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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 827 8 2 3 Hennepin Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 NW NW SWC 8-15-18 f1. 149 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 q / ❑Other 465 Lakeview Parkway, Orono 55364 DRILLING FLUID t WELL HYDROFRACTURED? ❑Yes XNo Show exact location of well/boring in section grid with"X." Sketch map of wel ring location. bentonite From ft.To ft. Showing roperty lines, N roads,buildings and direction. USE Domestic El Monitoring ❑Heating/Cooling ` ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial / ❑Community PWS ❑Irrigation ❑Remedial ❑Elevator ❑Dewatering ❑ CASINGERIAL Drive Shoe? ❑Yes No R MAT HOLE DIAM. _ - T ❑Steel ❑Threaded ❑Welded Mile s lastic 1- O CASING ❑ S 9 Diameter Weight Specifications F--1Mlle— I 4 in.To 14n ft. lbs./ft. L$_in.To ft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6'2 in.To150 ft. Norton Homes LLC in.To ft. lbs./ft. in.To ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Johnson Make From 2— ft. To ft. 18215 45th Ave N, Ste D Type stainless steel Diam. Plymouth, MN 55446 SloVGauze .010 Length 4'Y+ 4/ Set between 140 ft.and 149A ft. FITTINGS 2'x3' w/leader STATIC WATER LEVEL 65 ft.,'Below CIAbove land surface Measured from top of late measured 8-15-18 Dry hole ❑ Yes XrNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 133 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 res KPitless/adapter manufacturePhiteWa ter Model Casing protection X12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentDflit,rom 0 To 50 ft. 3]Yds. KBags Material cut t ings From 50 To 140 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. _ ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL bane cement o94 lbs.lbs. Driven casing seal From To Bags One e5lag,b94t NEAREST KNOWN SOURCE OF CONTAMINATION clay L medium 0 • �,r r brown fiedit71f1 14 Well is J� feet direction from._.� type medium Well disinfected upon completion? rgYes ❑No medr clay gray i 14 79 PUMP p 1�l ❑Not installed Date installed 8-21-1 8 sand/ 'avel mix soft 79 100 Manufacturer's name Schaefer fine sand/ Model Number HP 1.5 Volts 230 silty clay gray soft 100 124 Length of drop pipe } ft. Capacity g.p.m. 137 ABANDONED WELLS T ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ sand brown soft 124 a � c3Vel mix medium 137 15d Does property have any not in use and not sealed well(s)? ❑Yes �Tlo VARIANCE Was a variance granted from the MDH for this well? ❑Yes tX'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,etc. Don Stodola Well Drilling Co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. --7,—", ,-/-/' 8-23-18 YC Hie 6epresenta✓v: ignature Certified Rep.No. Date LOCAL COPY 8 2 7 8 2 3 Name of Driller Rob Stodola ID#52603 1-1E-01205-161Rev.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: 18-10650 Twin City Water Clinic Inc. Sample Collection Date: 08/15/18 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 12:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 08/16/18 Phone: (952)935-3556 Report Issue Date: 08/17/18 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 18-10650 Coliform Drinking Water 08/16/18 12:38 Absent 18-10650 Nitrate/N Drinking Water 08/16/18 12:56 <1.0 mg/L 18-10650 Arsenic Drinking Water 08/16/18 9:00 08/17/18 11:44 4.01 µg/L Lead Drinking Water I-tg/L Well No.: 827823 • x No samples were subcontracted;or the above test result(s) with'**'designation were produced by a subcontracted Sample Pt: well laboratory. [Laboratory name;address;MDH Lab ID#]. The Well Adr: 465 Lakeview Parkway;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Norton Homes field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 16 °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 EPA 353.2-Nitrate Nitrogen expressed as NO3+NO2,1.0 mg/L Nitrogen 10.0 mg/L Arsenic,10.0 5M3113B-Arsenic,2.0µg/I,Lead,2.0 µg/L µg/L Lead,15.0 p.g/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 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 4.0 Page 1 of 1