HomeMy WebLinkAboutwell info ;
.. ......: ... ... .. . ...._. . �.., _. . _. .�, _ ,, . -+. ,. ., .. . _.__ . , , �_
;. . _: . _. �. ._. _ ._ . _ ,
MINNESOTA UNIQUE WELL
WELL OF�RIN��OCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO.
County Name ' WELL AND BORING CONSTRUCTION RECORD
������l��n Minnesota Statutes,Chapter 10.?I 8 2 6 6 4�
Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED
th�ono 117 ?3 15 ,�S�a ��? ��� �3 tt. �;_29-17
GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD
Latitude Longitude ❑Cable Tool ❑Driven �
[]Auger �Rotary
House Number,Street Name,City,and ZIP Code of Well Location []Other
2f�9� Shoreline DL�� �COI7O 55391 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o
- Show exact location of welllboring in section grid with"X:' Sk ap o(well/bori g location. !')F,?(j��("1'2,t� From ft.To ft.
.; Showing pr erty lines,
' �ads,buildings,a direction. USE
N �Domestic ❑Monitoring [�Heating/Cooling
.�', __ ___ _____ ____ ___ __ �� � Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial
�\ � ❑Community PWS ❑Irrigation ❑Remedial
i _� � ❑Elevator ❑Dewatering ❑ �
- `/� , , , , E T - ASIN HOLE DIAM.
� � � � � ;.
�' --�-----�--- --�----%-- I ' ��tl G�SteelAL �Threaded ❑Y❑We�do
'h Mile ) � ��'� C �
? ; ; ; ; StiC
� � Pla
--;-----�--- --�----�- , �
CASING
g � _����'p '�w,� Diameter Weight Specifications
�—iMiie—� � 4 in.To c7l ft. Ibs./ft. in.To ft.
��
PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. Ibs./ft. � in.To�ft.
`�artha ?�eac2
in.To ft. Ibs./ft. in.To ft. �
Property owner's mailing address if ditterent than well location address indicated above.
SCREEN ?r. ,�,,� OPEN HOLE
s�� Make From ft. To ft.
Type Diam.
SIoVGauze �' Length '� *
Set between ft.and ft. FITTINGS ZpI�3� ��$���
STATIC WATER LEVEL
�1 Measured from o�
4 h ft. Below ❑Above land surface Date measured C7'—�
WELL OWNER'S NAME/COMPANY NAME pUMPING LEVEL(below land surface)
A� c
' ft.after � hrs.pumping )� g.p.m.
Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION
Pitless/adaptermanufacturer T�hitewater Model
Casing protection �2 in.above grade
❑At-grade ❑Well House ❑Hand Pump
GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)
Material�i]tin[1�CP From_�To�_ft. __"� ❑Yds. '�Bags
Matenal�.��C From_r To_��_ft. �Yds. ❑Bags
Tr—
HARDNESS OF Material From To ft. ❑Yds. ❑Bags
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To _Bags
NEAREST KNOWN SOURCE OF CONTAMINATION p
;. 7 7 7,, t ::-' '� „ ,':
CJ.1.iy��Y'c'1VP_L VCf3Wn 11f�j.1:Ri1 � 12 `I�• feet '�-� direction r:'.� , �,.>.' �.."_ ��type ;
�.:
r �1 Well disinfected upon completion? Yes ❑No _ ��.��.—i_�L..�.1�
$a�� hrc��ar $�lt �2 :l5 PUMP
�Not installed Date installed ��iT1�
Manufacturer's name S�`��L�C
Model Number HP � �� Volts ��`'�
Length of drop pipe �2 ft. Capacity g.p.m
Type:��� Submersible J l.S.Turbine [�Reciprocating [J Jet ❑
ABA ONED 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,if needed.
REMARKS,ELEVATION,SOURCE OF DATA,eta
} 1)on Stodola t�1e�1 nrillinU t�o. Inc. lh9i
Af�{� J: ZJ �IJ i� Licensee Business Name Lic.or Reg.No.
. � _
-.
CITY 0�ORONO - 2-7-1�3
Certified Representative Signature Certified Rep.No. Date
� 2 5 6 4 5 ��h �t«�a�a
LOCAL COPY Name of�ri��er ---
ID#52603 HE-01205-15(Rev.B/13)
� -
� � Minnesota 5#at�taborato►'Y ID#Q27-053-119
Twin City.Water�lin�c f�borat�;cy�`est'.R@�C�1"t ' Wfsconsin St2�e Laboratciry ID#iQS•�,os��
WiScarnsin DNR L8b ID#399073400
Client: Don Stodola Well Drilling Report Number: i�-io3o9 Twin City Water Clinic Inc.
Sample Collection Date: O8/29/17 617 13th Avenue South
Address: 3841 N Main Street Sample Collection Time: �3:0o Hopkins,MN 55343
st.eonifacius,MN 55375 Sample Receipt Date: os/3o/�� Phone:(952)935-3556
Report Issue Date: os/3�/�� Fax:(952)935-5077
I.abcrato £�lnalyte`: °�11ent,IQ ' Ra�rr��te� „ �.:Sample'Pre _ ` =Sar»pl�Ana�ysis ' Test
Sarr�pi�t0 Qate ',Time Uate Time Resutts Units
17-10309 Coliform Drinking Water OS/30/17 13:19 Absent
17-10309 Nitrete/N Drinking Water 08/30/17 12:23 <3.0 mg/L
17-30309 Arsenic Drinking Water 08/30/17 830 08/31/17 30:52 30.8 µg/L
�ead Drinking Water µg/L
mg/L
°` well No.: 826645
XNosamplesweresubcontta�kecl;artheabavetestr�sult(s) ;Sample pt: guest house well
with'•s'desigrtatian w�re produe�d by-a subccrKtra��i"' '`
labc��Fa#or�, [i.ab6xatt�rynarni�;�add�ess;��NIpH i.ak�iLt#�.Th� -���Well Adr: 2090 Shoreline Drive;Orono,MN
b �
;4�b�c4ntractee!lab�tary tn�fntalns�AQM C�erEiftea�l4n fort��.���
,,.. � Owner: Martha Head
fieldk�'of te�tir�g peVfiQrmed.
�,wn. p..`;� �=OwnerAdr:
Sample Conditions: Sample Temp: 17 "C
Discussion:
Notes:
A�proued rriethvds used in ar�alyzing tM�'sam�sies tisted a�iowe have
the foflowing,cepor#in�levels: , . Maximum contaminar�t'levels:
5M9222B-�olifarrri,l cfu/.1flQ mi' Col�form-<1 efu,;,/100 rnl'Nftrate ':
Et�A 35�.2-Nitrate Nitrogen exjir�ss�d�s N83+.NO2;1�0-mg,(L Nftragen 10.0 mg/� Ars�nic.10.0
*�M32136"AKS211ICr 2.0µg/I,I.eadk-2:Q l�P,1�. �ag/L < Lead,iS.Q F�8/�;
EPA 353.2=Nitrite iVitrogen,l.tf mBf� Ni#rite,i mg/L
,�
Sample Collected by: X Client _TCWC Approved By`. �._`�"�;��
Bill Van Arsdale
Laboratory Manager
the�esul�s listed In this reporE�appty on(y ta�th�above IisteiJ_samples:Ali routine quality assurance procedur�s were ftllt�wecJ,uirless ottrerwtse
nsitecf.This anelyktcal report musk k�`reporteii in tts errtirety,!�I�r��thads are certifted by the Minnespta Departinent of Health,uniess ptherw�se
notetl.'
i �
TCWD Rev 4.0 Page 1 of 1