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Home My WebLink AboutWell Boring & Sealing Construction Record It • WELL OR BORING LOCATION MINNESOTA UNIQUE WELL MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 792015 Hennepin Minnesota Statutes,Chapter 1031 Township Name - Township No. Range No.;; Section No. Fraction • WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 2303. ,W 1NE NW 136 n. 3-22-13 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees -- minutes seconds ❑Cable Tool ❑Driven jjj Auger ,®,Rotary House Number,Street Name,City,and ZIP Code of Well Location Fire Number -.,,,. '!'❑Other 25 Brown Rd S, Orono 55356 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes *Jo Show exact location of well/boring in section grid with"X." Sketch map of well/boring lot ation. meter From ft.To Showing property lines, ft. roads,`uifainge,and dir�eYyti. USE mi N `'�1 Domestic ❑Monitoring ❑Heating/Cooling ---j------------------ --- ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial ❑Elevator ❑Dewatering ❑ w ' E �� CASING MATERIAL Drive Shoe? ❑Yes �No HOLE DIAM. • • ❑Steel ❑Threaded ❑Welded S Miie $Plastic El4- 1 CASING s Diameter Weight Specifications 1 Mile in.To 127ft. lbs./ft. ur.7o I —� -$-.:' ., Oft PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.To_. ft Suchmeete (Jolly) in.To ft. lbs./ft. in.To ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. * ,,.�� 3103 a'uQg� -u Make On . From ft. To ft. St ills•r lwWIsod Place Type �ineiC itsl Diam. 2" St Joseph, 49085 Slot/Gauze .010 Length 42 ♦ 4. Mi Set between im ft.and 136 ft. FITTINGS 2"x3' v STATIC WATER ikp Measured from 77 ft.X3elow ❑Above land surface Date measured 3"22-13 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) ` 120 ft.after 3 hrs.pumping g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION gPitless/adapter manufacturer dlitetar Model ❑Casing protection A 12 in.above grade LI At-grade ❑Well House ❑Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Mate rial_beritordrem_0_To 50 ft. 3 ❑Yds. Aags Materiae#f ii_50 To 127 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing sealDriven casing seal From To Bags trown NEAREST KNOWN SOURCE OF CONTAMINATION,( ^g' C � 0 17 `� feet /'� direction -� "'—C-' type Well disinfected upon completion? (es ❑No sandy clay gray soft 17 113PUMP C_qq ❑Not installed Date installed 3-25-13 sand/gravel mix medium 113 136 —Manufacturer'sSchaefer • Model Number HP 1 Volts 230qq • Length of drop pipe 105 ft. Capacity g.p.m Type:Xiubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ • ABANDONED WELLS • Does property have any not in use and not sealed well(s)? ❑Yes .c 'No VARIANCE Was a variance granted from the MDH for this well? ❑YesNo 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,etc. D011 Stodola Well '•�i=Dri j Go,. Inc. 1691 Licensee Business Name {ng S Lic.or Reg.No. 4-48-13 C e e r sentative . ature Certified Rep.No. Date Rob Stodola LOCAL COPY 792015 Name of Driller IC 140-0020 1-1E-01205-13(Rev.11/10) MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 3 6 2 7 5 /� WELL'OR BORING LOCATION WELL AND BORING SEALING RECORD sealing No. H �t County Name Minnesota Unique Well No. Minnesota Statutes,Chapter 1031 or W series No. Hennepin (Leave bk il not known) Township Name Township No. Range No. Section No. Fraction(sm.-.lg.) Date Sealed Date Well or Boring Constructed Orono 117 23 03 NW NE IN i/451/8 GPS LOCATION-decimal degrees(to four decimal places) 4, Depth at Time of Sealing 97 ft. Original Depth ft. Latitude Longitude AQUIFERS) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer 25 n= ' Rd S' o � WELL/BORINGMeasured Date Measured SA/1mL LIQ r ❑Estimated D v Water-Supply Well ❑Env.Well _ e Show exact location of well or boring Sketch map of well or ring in section grid with"X" location,showing prop ty ❑ /S Temp.Env.Well ❑Other ' ft. Kbelow ❑above land surface lines,roads,and buildit s. N CASING TYPE(S) *tee! ❑Plastic ❑Tile El Other ---1--- --i------F------'--- rz t WELLHEAD COMPLETION W ET �— ;___ +___ -+ Outside: ❑Pitless Adapter/Unit ❑At Grade Inside: Basement Offset Mile ` iaW Well Pit ❑Buried ❑Well House ---I------ - --- ❑Well Pit . _ ❑Other 3 ❑Buried 1 Mile _..... El Other ~' For multiple temporary environmental wells,provide ad al location CASING(S) information,a site sketch,and geology on a separate page. Diameter" � / Depth Set in oversize hole? Annular space initially grouted? PROPERTY OWNERS NAME/COMPANY NAME / i'it n.from_40__ Yes a_ to 53 ft. ❑ �INo ❑Yes]\ ❑No ❑Unknown WojAVAPPIRetaktaddress indicated above in.from to ft. ❑Yes ❑Na ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown SCREEN/OPEN HOLE r , Screen from 93 to 17ft. Open Hole from to ft. WELL OWNER'S NAME/COMPANY NAME OBSTRUCTIONS Well owners mailing address if different than property owners address indicated above ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill Jo Obstruction Type of Obstructions(Describe) Obstructions removed? ❑Yes ❑No Describe _, PUMP GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO FORMATION Not Present ❑Present,Removed Prior to Sealing ❑Other If not known,indicate estimated formation log from nearby well or boring. A Type If .1 C'-/ METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE 1�� /f[ l I X No Annular Space Exists El Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal UCasing Diameter in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator VARIANCE Was a variance granted from the MDH for this well? ❑Yes No TN# GROUTING MATERIAL(S) (One bag of cement- 4 lbs.,one bag of bentonite=50 lbs.) Grouting Material�� T�' _'� 'rom_egt._ to___51 ft. yards$__ bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes XNo How many? _ LICENSED OR REGISTERED CONTRACTOR CERTIFICATION REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. rim todoin Well Drilling ('.o, . Inc- 1691 Licensee Business Name .1„ License or Registration No. AppripA i i!'� 1 I - / o -/8 Ce ed-epr en �-'- ' Ar-a ' Certified Rep.No. Date ct,,*,„ LOCAL COPY " 3 6 2 7 5 4Name of Person Sealing Well or Bo'q '41.4.-~r"N. HE-01434-16 ID#53159 9t1711 r • /Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053119 / Wisconsin State Laboratory ID#105-10117 Client: Don stodola Well Drilling Co, Report Number: 13-3442 Twin City Water Clinic Inc. Sample Collection Date: 03/25/13 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 7:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 03/25/13 Phone: (952)935-3556 Report Issue Date: 03/26/13 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 13-3442 Coliform Drinking Water 03/25/13 13:48 Absent 13-3442 Nitrate/N Drinking Water 03/26/13 12:06 <1.0 mg/I 13-3442 Arsenic Drinking Water 03/25/13 9:00 03/26/13 14:05 5.19 p.g/I Lead Drinking Water tg/I Drinking Water Drinking Water Drinking Water Well No.: 792015 X No samples were subcontracted;or the above test result(s) with'**'designation were produced by a subcontracted Sample pt: laboratory. [Laboratory name;address;MDH Lab ID#l.The Well Adr: 25 Brown Rd S Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temperature: 12 °C Discussion: Notes: Approved methods used in 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 Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen, 1.0 mg/I Arsenic,10.0 µg/I SM3113B-Arsenic,2.0 1,i.g/I Lead,15.0µg/I SM3113B-Lead,2.0 tg /f Sample Collected by: X Client _TCWC Approved By: v Bill 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