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HomeMy WebLinkAbout07-16-19 Well and Boring Construction Record f • •`- MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING Na Countypiene - ' WELL AND BORING CONSTRUCTION RECORD Minnesota Statutes,chapter 1031 8 3 9 5 8 9 n TownshipmNam Township No. Range No. Section No. Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED 1 din" ,.• 117 '- ` 23 06 SE's 225 n. 7-16-19 GPS LOCATION—"' ecimal degrees(to four decimal places). DRILLING METHOD Latitude \dLongitude ❑Cable Tool ❑ riven ❑Dual Rotary ❑Auger Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location r, ❑Other .....rrr�rfffff 4315 " few �, Orono 55364 DRILLING FLUII WELL HYDROFRACTURED? ❑Yes 1 No Show exact locatiph of well/boring in section grid with"X" Sketch map of well/boring location. bentonite'',_;. Froth' ft.To 01K ft. .' Showing property lines, ` N roads,buildings,and direction. USE Domestic ❑Monitoring ❑Heating/Coaling ;___ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ddLCy� So Community PWS ❑Irrigation ❑Remedial Q ee �j X7 ❑Elevator ❑Dewatering ❑ w ! E T "4(`� I `(\ CASING MATERIAL Drive Shoe? ❑Yes ,No HOLE DIAM. -"' I a ❑Steel ❑Threaded ❑Welded f Mile �¢ 'Plastic ❑ ...r-"-T--------- I 1 CASIN a - 1 ,i t` Diameter Weight Specifications s ) 1 Miley in.To 215 ft. lbs./ft. 8 in.To R/!� tt. PROPERTY OWNER'S NAME/COMPANY NAME n.To ft. lbs./ft. *+(`i in.To225ft. Swanson Hoopes in.To ft. lbs./ft. in.To ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. T 1360 Hamel Rd Make Johnson From " ft. To ' ft. C Type stainless Steel Diem. 2 Medina,, MR 55340 Slot/Gauze .010 Length 4S + 41 Set between 215 ft.and 225 ft. FITTINGS ewer f 1 __. STATIC WATER LEVEL 74 ft.x Below ❑Above land surface Date measured 7'1649 ._ Dry hole ❑Yes'No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 210 ft.after 2 hrs.pumping 50, q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION • �itless/adapter manufacturer el asing protection 1 12 in.above grade ❑At-grade p Well House ❑Hand Pump /"' GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)� Material ent dteFrom 0 To 50 ft. 3 ❑Yds. Bags Material eating/I From To 2145 ft. ❑Yds. ❑Bags • HARDNESS OF Material From 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 ;z l 5-*NEAREST KNOWN SOURCE OF CONTAMINATION Q-.—�. clay b medium © 22 Well is r feet direction from `=k•'F type _ti Well disinfected upon completion? A Yes ❑No sandy clay gray medium 22 1(X) PUMP J/; fine sand/ ❑Not installed Date installed /V — /9 sty clay gray sof t 100 Manufacturer's name g �!� mix medium 206 225 Model Number HP /4� Volts ta3cO YCJ4lJV 4G ,Length of drop pipe /6J5 ft. Capacity g.p.m Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABA DONED WELLS Does property have any not in use and not sealed well(s)? ❑YesNo VARIANCE T Was a variance granted from the MDH for this well? ❑Yes XNo 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. 9-26-19 C i presentative ignature Certified Rep.No. Date LOCAL COPY 8 3 9 5 8 9 Name of Driller ' 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: 19-07565 Twin City Water Clinic Inc. Sample Collection Date: 07/16/19 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 13:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 07/17/19 Phone: (952)935-3556 Report Issue Date: 07/18/19 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results :Units 19-07565 Coliform Drinking Water 07/17/19 13:04 Absent 19-07565 Nitrate/N Drinking Water 07/17/19 13:46 <1.0 mg/L 19-07565 Arsenic Drinking Water 07/17/19 9:20 07/18/19 11:38 5.55 Ilg/L Lead Drinking Water i Well No.: 839589 X No samples were subcontracted;or the abovetest result(s), p Sample t with'**'designation were produced by a`,subcontracted. p . well laboratory. (Laboratory name;address;MDH Lab 1D4#1. The Well Adr: 4315 Lakeview Court;Orono,MN subcontracted laboratory maintains MOH Certification,for the Owner: Swanson Homes field(s)of testing performed. Owner Adr: Sample Conditions: Sample received on ice. Sample Temp: 6°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 mlColiform <1 cfu/100 ml EPA 353.2-Nitrate Nitrogen expressed as NC?3k Np2,1 fl mg/1. Nitrate Nitrogen 10.0 mg/L 5iV13113$-Arsenic;'2.0-µg/{ Lead, ugi.L ,rsenic,,10,0 µg'/L EPA 353.2 Nitrite Nitrogen,1.0 mg/L Lead,15 Nitrite,1.mg/Lr, . n r --- 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. TCW D Rev 4.0 Page 1 of 1