _ft. Ibs./ft. __ � in.To +�t �� J�� __ in.To _ _ _ft. Ibs./ft. in.To ft Property owner's mailing address if different than well location address indicated above. SCREEN��r� OPEN HOLE �. 1'fIV1 l�f,.��\2.0 M. Make �iii�4Al 17 W �7L7VLC1.LI7C Sta -- — From_ ft. To ft. '� T e �ain�ess �� Diam. � ' � YP — — — -- ------- ---— �� SIoUGauze ;�� __ _Leng[h� � {}t Set between ft.and ft. FITTINGS „ � ` STATIC WATER LEVEL Measured from {� �w�Q�� ;�' "� tt.�'$elow [_Above land surface Date measured "' �'� �•' WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 1� ft.after_ _ V" hrs pumping �"� g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION —�e t��c� ,�j PiUess/adapter manufacturer �i13_ ._ __��Model 3 ❑Casing protection ____ _ �{2 in.above grade -� ❑At-grade []Well House !�Hand Pump � � -' GROUTWG INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Matenal_�t�C�rom V To_ JV _ft J ❑Yds �'Bags Matenal ffi�IiC�J. �2rJf�_�_To�fL ❑Yds. ❑Bags ' HARDNESS OF Matenal . _____ _From____,_.._To__ _fL ❑Yds. ❑8ags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Dnven casing seal From __To__ Bags NEAREST KNOWN SOURCE OF CONTAMINATIO/N �� `'�� t � � /,�'�-�r feet �`� direction ��--^��-^�'` type tr Well disinfected upon completion? ,SC�Yes �No .� Cl� �L�1{� �Qlt Z 27 PUMP �� j! �� ❑Not installed Date installed __�`_ �� .__ _ � ��'Z Manufacturer's name .�'f►�tAA�O/' C�� g�/UiiJi WC�.L3.� 2s3 I6i Model Number _ HP__3___Volts__2�____ Length of drop pipe iGV __. _ft. Capacity _ g.p.m �te� �� 6�Eli.� lb3 1/V Type: Submersible (J 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? ❑Yes No 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,il needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Dc�_S�4ct��tt ��Dcil� CO.��_�Ei91_-- Licensee Business Name Lic.or Feg.No. �'.�' �i-ia-12 rfied e � S'e'ntative Si ure Certified Rep.No. Date � LOCAL COPY — __ — _ —— —� �� .�. 7 919 g 7 Name of Driller IC 140-0020 HE01205-13(Rev.11/10) t . i. Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 Client: Don Stodola Well Drilling Co Report Number: 12-11967 Twin City Water Clinic Inc. Sample Collection Date: io/zz/sz 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time:, roo Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: so/zz/i2 Phone: (952)935-3556 Report Issue Date: 10/22/12 Fax:(952)935-5077 Laborato Analyte Client ID Parameter Sample Prep Sample Analysis Test Sampie ID Date Time Date Time Results Units 12-11967 Coliform Drinking Water 10/22/12 14:27 Absent 12-11967 Nitrate/N Drinking Water 30/23/12 14:43 <1.0 mg/I 12-11967 Arsenic Drinking Water 10/22/12 9:40 10/23/12 13:50 7.02 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water Well No.: 791997 X No samples were subcontracted;or the above test result(s) with'**'designation were produced by�subcontracted Sample pt: laboretory. [Laboratory name;address;MDH Lab ID#].The Well Adr: 1700 Shoreline Dr Orono,MN subcontracted laboretory maintains MDH Certification for the Owner: Irvin Jacobs field(s)of testing performed. � Owner Adr: Sample Conditions: Sample Temperature: 13 °C Discussion: Notes: Approved methods used in analyzing the samples listed above have the following reporting levels: Maximum contaminant levels: Coliform-<1 cfu/100 ml SM9222B-Coliform, 1 cfu/100 ml Nitrate Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen, 1.0 mg/I Arsenic,l0.o µg/1 SM3113B-Arsenic,2.0µg/I lead,15.0µg/I SM31136-Lead,2.0µg/I t�,k��7� 1'',✓;;/ C� d _. Sample Collected by: X Client _TCWC Approved By: ;, ` � eill Van Arsdale Alan Senechal Laboratory Manager Senior Analyst The results listed in this report apply only to the above listed samples.All routine quality assurance 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 1.2 Page 1 of 1 STATE OF MINNESOTA DEPARTMENT OF HEALTH 1 WATER WELL RECORD M/NNESOTq UN/pUE WELL NO. ��s�O Count. �e j�, /o'Wafe�Sample ..tt r',1�?y� Minnesofa Sfafrles 156A.0/�.08 � Township. , ownship Number Range Number Section No. Fraction 4.WELL DEPTH(mmpletedl Date of Completion f?C�.�r��s 1�! � �� W lri at� '' SF''' [+� ��:`� u. 11—�—�i� Numer�al Street Address and City of Well Loca�po or Distance from Road Intersection. 5.DRILLING METHOD �/j l"�� ❑CableTool ❑Reverse ❑Driven ❑p� 1� J�:: . �t�UiF.:1i21� l..�i' �it� �3�"(3;1K:s! �";:1,Iit1. e ct lacation d well in section � with"X." Sketch map of well location. ❑HollowNod ❑Air ❑Bored p �� _i _i_ Addilion Name �t.. '->�� I Rotary Oletted O Power'AuBer �_ , � ' € 6.DRILLING FLUID ' ' ' t 4—d '-�- -�- �- �- Block Number 7. USE W � � � E i _i_ _y_ _� __ ,ei(7 Domestic O Monitoring ❑Heat Pump � � f mi. �t Number .��i.,�. , ..J_�v ,i-.t . ❑Urigation ��Public O Industry ' � � � � --�� ❑Test Well {]Municipal O Canmercial --�- �- - -r- ❑AirConditioning ❑ �—l mile—'a 8.CASING HOLE DIAM. 2.PROPERTY OWNER'S NAME Mailing Address if different than property address HEIGHT:Above/Below f�[Black �j Threaded � �,ti�.l�� ,p.��. indicated above Sur(ace (t. t 't��,,.� ❑Galv. � �ti.i .�ac+}��L14.Ji�� .��<_?Xi�1�A[sy ❑Welded Drive Shce? Yes�No_ YW1.�`1 a7�t::)�'7:3 �1[f6��:lSwfE:"L OPlastic ❑ (� 1 i� .��t?.L'� 3.' 'i; ` . r -y3� ,.�.. ., `". in.to �-�� fL Weight IbsJ(t. �n. to�..�.,t,_1�[. 3. FORMATION LOG COLOR ORMATtON FROM TO in.to ft. Weight Ibslft. —�n. to�t. in.to (L Weight Ibs./ft. �n. to-1[. t 9.SCREEN Or�open hole Make �U�,�„�� trom ft.to. ft. ']'ype ..�7��.i.Z.t�11L..�:.i �.ft'_C�E?t Diam. ,4,N SIoVGauze �,;y Length -�_ FI'P9'[NGS: - Set between '�P�ft.and `��(t. 10. STAT[C WATER LEVEL � :.t�. �;r f[�below ❑above Date Measured t ��H�� land surface I1.PUMPING LEVEL(below land surface) '�c'� F- ( �i+ � ft.after hrs.pumping �•+ g.p.m. ' (t.atter hrs.pumping g.p.m. 12.HEAD WELL COMPLETION Pidess ada ter manufacturer �++s- t�7 Model �ip P ��rtr�E° rv"K1�P3— — ❑Basement ottset jp At least 12"above ground ❑Plastic casing protection 1_ 13.WELLGROUTED? �Yes ❑No '� ❑NeatCement ❑Bentonite �h�.=t%"�tr'•�� p�+��ic3"f11 __ � �.. Grout material from ro ft.cu.yds.__ .:�:,.'� _ �. �..:.. �-- � I4. NEAREST SOURCES OF POSSIBLE CONTAMINATION feet direction �y� 'i� Well disinfected upon completion? �Yes ❑No �+�� 15. PUMP J Date installed ��.'��t.�.`�� ❑Nol installtd � Manufacturer's name ��i`"1,]��1, — Madel num6er HP � Volts�a��} Length o(drop pipe�f�� ft. Capacity �S g.p.m. Material of drop pipe � ��jf{u (�.f�ty �-} :� Type:�]Submersible ❑L.S.Turbine L]Reciprocating ❑Jet ❑Centrifugal L7 _ l6. ABANDONED WELIS Unused well on property? ❑Yes �No Use a sxond sheet,ij needed P�ealed O Permanent ❑ Temporary ❑ Not sealed l7.REMARKS,ELEVATION,SOURCE OF DATA,etc. t8.WATER WELLCONTRACTOR CERT[FICATION This well was drilled under my jurisdiction and this report is true to the best of my knowltdge and belief. �r`N `.-'.�?�. 'Lr'q {ti�51.,L 1�2I1.�L.I 'NCs � � IIVC: L f�.7� Lirensee Business Nnme Liante No. Addres�t:_,t�� 1 CiiZ{rt�,�7 i'�� i� M'�".�Cr"3� �t1_ - -.,�!`, Sign'Ti/�i^'�- ��Date�r'-�l-y�l Authortzed Re re ntatt �� t�` i�_ I�1tA'k;�i.:r, �acP I�—u—tl(! � NameoJDrtller - - 5/74 30M LOCAL COPY �� g 5 q � ;7e� HE-01205-03(Rev.9/88) ziE2 ip� � ' /l�CIG (� f�[/C�PJ� � � , _/I�C. 617 13TH AVE. SO. • HOPKINS,MINNESOTA 55343 • 935-3556 Stodola Well Drilling December 12, 1990 15306 Highway 7 Minnetonka, Mn. 55345 F E B �, g 199�. HEPORT OF WATER ANALYSIS /recoived Irom y��\ December 6, 1990 Our laboratory reports ihese analytical results, determined on a sample i 1 on \ t�s / well water f rom Jim Jensen Homes . (Irwin Jacobs) 1720 Shoreline Dr. Orono� Mn. Unique Well # 469540 Bacteria (Coliform group) less than 1/100 ml Nitrate nitrogen less than 0.1 mg/1 The results of these tests indicate that this well is producing water that �c�eei:s ihe standards for F'.H.A. , V.A. , or conventional loans. � Flinic, Inc. �`�\. \ Analytical laboratory Bl ll �/d Ar'SC3dg�su�t�ng engineer W ater analysis reagents Boile�water chem�cals 17.1 partslmilhon equals 1 U g�ainiyallon