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Home My WebLink AboutWell and Boring • •. UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTAAND BORING NO. County Name WELL AND BORING RECORD 783515 : ih Minnesota Statutes,Chapter 103/ Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 3 NESE SW/ 335 h. 7-'284 GPS Latitude degrees minutes seconds DRILLING METHOD LOCATION: ❑Cable Tog . ❑Driven ❑Dug Longitude degrees minutes ' seconds ❑Auger I Rl9otary ❑Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number ❑ 2120 Webber Tulle Rd Orono o 55DRILLING FLUID WELL HYDROFRACTURED? ❑Yes .1I-No Show location of well/boring in section grid with"X." Sketch imap of well/boring location. ��, From ft.To ft. Showing property lines, N roads,buildings,and direction. USE Cirpomestic ❑Monitoring ❑Heating/Cooling _ ____i ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial k, ❑Elevator ❑Dewatering ❑ w - ' E , , * CASING MATERIAL Drive Shoe? Yes ❑No HOLE DIAM. T O *I Steel ,rThreaded ❑Welded --'--- I 'k Mite ❑Plastic ❑ 1.-- 1 CASING s / Diameter ,�J/{, J Weight Specifications �''{� 1 Mile y w ► A J es 4 in.t� ft. lbs./ft. 77/(.t0�5y0ft. 63/4 PROPERTY OWNER'S NAME/COMPANY NAME j� in.to ft. lbs./ft ��iin.to�+ ft. in.to ft. lbs./ft. "•`Ih.to 335ft. Sargent JEson OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN Make From 3 ft. To 335 ft. same Type Diam. Slot/Gauze Length Set between ft.and ft. FITTINGS STATIC WATER LEVEL Measured from 90 kik Below ❑Above land surface Date measured 7..20..11 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 250 ft.after hrs.pumping g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ❑Pitless/adapter manufacturer Model Model ❑Casing Protection [ieI2 in.above grade ❑At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well , s `F fJi/ f ) Grout�ma--pals � nt Bent..,t��Concrete I❑Other rom To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. ❑Yds. ❑Bags MATERIAL From To ft. ❑Yds. ❑Bags NEAREST KNOWN SOURCE OF CONTAMINATION 1 0 / clay blue mod irapPI) cp-3,, feet direction . }_it .,1,-41jtpq,.. Well disinfected upon completion? 4es CI No �..Jl sand p� 1ti 1,5 PUMP A d"'J 80 1 J ❑Not installed Date installed 7 21-1l clay/sand brown *edit 175 200 Manufacturer's name Schuller Model Number HP 3/4 Volts 230 rocks 200 205 Length of drop pipe 105 ft. Capacity g.p.m. Type:A5ubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ fine sand brawn soft 235 270 ABANDONED WELLS sabdstlimi/ white/ shale �� soft Does property have any not in use and not sealed well(s)? ❑Yes No 1 VARIANCE shale/ blue/ 3AtIc�BtlfflP Was a variance granted from the MDH for this well? Li Yes +�IVo TN# mite medium 300 335 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. ' !'' 8-16-11 3K.d./°#/.; id/ • iietl Represe tative SigrfaTurey` Certified Rep.No. Date C + � Stodola LOCAL COPY 7 8 3 515 Name of Driller IC 140-0020 '. HE-01205-12(Rev.12/08) 144 Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 Client: Don Stodola Well Drilling Co Report Number: 11-1170 Twin City Water Clinic Inc. Sample Collection Date: 07/21/11 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 15:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 07/22/11 Phone: (952)935-3556 Report Issue Date: 07/25/11 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 11-06767 Coliform Drinking Water 07/22/11 13:47 Absent 11-06767 Nitrate/N Drinking Water 07/22/11 13:52 6.11 mg/I 11-06767 Arsenic Drinking Water 07/22/11 8:45 07/25/11 12:50 2.33 pg/1 Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water 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-2120 Webber Hills Rd Orono,MN [Laboratory name;address;MDH Lab ID#]. The subcontracted laboratory maintains MDH Certification for the field(s)of testing performed. Sample Temperature: 11 °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, Coliform-<1 cfu/100 ml SM9222B-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/ILead,15.0µg/I drinking water for the SM3113- Lead, 2.0µg/I analytes tested. Sample Collected by: X Client TCWC Approved By: 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 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 296348 Wo. ELL �'ORING LOCATION WELL AND BORING SEALING RECORD MinnesotaSealinUnique Well No. County Name Hennepin Minnesota Statutes,Chapter 1031 Leave a eries No. Township Name Township No. Range No. Section No. Fraction(sm.-+lg.) Date Sealed Date Well or Boring Constructed Orono 117 23 3 tiR 4 / Rf.G II Latitude degrees minutes seconds /M��/ GPS g Depth Before Sealing �W ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds i9UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer 2120 Webber Hills Rd Orono 55391 L/BORING DieMeasured ❑Estimated Date Measured 5A1Y1c ,0/9/--,[ Vater-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring Env.Bore Hole Other ft. elow above land surface in section grid with"X." location,showing property ❑ ❑ ❑ lines,roads,and buildings. N CASING TYPE(S) x Steel ❑ ❑Tile ❑Other T WELLHEAD COMPLETION w EI • } Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset Yr Mile �, ❑Buried ❑Well Pit 1 .s7 X Pitless Adapter/Unit - -T- .- -- ------- � I ❑Well Pit ❑Buried s iZek ❑Other ❑Other I Mile I Lz_�Q�.r+O.�- "11-3241--a. PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) - remit Jori Diameter t Depth t Set in oversize hole? Annular space initially grouted? Property ner's mailing address if different than well location address indicated above q .,- in.from__ to /94, ft. ❑Yes glo ❑Yes ❑No ❑Unknown saw 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 Well owner's mailing address if different than property owner's address indicated above Screen from to 2eiti ft. Open Hole from to ft. OBSTRUCTIONS ��ttt''' rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ) o Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring. PUMP cl Type ^(/+J{��j` 1:21Z❑Removed X Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: lifNo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) ./1_f MMI Grouting Material�t7/ f/7��l.i/ from en to 2 cc)ft. yards e bags 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,'No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION 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 NameLicense or Registration No. ifi Re resentative Signal Certified Rep.No. Date LOCAL COPY H 298348 � �� Name of Person Sealing Well or Boring t� HE-01434-12 IC#140-0423 9/09R