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Home My WebLink Aboutwell info WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring " 324737 Seal ng County Name WELL AND BORING SEALING RECORD Minnlesso aoUnique Well No. Hennepin Minnesota Statutes,Chapter 1031 or W s erieskNo. Township Name Township No. Range No. Section No. Fraction(sm.-Ig.) Date Sealed Date Well or Boring Constructed Orono 117 1 23 08 SV Sq Nle f` / GPS LOCATION-decimal degrees(to four decimal places) Depth Before Sealing_ v ft. Original Depth ft. Latitude Longitude IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer 1070 Tonkava Road OrocxV W WE UBORING Measured [:1 Estimated Date Measured WE Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring in section grid with"X:' location,showing property ❑Env.Bore Hole ❑Other ft. below ❑above land surface N �, lines,roads,and buildings. CASINGTYPE(S) rELLHEAD eel Alastic Tile ❑Other _ ____ ______ ❑COMPLETION W E T � Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset h Mile XPitless Adapter/Unit ❑Buried ❑Well Pit T I Buried 1 � ' xL.t ❑Well Pit ❑ S ❑Other —1 Mile ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) DiaDepth f ft. Charles 1W r Set in oversize hole? Annular space initially grouted? ddre Property owner's mailing ass if different than well location address indicated above in.from a to ❑Yes )lo L]Yes E]No ❑Unknown 15050 23rd Ave N in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Plymouth, M. 55447 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE OF Well owner's mailing address if different than property owner's address indicated above Screen from /Uf to 05 ft. Open Hole from to ft. OBSTRUCTIONS Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill /n❑No Obstruction Type of Obstructions(Describe) �� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? XYs ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. �`„/� Pump '}�M(� Type Lf3 ( r 64-5 Xemoved ❑Not Present ❑Other eEjHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: ,'��',`',o Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal in.from to ft. E]Perforated [1Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator VARIANCE Was a variance granted from the MDH for this well? ❑Yes do TN# GROUTING MATERIAL(S) (One bag ofcement=94 lbs.,one bag ofrf bentonite=50 Ibs.) Grouting Material � tom`/�'- ��from Q , to �ft. yards bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS.SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes Xo 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. DIM STODOLA WELL DRILLING CO., INC. 1691 Licensee Business Name License or Registration No. 558, rti d Oepresentative Signature Certified Rep.No. Date LOCAL COPY " 324737 Name of Person Sealing Welt or Bo'g HE-01434-14 IC#140-0423 li 5/13R ` MINNESOTA UNIQUE WELL WE R BA"ING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County.Name WELL AND BORING RECORD vTennE' in Minnesota Statutes,Chapter 1037 8,94574 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COKQLETED Orono 117 23 1 08 NE ;?? 'TF,, 0 ft _31_ CEJVED GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds LOCATION: Longitude degrees minutes seconds ❑Cable Tool Driven _ 32015 El Auger Rotary I House Number,Street Name,City,and ZIP Code of Well Location Ll Other 1170 ton"wa Rd, Drono 55356 DRILLING FLUID WELLHYDRURIHCSUfj aY�s No Show exact location of well/boring in section grid with'X:' Sketch map of well/boring location. 1(ntonjte From �� t i ft.To K NO ft. E Showing property lines, N ++ roads,buildings,and direction. USE F1Domestic ❑Monitoring ❑Heating/Cooling :_____–_____:_____t__ Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial i -- ---------t-- �–^ '� ❑Elevator ❑Dewatering ❑ W ET i CASING MATERIAL Drive Shoe? [_1 Yes No HOLE DIAM. - -- ---------: i ❑Steel ❑Threaded ❑Welded 'h Mile a: Plastic ❑ CASING S f Diameter L Weight Specifications 1 Mile 4 in.To 161 ft. lbs./ft. �in.To 5(4t PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6 4 in.To 17`-1t Cha s Codd T)e ATovo' LWin.To ft. lbs./ft. in.To _ft Property �owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE 15,15 23rd AVe :�s Make nson From - ft. To ft. e{� Type stainlessteel Diam. Plymouth, ?':, 55447 Slot/Gauze _010 Length 41 ♦ 41 Set betweeni ft.and ft. FITTINGS M STATIC WATER LEVEL Measured from50 — — ft.X Below ❑Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME - PUMPING LEVEL(below land surface) 158 ft.after 4 hrs.pumping 40 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION „� a tT�te r Pitless/adapter manufacturer wt LL Model Casing protection X 12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentonite From To�ft. 3 ❑Yds. lags Material natural f trinl__50_To 16 ft. ❑Yds. ❑Bags 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 ssnly cls, 1)rotm medlum n t�7 1! feet .......type ��. direction �., - �.;.,-.. Well disinfected upon completion? Yes ❑No St?< k+L "Jt1 Soft 17 62 PUMP ❑Not installed Date installed 4-7-15 Cla /sand J,rn milium 62 $8 Manufacturer's name Scharer Model Number HP- 2 Volts sand hrocim soft �r 17C1 Length of drop pipe 126 ft. Capacity g.p.m Type:X Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANCIONED WELLS Does property 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,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. itodola Itiell nrillin Co Licensee Business Name Lic.or Reg.No. f~ 7-28-15 ,Certified Representative Signature Certified Rep.No. Date $tab Stodola LOCAL COPY Name of Driller IC 140-0020 HE-01205-14(Rev.5/12) 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: 15-01219 Twin City Water Clinic Inc. Sample Collection Date: 02/01/15 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 11:00 Hopkins,MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 02/02/15 Phone:(952)935-3556 Report Issue Date: 02/03/15 Fax: (952)935-5077 LaboratorV Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 15-01219 Coliform Drinking Water 02/02/15 12:46 Absent 15-01219 Nitrate/N Drinking Water 02/03/15 10:34 <1.0 mg/L 15-01219 Arsenic Drinking Water 02/02/15 8:15 02/04/15 14:20 10.10 ltg/L Lead Drinking Water µg/L Nitrite/N Drinking Water mg/L Drinking Water Drinking Water X No samples were subcontracted;or the above test result(s) Well No.: 804574 with'"'designation were produced by a subcontracted Sample pt: Well laboratory. Well Adr: 1070 Tonkawa Rd;Orono,MN [Laboratory name;address;MDH Lab ID#]. Owner: Charles Cudd DeNova The subcontracted laboratory maintains MDH Certification for the field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 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/IL SM450OF or EPA 353.2-Nitrate Nitrogen,1.0 mg/ Arsenic,10.0 µg/L L SM3113B-Arsenic,2.0 Lead,15.0µg/L gg/I,Lead,2.0 µg/L Nitrite,1 mg/L EPA 353.2-Nitrite Nitrogen, 1.0 m L Sample Collected by: X Client _TCWC Approved By: L,/ 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 2.0 Page 1 of 1