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Home My WebLink About04-29-19 Well and Boring Construction Record MINNESOTA UNIQUE WELL : WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD Minnesota Sta 'tes,chapter 1031 8 3 9 6 2 3 Hennepin Township Name Township No. Range No. Section No. Fraction(sm.—Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 NW NE SWy, 138 „. 4-29-19 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool aDriven ❑Dual Rotary ❑Auger Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ,,,. ❑Other iS St. [L+47g St, Orono 553( DRILLING FLUID WELL WELL HYDROFRACTURED? ❑Yes, to Show exact location of well/ ring in section grid with"X" Sketch map of well/boring location. Bentonite From ft.To ft. Showing property lines, roads,buildings,and direction. USE N Domestic ,r'. ❑Monitoring ❑Heating/Cooling _ 414 ` ❑NoncommunityPWS ❑Environ.Bore Hole ❑Industry/Commercial 1 ❑Community PWS ❑Irrigation ❑Remedial - ---i------- ❑Elevator ❑Dewatering ❑ w E - e_r4,9, CASING MATERIAL❑Steel Drive Shoe? ❑Yes No ❑Threaded ❑Welded HOLE DIAM. --;-----;- F------ � -7. 6- 'h Mile litiglastic ❑ I CASING Diameter Weight Specifications 1 Mile— in.To 129ft. lbs./ft. in.To . in.To ft. lbs./ft, in.To 1 . PROPERTY OWNER'S NAME/COMPANY NAME . • i a{7tl,R1 BOMB in.To ft. lbs./ft. in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE 1360�� Hamel Rd Make From ft. To ft. Medina, MN 55340 Type stainless steeI Diam. Z" Slot/Gauze .010 - Length 41 f 44 Set between 129 ft.and 138 ft. FITTING8rx3. leader STATIC WATER LEVEL 54 ft.," Below ❑Above land surface Date measured 4'29-19 Dry hole ❑Yes liNo ,, WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 120 40 ft.after 2 hrs.pumping g.p.m. Well/boring owner's mailing address if different than properly owner's address indicated above. WELLHEAD COMPLETION ]g Pitless/adapter manufacture odel I�Casing protection 12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentOniterom 0 To 50 ft. 3❑Yds. NeBags Material cuttings. From 50 To .IX 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 b 0 17 Well is 045.--° feet direction from c`,"�' type Off Well disinfected upon completion? ;gl'es ❑No Clay .gray �u1 9017 90 PUMP > /9 — sand/gravel mi% soft 112 ❑Not installed Date installed ( /" I5— Manufacturer's name rig—sand brown soft 112 124 Model Number [�j u HP ,/dam- Volts �O - --- Length of drop pipe O I ft. Capacity g.p.m sand brown soft 124 138 Type:` e'ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ — ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes.No VARIANCE Was a variance granted from the MOH 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. Don Stodola Well Drilling Co,. Inc. 1691 • Licensee Business Name Lic.or Reg.No. r /�,/' ,1/- / 9- /9 —‘(/:, ' Re•res'nt.,i -Signature Certified Rep.No. Date LOCAL COPY 8 3 9 6 2 3 Name of Driller A tY —2±.---Erd-g--4-19'....... ID#52603 HE-01205-17(Rev.5/17) a 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: 19-04738 Twin City Water Clinic Inc. Sample Collection Date: 04/29/19 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 14:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 04/30/19 Phone: (952)935-3556 Report Issue Date: 05/01/19 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 19-04738 Coliform Drinking Water 04/30/19 12:40 Absent 19-04738 Nitrate/N Drinking Water 04/30/19 12:51 <1.0 mg/L 19-04738 Arsenic Drinking Water 04/30/19 9:35 05/01/19 12:43 2.54 µg/L Lead Drinking Water µg/L Well No.: 839623 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: 4665 St.Andrews Street;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Swanson Homes field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 4 °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 EPA 353.2-Nitrate Nitrogen expressed as NO3+NO2,1.0 mg/L Nitrate Nitrogen 10.0 mg/L Arsenic,10.0 tg/L SM3113B-Arsenic,2.0 pg/I,Lead,2.0 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 otherwise noted. TCWD Rev 4.0 Page 1 of 1