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Home My WebLink About08-17-19 Well & Boring Construction Record MINNESOTA UNIQUE WELL WELL OR PORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name . WELL AND BORING CONSTRUCTION RECORD 8 3 9 5 8 6 Minnesota Statutes,chapter 1031 Township Name Township No. Range No. Section No.., Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 23 NW M NW ,' 129 n. 8-17-19 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude C Cable Tool ❑Driven _ ❑Dual Rotary ❑Auger N�j Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 750 Big Island, Orono 55331 DRILLING GFFLUID'r WELL HYDROFRACTURED? ❑Yes SiNo Show exact location of well/boringin sectiongrid with"X." Sketc mapof well/b rin los ion. bentonite " '` $t�J�6�Qrog9e ��jue� From ft.To ft. a 14c- imdsi l�tlildWnT�s,9nd di ectiolr USE N ]Domestic ❑Monitoring ❑Heating/Cooling _________________________ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial •1 ❑Community PWS ❑Irrigation ❑Remedial ---=--------- , ' ❑Elevator ❑Dewatering ❑ w E CASING MATERIAL Drive Shoe? ❑Yes , No HOLE DIAM. El Steel ❑Threaded ❑Welded ,h Mile Plastic ❑ rs 1 - CASING ////7.. Diameter Weight Specifications 4 1 Mile- { \ in.To 120 ft. lbs./ft. 8 in.To50 ft. •• PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. bs./ft. in.Tot ft. Terry D orf in.To ft. lbs./ft. n.To ft. L SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. ThnionMake � 10575 Robinaoc3 Dr NW Type eta1A steel From ft. 2 ft. To ft. /�.'_�r �{ y+� stain.less t� Coon Rapids, MN 55433 Slot/Gauze .15 Length qV + 4$ Set between 120 ft.and 129 ft. FITTINGS mat leader STATIC WATER LEVEL 42 ft.xi Below ❑Above land}surface 8 Date measured 4749 Dry hole ❑Yes yiNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 115 ft.after_ 2 _ hrs.pumping g.p.m. Well/boring owners mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ❑Pitless/adapter manufacturer Model ❑Casing protection Xr2 in.above grade ❑At-grade ❑Well House ❑Hand Pump Sanitgry Seal GROUT INFORMATION(specify bentonite,cement-sand,-sanneat-cement concrete,cuttings,or other) Material bentonite From 500 To'f X50 ft. 3 ❑Yds. Bags Material cuttings From To120 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags One bag94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION clay brown medium 027 Well is //. , feet direction from ‘,--) type -*- � Well disinfected upon completion? Yes ❑No y gray � 27 102 PUMP LINot installed Date installed 8-1.7-19 clay/gravel gray medium 102 115 Manufacturer's name sand gray soft 115 130ill Model Number HP 1/2 Volts 230 Length of drop pipe 80 ft. Capacity g.p.m Type'Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes l- No VARIANCE Was a variance granted from the MDH for this well? ❑Yes lei 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 •"IT nc. 1691 Licensee Business Name Lic.or Reg.No. '` / 9-5-19 J G !-rtrled`epresentati•- .nature Certified Rep.No. Date ' LOCAL COPY 8 3 9 5 8 6 Name of Driller Rob Stodola 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: 19-08896 Twin City Water Clinic Inc. Sample Collection Date: 08/18/19 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 14:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 08/19/19 Phone: (952)935-3556 Report Issue Date: 08/20/19 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Semple Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 19-08896 Coliform Drinking Water 08/19/19 12:19 Absent 19-08896 Nitrate/N Drinking Water 08/19/19 12:49 <1.0 mg/L 19-08896 Arsenic Drinking Water 08/19/19 11:00 08/20/19 11:30 4.31 µg/L Lead _ Drinking Water µg/L Well No.: 839586 X No samples were subcontracted;or the above test result(s) with.**'designation produced by a subcontracted Sample pt: well laboratory. [Laboratory name;address;MDH Lab ID#j, The Well Adr: 750 Big Island,Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Terry Deggendorf field(s)of testing performed. Owner Adr: Sample Conditions: Sample received on ice. Sample Temp: 4°C Discussion: Notes: Approved methods used in analyzing the samples listed above have the following reporting levels: Maximum contaminant levels: SM92228 Coliform,1 du/100 ml Coliform-<1.cfu/100 ml EPA 353.2"-Nitrate Nitrogen expressed as NO3+NO2,1.0 mg/L Nitrate Nitrogen 10.0 mg/L Arsenic,10.0 µg/IL SM3113B-Arsenic,2.0µg/I,Lead,2.0 µg/L Lead,15.0µg/L " EPA 353.2 =Nitrite Nitrogen, LO mg/L Nitrite;1 trig/L :,fit L Sample Collected by: X Client _TCWC Approved By: Hill Van Arsdale Laboratory Manager The results listed in this report apply only tothe 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