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Home My WebLink Aboutwell info � MINNESOTA UNIQUE WELL 'rNELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BOA/NG NO. County Name WELL AND BORING CONSTRUCTION RECORD g 18 0 41 ` F�ermepin Minnesota Statutes,Chapier 10.3I ; Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 118 23 29 SW,,SE ,, 1 G� K 7-5-I6 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven �Auger �'Rotary House Number,Sheet Name,Ciry,and ZIP Code of Well Location ❑Other 35�i5 Sixth Ave Ns vLO�K� 5535b DRILLING FLUID WELL HYDROFRACTURED? ❑Yes '�No - Show exact location of well/boring in section grid with"X" Sketch map of well/ oring locatio (�t�[ From ft.To ft. Show roper ' s, ��;. N roa�di rection. USE io/Domestic `Monitoring ❑Heating/Cooling , � �� ^: __;_____j___ ___!__ ___�__ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Indushy/Commercial � _ ❑Community PWS ❑Irrigation I J Remedial c --'--- --;--- --F-- ---t-- 'r�.�} ❑Elevator ❑Dewaterin9 :J � ' w ; ; ; ; E� + CASING MATERIAL Drive Shoe? ❑Yes ,�'No HOLE DIAM. --;--- --�-----�-- --�-- J' : , , � � Threaded ❑Welded �� , , , , ile Steel �, � , , , , �� lastic ❑ . ; --�--- --�--- ---�-----�- l -�� ; ; ; ; � CASING S Diameter Weight Specifications �—t Mile--� `+ in.To 1� ft. Ibs./ft. in.To__��tt. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. Ibs./ft. _�_in.T��ft. Rick .Anderson in.Ta ft. Ibs./ft. in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE IW t�A�y�CI� Rd Make � From ft. To ft. s [I�l �LC1� '�I 553�►3 Type stainleaa RtPP� Diam. - � SIoVGauze �1(1 Ler�tll� / � Set between ft.and it. FITTINGS ! STATIC WATER LEVEL �+ Measured from 1 73 ft. Below ❑Above land surface Date measured �S�i6 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surtace) 1�� ft.after � hrs.pumping 30 g.p.m. ; Well/boring owner's mailing address if different than propert i t above. WELLHEAD COMPLETION �itevaater Pitless/adapter manufacturer Model FEB ? � ��17 �Casing protection _�12 in.above grade �At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Cll'Y OF ORONO Material[I�EItCMlte From�To��ft. _�_ ❑Yds. '�ags Matenal[Ifi'�t7CR� f'��r�_..S�To��_ft. U Yds. [i Bags HARDNESS OF Matenal _From To ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOR MATERIAL FROM TO Drivencasingseal From To Bags NEAREST KNOWN SOURCE OF CONTAMINATION „ C..�` a � ,^� feet `+�-� direction ' �„,l-f'�4 type a Well disintected upon completion? Yes [J No PUMP 1 Not installed Date installed 11-7-16 ` �Y Manufacturer's name ��€e�_— Model Number HP��f}_Volts� � Length of drop pipe �.0� ft. Capacity g.p.m � Type: Submersible ❑LS.Turbine ❑Reciprocating L,�Jet ❑ ABANDONED WELLS Does properry have any not in use and not sealed well(s)? ❑Yes No 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,Chapte�4725. The information contained in ihis report is true to the best of my knowledge. Use a second sheet,il needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. � SL��$ �11 Drillin�+; Co,. J,�:. 1b92 Licensee Business Name Lic.or Reg.No. , r ' - iz-i2-l� � e � ntati '� atu Certified Rep.No. Date .�3 � LOCAL COPY ROb Stodol� 818 0 41 Name of Driller ID#52603 HE-01205-15(Rev.8/13) P �. r ✓� Minnesota State Laboratory ID#027-053-119 TWI11 Clty W8t2C C�II11C �ab01'at01'�/TeSt Rep01't Wisconsin State Laboratory ID#105-10117 Wisconsin DNR Lab ID#399073400 Ciient: Don Stodola Well Drilling Report Number: 16-o9iai Twin City Water Clinic Inc. Sample Collection Date: 07/05/16 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: Za:oo Hopkins,MN 55343 St.Bonffacius,MN 55375 Sample Receipt Date: o7/oe/�5 Phone: (952)935-3556 Report Issue Date: 07/07/16 Fax:(952)935-5077 Laborato Anatyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 16-09141 Coliform Drinking Water 07/06/16 14:11 Absent 16-09141 Nitrate/N Drinking Water 07/06/16 1321 <1.0 mg/L 16-09141 Arsenic Drinking Water 07/06/16 8:30 07/07/16 13:35 3.10 µg/L Lead Drinking Water µg/L Nitrite/N Drinking Water mg/L Drinking Water Drinking Water Well No.: 818041 X No samples were subcontracted;or the above test result(s) with"*'designation were produced by a subcontracted Sample pt: Well laboretory. [Laboratory name;address;MDH Lab ID#]. The Well Adr: 3585 Sixth Avenue N;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Rich Anderson field(s)of teSting performed. � Owner Adr: Sample Conditions: Sample Temp: 12°C Discussion: Notes: Approved methods used in analyzing thesamples listed Maximum contaminant levels: abovehave the following reporting levels Cotiform-<1 cfu/100 ml SM92226-Coliform;1 cfu/100 ml ' Nitrate Nitrogen 10.0 mg/IL ` SM4500F or EPA 353.2-Nit�ate Nitrogen,1.0 mg J L Arsenic,10.0 µg/L SM31136-Arsenic,2.0{rg/;1,Lead,2.0 µg/L' Lead,15.0µg/L EPA 353.2-Nitrite Nitrogen;l.0 mg/L Nitrite,1 mg/L .4 '�� [�'4��i��.a.c.+c.�^'^�",� Sample Collected by: X Client _TCWC Approved By: J'��,/� Bill Van Arsdale Alan Senechal Laboratory Manager Senior Analyst The reeultslisted in this report apply only to the above listed samples.All routine qualiry 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. � TCW D Rev 2.0 Page 1 of 1 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H Z 617 0 4 WELL AND BORING SEALING RECORD Sealing No. County Name Minnesota Unique Well No. _ Minnesota Statutes, Chapter 103i or W-series No. � ' J�, " �Leeve blank i�na�known) Township Na e Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed '/.� '/: �. � ' �y� ! GPS Latitude degrees minutes_ seconds Depth Before Sealing /� �S� ft. Original Depth ft. LOCATION: Longitude___ degrees_._. minutes___ seconds pQUIFER(S) STATIC WATER LEVEL ' Numerical Street Address or Fire Number and City of Well or Boring Location � ,Single Aquifer �J Multiaquifer p/�,�, ; WELUBORING Measured j_�Estimated Date Measured,��J�� fl/``4'— � j Water-Supply Well ❑MoniL Well + Show exact bcation of well or boring Sketch map of well or boring �( � in section grid with"X° location,showing property ❑Env.Bore Hole ❑Other �i ft. �I below L above land surface N lines,roads,ancj b�ildings. CASING TYPE(S) �' '. --'-- --'--- --`-- --'-- - � � N k i _�� _� `, Steel ']Plastic ❑Tile ❑Other z I ; I I �•� �_ --�'-'"�--- "-�-- --'`-- 4�� WELLHEAD COMPLETION �� : W : ; ; � ET �:�. � � � � Outside: ��Well House ❑At Grade Inside: �_'j Basement Offset , 'h M'ie �Pitless AdapterNnit ❑Buried ❑Well Pit ; I ; I ; I d --�--- --�-- --�-- ---•-- � _. ❑Burie ; L ( [�Well Pit S ❑Other � 1 Mile--{ L�Oth2f � PROPERTY OWNER'S NAME/COMPANY NAM CASING(S) Diamfet�rr � Depth � Set in oversize hole? Annular space initially grouted? Property owners mailing address if diflerent than well location address indicated above C./ � �_ to��S ft. i�Yes ��No �Yes U No U Unknown _f_in.from �� Cacl Bolarxier a � �y in.from ro ft. ��Yes ❑No ❑Yes ❑No �Unknown 251 STacke� St .St � A!N 55207 in.from to ___ft. I]Yes �No ❑Yes ❑No ❑Unknown WELL OWNEF'S NAME/COMPANY NAME SCREEN/OPEN HOLE r � Well owner's mailing address if tlifferent than property owrer's address indicated above Screen fromf�__�to ? ft. Open Hole from to ft. OBSTRUCTIONS ;Rods/Drop Pipe ❑Check Valve(s) ❑Debris ',.='Fill ❑No Obstruction � Type of Obstructions(Describe) ��fN�� Tl� g ��„�� i GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO �bstructions removed? Yes ]No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. �� .�'y�� Type � }�'�`� °�-� ��!�emoved ❑Not Present ❑Other 2 �� METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �fVo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe �J Casing Perioration/Removal !� in.from to ft. ❑Perforated Lj Removed _ in.from to ft. ❑Perforated ❑Removed - � Type of Perforator ' �_'��,Other--------------�-------- - ": _ d GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) ,ry�� I � Grouting Material '� �_[�!'-��from�,�., to�� ft. __ yards f�_ bags _ from___ to R _ yards_____ bags �� from to__ _ _ k._._,____.__ yards___._.___ bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES!N SEALING Other unsealed and unused well or boring on property? []Yes o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION 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. Don Stodola t�e1l Drillirig Co,, Irnc 1691 � ----- --_---- — ----- — - — � Contractor Business Name � License or Registration No. - "'.3 �.� �/ �., 7 - --- �Representative SignBt Certified Rep.No. Date � . LOCAL COPY H /y�� "_�,,". ._�t �•=` i_...�.v_ � 2�,/��O� Name of Person Sealing Well or Boring �� `� � � HE-01434-09 IC#140-0423 - s/osR