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HomeMy WebLinkAboutwell and boring record ESOTA UNIQUE MINNESOTA DEPARTMENT OF HEALTH MW AND BORING NO. WELL Gil BORING LOCATION WELL County Name WELL AND BORING RECORD 7 7 0 015 pin Minnesota Statutes,Chapter 1031 Henne Township Narpe Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 03 SW SE SWC 208 ' 6-23-09 GPS DRILLING METHOD LOCATION: Latitude degrees _ minutes seconds Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Dug ❑Augerotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑ 2095 5 53si DRILLING FLUID WELL HYDROFRACTURED? ❑Yes k100 Show exact location of welVboring in section grid with"X." Sketch map of well/boring location. bentonite From ft.To ft. Showing property lines, N roads,buildings,and direction. USE 1 omestic ❑Monitoring ❑Heating/Cooling __ -_ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial �� 4 i ❑Community PWS ❑Irrigation ❑Remedial -i- F-- ;- rl ,` , ❑Elevator ❑Dewatering w ; E ` CASING MATERIAL ❑ HOLE DIAM. Drive Shoe? ❑Yes fflo ; r T c,::7"./ ❑Steel ❑Threaded ❑Welded 'h Miley ❑ i I Il astic CASING s ' Diameter Weight Specifications ) 1 Mile in.to _ft. 1.9>s./ft. mots _8_in.to 50. PROPERTY OWNER'S NAME/COMPANY NAME in.to N. lbs./ft. _6%_ in.to . �{..� in.to ft. lbs./ft. in.to ft. ThrIMMOUIVOn SWAM SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make Johnson From ft. To ft. same as above Type_ertaitilestriDiam. 2« Slot/Gauze .11'131 M© Length�i t y? Set between q.01 tt.and ft. FITTING _ STATIC WATER�L�FEL Measured rom p ft.Neelow ❑Above land surface Date measured 60.23..09 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 196 ft.after 1.5 hrs.pumping 5fl q.p.m. WelVboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer t 3` ,1 N '--..,Model ❑Casing Protection r�12 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted RYes ❑No Grout materials ❑Neat cement RBentonite ❑Concrete ❑Other From_To 50 ft. 4 ❑Yds. ArBags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To_ _ft.� f f s. ❑Bags MATERIAL From To ft. ❑Yds. ❑Bags NEAREST KNOWN SOURCE OF CONTAMINATION clay brawn sof I 16 - J. feet C_ direction t a--' type Well disinfected upon completion? IRYes ❑No clay aray soft 16 50 PUMP r ❑Not installed Date installed ll " -,1 7U- <- s ' : .i- • •:.0 -• a I''1Y Manufacturer's name r,1,r,."-, 6r ay Model Number HP / Volts /.'if) clay/rocks fray 1!edd�.t m 100 180 Length of drop pipe /)40 ft. Capacity g.p.m. Type:[Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ clay red medium 180 195 ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes �No sand gray soft 195 208 VARIANCE 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 C o,. Inc. 1991 Licensee Business Name Lic.or Reg.No. • /f epresentative Signature Certified R ..No. Date Cljatie Moore LOCAL COPY 7 7 0 0 15 Name of Driller IC 140-0020 HE-01205-11(Rev.3/07) Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory IDft 027 053-119 Wisconsin State Laboratory loll 105-10117 Client: Don Stodola Well Drilling Co, Report Number: zi-oos1 Twin City Water Clinic Inc. sample Collection Date: 01/18/u 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 14:00 Hopkins, MN 55343 St.Bonlfaclus,MN 55375 Sample Receipt Date: 01/19/11 Phone:(952)935-3556 Report Issue Date: 01/20/11 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 11-00603 Coliform Drinking Water 01/19/11 _ 13:12 Absent • Nitrate/N Drinking Water _ mg/I Arsenic Drinking Water µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water fi X No samples were subcontracted;or the above test result(s) Sample Conditions/Discussion/Notes; with"'designation were produced by a subcontracted laboratory. Sample Location-770015/Well 2095 Webber Hills Rd 0rono,MN (Laboratory name;address;MDH Lab IDN]. The subcontracted laboratory maintains MDH Certification for the field(s)of testing performed. Sample Temperature: 8 °C Sample Conditions: Discussion: Notes: Approved methods used in analyzing the samples This Sample meets the listed above have the following reporting levels: Maximum contaminant levels: State of Minnesota, SM9222B-Coliform, 1 cfu/100 ml Coliform <1 cfu/100 ml Wisconsin and EPA Nitrate Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen,1.0 mg/I Arsenic,10.0 µg/I guidelines for safe SM 3003-Arsenic, 2.0µg/I Lead,15.0 lsg/I drinking water for the 5M3113-Lead,2.0µg/I analytes tested. Sample Collected by: X Client _TCWC Approved By: f ll Bill Van Arsdale Alan Senechal Laboratory Manager Senior Analyst 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 1.2 Page 1 of 1 Laboratory Test Report Engel Water Testing, Inc. 9300 County Rd. 15 * Minnetrista, MN 55359 Phone: (952) 955-1800 Fax: (952)955-1806 Minnesota State Certified Laboratory#027-003-105 * Wisconsin State Certified Laboratory#105-10115 Don Stodola Well Drilling Co., Inc. 3841 North Main Street St. Bonifacius, MN 55375 Water Test Location: Report Issue Date: July 2, 2009 2095 Webber Hills Rd. Year: 2009 Orono, MN Date/Time: Sample Collection: 7/1 12:25pm Date/Time: Sample Recd. in Lab: 7/1 9pm Well Unique Number: 770015 Laboratory Test Number(s): 09-6795 'Required when critical to the validity and application of the results Laborato Date/T'une DateCrime Test ry Matrix I Results A roved Method Notes Test No Sam le Atial sis # < Prep {amts) Coliform SM 9223 B 18th ED 09-6795 Bacteria 7/1 9pm 7/2 9pm *Positive colilert© 09-6739 Nitrate 6/24 7pm 6/24 7pm <1.0 mg/I Per ISE Method SM Nitrates Tested 4500-NO3 D I8th ED 6/24/09 09-6739A **Arsenic 7/2 l lam <0.002 ppm Arsenic Tested 7/2/09 Allowable Limits: ➢ Nitrate Nitrogen,mg/1: Maximum allowable limit is 10.0 mg/1 or Less ➢ Coliform Bacteria: Allowable Limit is NEGATIVE > Lead,ppm:Maximum allowable limit is 0.015 ppm or Less > Arsenic,ppm: 0.010 ppm or Less—(0.010 ppm or more exceeds the MDH-recommended health limit for long-term consumption of arsenic in drinking water. Subcontracted test results: !❑ o samples were subcontracted;or The above test result(s)with"**"designation were produced by Stearns DHIA Laboratories,825 12th St. S.,Sauk Center, MN 56378(MN Cert.No.027-145-378).The subcontracted laboratory maintains MDH certification for the field(s)of testing performed. Discussion/Notes: These test results are not within the allowable limits for Coliform Bacteria. .24 /, Report authorized by: /%/ ! / Date: July 2, 2009 Kathryn M. Engel, Laboratory Di rctor / The results listed within the report relate only to the samples received on the dates indicated. This report must not be reproduced,except in full,without the written approval from Engel Water Testing,Inc. Created by Engel Water Testing,Inc.October,2008 Page 1 of 1 MINNESOTA DEPARTMENT OF HEALTH• Minnesota Well and Boring WELL OR BORING LOCATION Sealing No. H 279287 County Name •-, WELL AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes,Chapter 1031 or W a ek ries No. not known) Hennepin (Leave Township Name Township No. Range No. Section No. Fraction(sm.-+Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 02 ' W 'SE 'SW 9 `f U kI 7 I r GPS Latitude degrees minutes seconds Depth Before Sealina ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds ,A( UIFER(S) ST TIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ySingle Aquifer ❑Multiaquifer jI M` /�/)!� WELL/BORING Measured ❑Estimated Date Measured ''+r rte] 2095 Webber Rills Ed, Orono 55391 �tnfater-Supply Well ❑Monit.Well t Show exact location of well or boring Sketch map of well or boring ��//''�, ` 5 in section grid with"X." location,showing property ❑Env.Bore Hole ❑Other ft. below ❑above land surface N lines,roads, buildings. CASING TYPE(S) Steel ❑Plastic ❑Tile Q Other -----' --"--" T WELLHEAD COMPLETION L W EI Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset 'h Mae 1,....i0❑Buried ❑Well Pit Pitless Adapter/Unit T 0 ❑Buried s \i ❑Well Pit ❑Other 1--t Mile---1 ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Thomas Sween Dille'?f f Depth / Set in oversize hole? Annular space initially grouted? Property owner's mailing address it different than well location address indicated aboveq in.from o !.3 ft. Q Yes )(No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN/HOLE t I Well owner's mailing address if different than property owners address indicated above Screen from S � to ft. Open Hole from to ft. OBSTRUCTIONS ❑Rods/Drop Pipe Q Check Valve(s) ❑Debris ❑Fill [(o Obstruction Type of Obstructions(Describe) i GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION If not kn wn,indicate estimated formation log from nearby well or boring. PUMP Type iv , •7❑Removed KNot Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: 'Vo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed 4 Type of Perforator ❑Other GROUTING MATERIAL(S)�� ((One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) AI e�/'rf�ffrom O f to / /�ft. / Grouting Material yards bags 9 from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes How many? _ LICENSED OR REGISTERED CONTRACTOR CERTIFICATION fff�f ����j. This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. Don Stodola Well Drilling Co., Inc. 1691 Licensee Business/Name \ License or Registration No. ,,...2 •;(. i/: /- . 7- 9- Q 5, C rfrtrve•ntatif Signature Certified Rep.No. Date N's'NoLl."'".--' c....i. LOCAL COPY H 279287Name of Person Sealing Weff or Boring HE-01434-11 IC#140-0423 2/08R