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HomeMy WebLinkAbout01-06-2019 Well and Boring Construction Record 4 . - . MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD llennepin Minnesota Statutes,chapter 1031 8 3 9 6 1 3 Township Name Township(Jo. Rang?e,No. Section No. Fr on(sm.��g.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 LJ' VV ,/.71• ,/ 225 h. 1-6-19 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude 4 Longitude ❑Cable Tool ❑Driven ❑Dual Rotary A. ❑Auger -(y�Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other �� �-,tI 4330 Lakeview C , Orono 55391 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes }[Jo Show exact location of well/boring in t'lQnyfid:with"X." Sketch map of well/boring location. bentonite From ft.To TT ft. �i Showing property lines, N roads,buildings,and direction. USE j��''(Domestic ❑Monitoring ❑Heating/Coaling y ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial J ❑Community PWS ❑Irrigation 00 Remedial ❑Elevator ❑Dewatering ❑ w E T CASING MATERIAL Drive Shoe? ❑Yes No HOLE DIAM. 1 t-- ❑Threaded ❑ elded Steel T I/z Mile Plastic ❑ 1 • CASING s2'-'t- Diameter Weight Specifications I 1 Mile U ___4_in.To_ 215 ft. lbs./ft. in.To_ . PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. bs./ft. in.To Lbs[. Homes in.To ft. lbs./ft. in.To ft. Norton OPEN HOLE Propertyerowner's mailing address if different than well location address indicated above. SCREEN Johnson10415 45th ASO N Ste D MakeJohnsonFrom ft. To ft�y�, t� Type stainless Steel Diam. 2w Plymouth, MN 55446 Slot/Gauze •0 © Length L$ + 4• Set between /i Vi ft.and ft. FITTINGS�i • 1 STATIC WATEf3'LEVEL 2i5 [4T —t— A ft. elow bove and surface Date measuredl"6 19 Dry hole ❑Yes jgrNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 210 ft.air 2 hrs.pumping 3 40 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer Wltirttemster Model /yy❑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 bentonite From 0 To 50 ft. ❑Yds. [ ags Material cuttings From To 215 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL Driven casing seal From To Bags One bag=94 lbs.cement „, or 50 lbs.bentonite e� NEAREST KNOWN SOURCE OF CONTAMINATION clay brown medium /► 24 Well is I %,O feet Edirection from --T type ��s 82 Well disinfected upon completion? Yes ❑No clay gray medium 24 PUMP ❑Not installed Date installed 6-14-19 clay/gravel gray medium 82 106 Manufacturer's name 9cl'laefer Model Number HP 1.5 Volts 230 fine sand brown medium 106 142 __r l Length of drop pipe 105 ft. Capacity g.p.m. siltyclay/sand brown medium 142 210 ABANDO ED EiLle ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ��,�� y ABANDONED WELLS sand/gravel brown medium 210 225 VARIANCEDoes property have any not in use and not sealed well(s)? ❑Yes/ f No Was a variance granted from the MDH for this well? ❑Yes 1�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 Na Lic.or Reg.No. ":".-F,- 6-19-19 i Representative Sig ature Certified Rep.No. Date Rob Stodola LOCAL COPY 8 3 9 613 Name of Driller ID#52603 HE-01205-17(Rev.5/17) 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: 19-00165 Twin City Water Clinic Inc. Sample Collection Date: 01/07/19 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 19:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 01/08/19 Phone: (952)935-3556 Report Issue Date: 01/09/19 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 19-00165 Coliform Drinking Water 01/08/19 12:31 Absent 19-00165 Nitrate/N Drinking Water 01/08/19 12:23 <1.0 mg/L 19-00165 Arsenic Drinking Water 01/08/19 9:30 01/09/18 11:11 5.19 [.!g/L Lead Drinking Water ug/L Well No.: 839613 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#i. The Well Adr: 4330 Lakeview Court;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Norton Homes field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 8 °C Discussion: Notes: 6 I 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,2.0µg/I,Lead,2.0 µg/L µg/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 o`herwise noted. TCWD Rev 4.0 Page 1 r