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Home My WebLink AboutWell & Boring • MINNESOTA UNIQUE WELL WELL C3R BOR11,0G LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County7Va/be WELL AND BORING CONSTRUCTION RECORD 823469 Minnesota Statutes,Chapter 10.4I Townshiirl Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED nano 117 23 10 NE Sg N4J'' 106 # 4-6-17 GPS LOCATION-decimal degrees(to four decimal places). DRILLING METHOD C � � Latitude Longitude ❑Cable Tool ❑Driven R❑Auger `'Rotary House Number,Street Name,City,and ZIP Code of Well Location f ❑Other / �� (� ) 1099 Willow Dc SA Or( f 55371 DRILLING FLUID WELL HYDROFRACTUREYek!X71 Nc�I 1 Show exact location o welVbonng in ction_gnTd_wi"th"X' Sketch map of well/boring location. bentonite From ft.To j� ft. Showing property lines, jr r-�� N n O roads,buil and di. tion. USE gsis Domestic ❑Monitoring ❑HOe r / obNrig ORONO `-. r ,....and . __;______:_____I __;__ 0 Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial �- ❑Community PWS ❑Irrigation ❑Remedial ❑Elevator 0 Dewatering w : ET. CASING MATERIAL Drive Shoe? ❑Yes }ry(No HOLE DIAM. --b F-- I ❑Steel ❑Threaded ❑Welded - ----_ 'k Mile f 6i[Plastic El1 CASING/- T s Diameter Weight Specifications — —1 Mile I 4 - in.To 9R ft. lbs./ft. ._in.To_50.ft. lla PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. bs./ft. 1/4_in.Toft. Nate ung in.To ft. lbs./ft. in.To ft. OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN mameG, i }_)n--. - Make Johnson From ft. To ft. /� �._ . Type stainless steel Diam.2M 7L/ai jJ 71-= (�- `1, Slot/Gauze .010 Length 4t 4 t_! l/S l� Set between an ft.and 106 ft. FITTINGS L it} leader A..........-• 474}.......:-..1_4- fY1 N S-Y 6 STATIC WATER'LLEVEL Measured from L-`- 36 ft. Below ❑Above land surface Date measured 4-6-17 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(belwlland surface) 95 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 XWhitewater �j yy Pitless/adapter manufacturer with ter Model ❑Casing protection 'i2 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentonite From 0 To 50 ft. 3 ❑Yds. [Bags Material cut t Ings From_ 0 To 98 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL Driven casing seal From To Bags NEAREST KNOWN SOURCE OF CONTAMINATION topsoil black soft 0 a!_..► feet E... direction (-2.t5 4:�-......s--t)pe Well disinfected upon completion? 1'Yes ❑No sand/clay brown soft 2 15 PUMP ❑Not installed Date installed 9-8-17 clay gray medium 15 74 Manufacturer's name Schaefer sand/clay gray soft 74 92 Model Number HP 1 Volts 230 Length of drop pipe 63 ft. Capacity g.p.m. sand brown soft 92 110 Type:tgSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes lino VARIANCE Was a variance granted from the MDH for this well? ❑Yes I�'No TN# WELL CONTRACTOR CERTIFICATION J^ 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,it needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling co,. Inc. 1691 Licensee Business Name Lic.or Reg.No. <7,- ter/ 11-17-17 ifie R se»YJSSign.u= - Certified Rep.No. Date LOCAL COPY 823469. Name of Driller Rob stodola ID#52603 HE-01205-15(Rev.8/13) 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: 17-03901 Twin City Water Clinic Inc. Sample Collection Date: 04/06/17 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 13:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 04/07/17 Phone: (952)935-3556 Report Issue Date: 04/10/17 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 17-03901 Coliform Drinking Water 04/07/17 11:31 Absent 17-03901 Nitrate/N Drinking Water 04/07/17 11:33 <1.0 mg/L 17-03901 Arsenic Drinking Water 04/07/17 9:00 04/10/17 10:33 3.03 tg/L Lead Drinking Water p.g/L mg/L Well No.: 823469 X No samples were subcontracted;or the above test result(s) with'**'designation were produced by a subcontracted Sample pt: laboratory. [Laboratory name;address;MDH Lab ID#j. The Well Adr: 1099 Willow Drive South;Orono,MN subcontracted laboratory maintains MOH Certification for the Owner: Nate dowing field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 15 `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 µg/L SM3113B-Arsenic,2.0µg/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: L .' 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 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota toNWell and Boring H 3 4 6 8 5 3 SealingCounty Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes,Chapter 1031 oe W s eties No. Hennepin Township Name Township No. Range No. Section No. Fraction(sm.-.Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 10 NT S NV 6.-//2/17 GPS LOCATION-decimal degrees(to fourdecimal places) , e Depth Before Sealing '9 ft. Original Depth_ __ft. Latitude Longitude AQUIFERS) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer 71099 Willow Dr S, Orono 55391 BORING X Measured ❑Estimated Date Measured-574/774- .•)Ar ,Water-Supply Well ❑Monit.Well / Show exact location of well or boring Sketch map of well or boring in land surface in section grid with"X:' • location,showing property ❑Env.Bore Hole ❑Other ft. below N f J + Iiad A A nes,roads buiidl e� CASING TYPE(S) Steel ❑Plastic ❑Tile ❑Other -----•- T WELLHEAD COMPLETION W ---1-----1 _____._ E I ' Outside: ❑Well House ❑At Grade Inside: y�i,Basement Offset 'h Mller , i _ ❑Pitless Adapter/Unit ❑Buried LJ Well Pit r 1 ❑Buried s ❑Well Pit ❑Other I 1 Mile---I ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Nate Downing D aa/p 5 // , Depth t Set in oversizeiz. o hole? Annular space initially grouted? Property owners mailing address if different than well location address Indicated above • f2 in.from 8 to 9( ft. 0 Yes ITN ❑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 r Well owners mailing address if different than property owner's address indicated above Screen from_ H9)OLE �� ' ft. Open Hole from to ft. OBSTRUCTIONS ,,��,,II ❑Rods/Drop Pipe ❑Check Valve(s) Ill Debris ❑Fill I�No Obstruction Type of Obstructions(Describe) �` GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP If notknown,indicate estimated formation log from nearby well or boring. Type aA-I6 j J 9V ❑Removed Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No 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 VARIANCE Was a variance granted from the MDH for this well? ❑Yes XNo TN# GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) r Grouting MateriayiAleiTLiFinF/-4 from to 9(1 ft. yards_ 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 XNo 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. nnn SI ty ola 74311 nrilling Co, . Inc_ 1591 Licensee Business Name License or Registration No. e died prase ativl� a Si. :turf.' r Certified Rep.No. Date " 34635351"-IVv. `d LOCAL COPY Name of Person Sealing Well or Boring ! HE-01434-14 ID#53159 f, 5/13R