The URL can be used to link to this page

Home My WebLink About7-27-18 Well & Boring Construction Record MINNESOTA UNIQUE WELL WELL OR BARING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 8 2 7 8 3 0 Hennepin Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction(sm.—..Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 07 NE W SW ,% 270 n. 7-26-1R GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool O given [I Dual Rotary ❑Auger ,'otary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 4755 Tonka View Lane, Orono 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes I'Wo Show exact location of well/boring in - tion grid with"X." Sketch map of well/boring location. bentonite From ft.To ft. Showing property lines, N roads,buildings,and direction. USE %%Domestic ❑Monitoring ❑Heating/Cooling _ __y____ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial -_-L-.-- -_. �, ❑Elevator ❑Dewatering I=1 w E CASING MATERIAL i arlG HOLE DIAM. T .� Dnve Shoe? ❑Yes ? '' ' ❑Steel ❑Threaded ❑Welded %mire .'lastic ❑ l �f CASING S Diameter Weight Specifications • mop, v� ' n.To 260 ft. lbs./ft. 8 n.To 5�ft. F1 Mile--( � 6 PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 2 n.To270 ft. Kim in.To ft. lbs./ft. in.To ft. & Hood Maronde OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN ohr`o,,�1it __MM Make �faon From ft. To ft. same Type stainless stain Diam. 2" Slot/Gauze .(if Length 4/ + 4 t Set between 260 ft.and 270 ft. FITTINGS 2"13' 1 adpr STATIC WATER LEVEL 126 ft. ' elow❑Above land surface Measured fro L late measured 7_26_18 Dry hole ❑Yes leo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL( elow land surface) 266 ft.after 3 hrs.pumping 40 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �ihitewater %Pitless/adapter manufacture Model ❑Casing protection NI2 in.above grade O At-grade ❑Well House ❑Hand Pump GROUT INFORMATIONFO (specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material belt iteFrom • _ 0 To 50ft. ['Ids. kit ags Material cuttings From 50 To_260ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags One bag=94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION L %7 topsoil black soft 0 3 Well is 7�-� feet direction fromA p clay brown medium 3 34 Well disinfected upon completion? Ares ❑No sandy clay gray medium 34 733 PUMP clay/gravel gray medium 73 84 ❑Not installed Date installed 7-26-18 clay/sand gray soft 1 84 113 Manufacturer's name Sr�Pfer sand mix soft 113 120 Model Number 7 �f HP 1 Volts 230 fine sand gray mediuminpriiuin 1D . 757 Length of drop pipe 14/ ft. Capacity g.p.m. gravel/sand mix 257 270 Type: 'Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes Aflo VARIANCE Was a variance granted from the MDH for this well? ❑Yeso 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. �f , .' >' 7-27-18 er ed R es ati +. .u e Certified Rep.No. Date Rol& Stodola LOCAL COPY 827830 Name of Driller ID#52603 HE-01205-16(Rev.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: 18-09559 Twin City Water Clinic Inc. Sample Collection Date: 07/26/18 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 11:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 07/27/18 Phone: (952)935-3556 Report Issue Date: 07/30/18 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 18-09559 Coliform Drinking Water 07/27/18 13:21 Absent 18-09559 Nitrate/N Drinking Water 07/27/18 12:35 <1.0 mg/L 18-09559 Arsenic Drinking Water 07/27/18 8:00 07/30/18 11:23 2.43 µg/L Lead Drinking Water pg/L Well No.: 827830 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: 4755 Tonka View Lane;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Kim&Honi Maronde field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 8 °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 SM3113B-Arsenic,2.0 pg/I,Lead,2.0 pg/L pg/L Lead,15.0µg/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 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 35 9 097 WELL OR BORING LOCATIONSealing No. Name WELL AND BORING SEALING RECORD. County Minnesota Unique Well No. Minnesota Statutes,Chapter 1031 or W-series No. /‘, 3 7 . p (Leave blank it not known( n Township Name Township No. Range No.,Section No. Fraction(sm.-•Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 .: 07 NS\NW SW el 4,//6, [I- ,a -79 GPS LOCATION—decimal degrees(to four decimal places) Depth at Time of Sealing 17/ J ft. Original Depth I %V ft. Latitude Longitude AOUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring LocationSingle Aquifer ❑Multiaquifer / Lane, Measured Date Measured ' ❑Estimated 4755 ' ikdiieN Lane Orono 55364 EWater-Supply Well ❑Env.Well Show exact location of well or boring Sketch map of well or boring ❑Temp.Env.Well ❑Other / J ft. below ❑above land surface in section grid with"X" �� location,showing property r lines,road;and buil ings. CASING TYPE(S) N - -----y----i---- I ;iitfSteel ❑Plastic ❑Tile ❑Other --_4--_ -----!---------- WELLHEAD COMPLETION w E r T I OutsldeXitless Adapter/Unit ❑At Grade Inside: ❑Basement Offset 'Iv Mile ❑Well Pit ❑Buried ❑Well House LII Well Pit i ❑Other s ❑Buried I----1 Miley "� ❑Other For multiple temporary environmental wells,provide additional location CASING(S) information,a site sketch,and geology on a separate page. Diameter��//�� Depth Set in oversize hole? Annular space initially grouted? PROPERTY OWNER'S NAME/COMPANY NAME in.from__ to_ �ft. ❑Yes •. No ❑Yes ❑No ❑Unknown Pro neo m!�RIQ`dtlEreslint RT11.eeell location address indicated above in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown SCREEN/OPEN/HOLEE Screen from /9(O to /96 ft. Open Hole from to ft. WELL OWNER'S NAME/COMPANY NAME OBSTRUCTIONS Well owner's mailing address if different than property owner's address indicated above ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill {moo Obstruction Type of Obstructions(Describe) T Obstructions removed? ❑Yes ❑No Describe PUMP HARDNESS OR GEOLOGICAL MATERIAL COLORFORMATION FROM TO .Not Present ❑Present,Removed Prior to Sealing 0 Other If not known,indicate estimated formation log from nearby well or boring. JTyype ci Id+ " i Vo METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE J ' No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal Casing 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 Xfqo TN# ` GROUTING MATERIAL(S) (One bag of cementemya 94 lbs.,one bag of bentonite a 50 lbs.) Grouting Material/ea n�r/�7Pgfrdm0_ to_/ _ ft. yards /6 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 allo How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION f 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. Don Stodola Well Drilling Co,. Inc. 1691 Licensee Business Name License or Registration No. e ' r s n gnaturertifiedI'No.—/(ate LOCAL COPY H 3 5 9 0 9 7 Name of Person Sealing Well or�g` Li v. HE-01434-16 ID#53159 k' 9/17R r