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Home My WebLink Aboutwell info MINNESOTA UNIQUE WELL WELD : BONG LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 79199_ 5 Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED orlow lie 23 31 I IN M q ft. GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds ❑Cable Tool Driven Longitude degrees minutes seconds ❑ E)Auger �lotary House Number,Street Name,City,and ZIP Code of Well Location Fire Number ❑Other 125 Tardam No Ocow DRILLING FLUID WELL HYDROFRACTURED? 71 Yes UMO Show exact location of well/boring in section grid tith"X:' Sketch map of well/boring location. bentonite From ft.To ft. s Old} Showing property lines, N roads,buildings,and direction. USE Domestic ❑Monitoring ❑Heating/Cooling ;___ __i_____________ \ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial 1 ❑Community PWS ❑Irrigation ❑Remedial _--_-a____ -----:.- ❑Elevator ❑Dewatering ❑ W ET CASING MATERIAL Drive Shoe? ❑Yes XNo HOLE DIAM. r 'h Mile rJ— — Threaded gilded ❑Steel T W I + i ]Plastic ❑ CASING s Diameter Weight Specifications 1Mile 1v�V",1 n.To 172 ft. lbs./ft. in.To �ft PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.T.180 ft Masterpiece I1 n.To ft. lbs./ft. n.To ft Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE 127 E Cty Rd C Make From ft. To ft. Little Cie MN 55117 Type a atl Diam. Z Slot/Gauze Len*f 49 Set between ft.and ft. FITTINGS STATIC WATER LEVEL Measured from j so ft.;XBelow ❑Above land surface Date measured 04 ti WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) IL60 ft.after 3 hrs.pumping 25 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer Model ❑Casing protection �W12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) ' Material I14>Glt romTo #(�_ft. 3 ❑Yds. Fags Material fl$tl2Mt c To 1, _ft. ❑Yds. [_1 Bags HARDNESS OF Material From To ft. [I Yds. El Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags yellow/ NEAREST KNOWN SOURCE OF CONTAMINATION UY Abrown its 0 13 7 feet direction _x type q� Well disinfected upon completion? KYes El No el" am soft 13 132 PUMP L]Not installed Date installed 10-17—12 smd 'al" ad meditm 132 180 Manufacturer's name Sicb,l Ew Model Number t HP 11 3f1 .!1 Volts 2 Length of drop pipe 126 ft. Capacity _ 9-p.m Type:VSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes o VARIANCE Was a variance granted from the MDH for this well? ❑Yes yNo 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,it needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Stell killing Co., Inc. 1691 Licensee Busmes ame i- Lic.or Reg.No. 10-25'-12 Kertill presentativ 'nature Certified Rep.No. Date LOCAL COPY 7 919 9 5 Name of Driller Ryan Ned"mcd 1C 140-0020 HE-01205-13(Rev.11/10) - Twin City Water Clinic Laboratory Test Minnesota State Laboratory ID#027-053-119 Report State Laboratory ID#105-10117 Client: Don Stodola Well Drilling Co Report Number: 12-11366 Twin City Water Clinic Inc. Sample Collection Date: 10/15/12 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 7:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 10/15/12 Phone:(952)935-3556 Report Issue Date: 10/16/12 Fax: (952)935-5077 LaboratorV Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 12-11366 Coliform Drinking Water 10/15/12 16:22 Absent 12-11366 Nitrate/N Drinking Water 10/16/12 9:10 <1.0 mg/1 12-11366 Arsenic Drinking Water 10/15/12 8:45 10/16/12 11:22 4.07 µg/l Lead Drinking Water µg/1 Drinking Water Drinking Water Drinking Water Well No.: 791995 X No samples were subcontracted;or the above test result(s) with"designation were produced bpfa subcontracted Sample pt: Well laboratory. [Laboratory name;address;MDH Lab ID#).The Well Adr: 125 Turnham Rd;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: SM92226-Coliform, 1 cfu/100 ml Coliform-<1 cfu/100 mlNitrate Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen, 1.0 mg/I Arsenic,10.0 µg/I SM3113B-Arsenic,2.0µg/I Lead,15.0 Vg/I SM3113B-Lead,2.0µg/I i' Sample Collected by: X Client _TCWC Approved By: 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 WELL OR BORING LOCATION ,A. MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring o. '' 305185 County Name WELL AND BORING SEALING RECORD Minn'eso a Unique well No. Q�1.e wnp* Minnesota Statutes,Chapter 1031 or W-series No. p f (Leave blank if not known) Township Name Township No. Range No. Section No. Fraction(sm.—Ig.) Date Sealed Date Well or Boring Constructed Orono 118 23 31 SN A& B U N 1 Z GPS Latitude degrees minutes seconds Depth Before Sealing 435 _ft. Original Depth_ ft. LOCATION: Longitude degrees minutes seconds IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location L^ingle Aquifer ❑Multiaquifer 125 Turnha,n Rd Orono,. MNWELL/BORING $&easured ❑Estimated Date Measured��i,rG lJI7� WWater-Supply Well ❑Monit.Well t Show exact location of well or boring JSketch map of well or boring in section grid with"X." �� location,showing property [:1 Env.Bore Hole [I Other "� ft. below E]above land surface N lines,roads,and buildings. CASING TYPE(S) Steel ❑Plastic ❑Tileh ❑Other "J-----T"----f-----f-- WELLHEAD COMPLETION W ET IOutside: El Well House ElAt Grade Inside: Xasement Offset 'h Mile � ❑Pitless Adapter/Unit ❑Buried LlWell Pit II, --r- ---•-- 1 --- ❑Buried 3 ' Well Pit I---1 Mile y )( ❑Other LJ Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) f Diameter a Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if differ nt than well location address indicated above in.from_ to ft. ❑Yes XNo ❑Yes ❑No ❑Unknown 127 R County Rd C in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Little Canada,. lei. 5511 in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE Well owner's mailing address if different than property owner's address indicated above Screen from to A4.345 ft. Open Hole from to ft. OBSTRUCTIONS )?ods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill [-]No Obstruction Type of Obstructions(Describe)—./sJ4� N_ �► ��"�� GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? Yes El No Describe FORMATION If not kn wn,indicate estimated formation log from nearby well or boring. PUMP_ n J Type,jF ! U fine ' �6emoved ❑Not resent ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: (VNo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed I Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) r � /� Grouting Material A/G 46WII5J from�jo to�'� ft. yards Go 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. DON STODOLA WELL DRILLING CO.s. INC. 1691 Licensee Business Name License or Registration No. C e esentative Sign Certified Rep.No. Date LOCAL COPY H305185 v (wf Name of Person Sealing Well or Boring HE-01434-12 IC#140-0423 s/asR