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Home My WebLink About12-16-2018 Well & Boring Construction Record ' MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 8 2 7 8 2 9 �� Minnesota Statutes,Chapter 1031 TowFnisFee��ip-Nae in Township No. Range No. Section No. Fraction(sm.--.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 28 10` NE ISI£. NE ' 123 11. 12-16-18 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude 4 ❑Cable Tool - ❑Driven ❑Dual Rotary ❑Auger s3' Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 980 Heritage Lane, orono 55391 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes X.No Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. bentonite From ft.To ft. gs properly lines, N oads,buildi .s,and direction. USE Domestic ❑Monitoring ❑Heating/Cooling 7 ':- ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial ' • . _off'— ❑Elevator ❑Dewatering ❑ w' E T /1" VVW�� CASING MATERIAL ❑ HOLE DIAM. Drive Shoe? Yes o ❑Steel ❑Threaded ❑Welded Mile v RPIastic 111 r s 1 CASING Diameter Weight Specifications O' p� ) 1 Mae { $ 4 in.To 119t. lbs./ft. 8_in.To 50 ft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. bs./ft. Z n.To125 ft. in.To ft. lbs./ft. in.To ft. Tom Potter Construction t,_ OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN Johnson Make From +� ft. To ft. 6531 Devonshire Dr Type stainless steel Diar1F.T Chanhassen, MN 55317 Slot/Gauze .010 Length' + 4' Set between 11 ft.and 123 " ft. FITTINGS 2"x8' leader STATIC WATER LE L 60 ft.Oelow ❑Above land surface Measured from top of WPLle measured7—�6-18 ry hole ❑Yes j 10 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 110 ft.after 2 hrs.pumping q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION XPitless/adapter manufacturer Whi tPWP1 tPr Model ❑Casing protection jig in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentonit °m 0 To 50 ft. 3 ❑Yds. iNt9ags Material cut tings From 50 To 115 ft. ❑Yds. ❑Bags HARDNESS OF Material From Jil 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 course gravel/ t, 8 NEAREST KNOWN SOURCE OF CONTAMINATION clay brown medium 0Well is 1<CJ feet Al direction from 452-p _-c__ type Well disinfected upon completion? Wes ❑No sandy clay brown medium 8 32 PUMP ❑Not installed Date installed 4-21-19 clay gray medium 32 83 Manufacturer's name Schaefer p Model Number HP 1•5 Volts 230 _ sand/gravel mix medium 83 100 84 Length of drop pipe ft. Capacity g.p.m CIS red soft 100 11 3 Type: ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet Ely ABANDONED WELLS sand/gravel mix medium 113 125 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,it needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling Co. ,Inc. 1691 Licensee Business Name Lic.or Reg.No. 4-25-19 C ie esgfi ive . n ur Certified Rep.No. Date r.. LOCAL COPY 827829r,.� eo...�-1— Name of Driller ID#52603 HE-01205-16(Rev.5/161 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: 18-16431 Twin City Water Clinic Inc. Sample Collection Date: 12/16/18 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 14:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 12/17/18 Phone: (952)935-3556 Report Issue Date: 12/18/18 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 18-16431 Coliform Drinking Water 12/17/18 14:08 Absent 18-16431 Nitrate/N Drinking Water 12/17/18 13:19 <1.0 mg/L 18-16431 Arsenic Drinking Water 12/17/18 11:25 12/18/18 10:59 3.17 .tg/L Lead Drinking Water .ig/L Drinking Water Well No.: 827829 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: 980 Heritage Lane;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Tom Potter Construction field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 13°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,2.0µg/I,Lead,2.0 µg/L l g/L Lead,15.0 vg/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