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HomeMy WebLinkAboutWell/Boring Construction Record a - MINNESOTA UNIQUE WELL ELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 823471 Henn in Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 03 SW SW NW 153 tt. 6-16-17 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑ riven E]Auger otary House Number,Street Name,City,and ZIP Code of Well Location ❑Other Willow Dr S 55356 DRILLING FLUID...t WELL HYDROFRA Show exact location of well/boring in section grid ith'X:' Sketch map of well/boring location. bentonite From ft.To ft. Showing property lines, N roads,buildings,and direction. USE <Domestic ❑Monitoring M-JIV-tQc4liW ;_____i____ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑irrigation ibRONO --i-----'----- ---- EI vato Dewatering p� ❑ e r CI �1' W ; T l* CASING MATERIAL Drive Shoe?ng❑Yes ;No HOLE DIAM. Steel ❑Threaded ❑Welded ❑S 'h Mile Plastic 1 ❑ r CASING s DiaLmeter Weight Specifications n —1 Mile � � `'F in.To 145 ft. lbs./ft. 8 in.To-30. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 6k in.To 1551. in.To ft. lbs./ft. in.To ft. Not—Son, Trit- Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE e Make $dn From ft. To ft. 700 Mast Lake St, #213 Type Stainless Qtl Di . Wayzata, W 55391 slot/Gauze _ M0 Length 6t*4 f Set between ft.and ft. FITTINGS M STATIC WATER LEVEL Measured from 62 ft. elow ❑Above land surface Date measured — 16-17 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 140 ft.after 2 hrs.pumping 30 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ;WPitiess/adapter manufacturlIhitemter Model ❑Casing protection ;! Minnesota State Lab 'a bll+ar ID#Q � IIA Twin City Water Clinic Lab©ratory Test Report Wisconsinstatelaboratory`it?fi06�i1l11�° Wisconsin DNR Lab ID#399073400 Client: Don Stodola Well Drilling Report Number: 27-12318 Twin City Water Clinic Inc. Sample Collection Date: 10/10/17 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 16:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 10/11/17 Phone:(952)935-3556 Report Issue Date: 10/12/17 Fax:(952)935-5077 Laborato Analyte Cllent',ID ParametOr Sample Prep Sample Analysis lest =„ Sample ID 'bate `Tim gate _ TimesResp1 �� Uwlt 17-12318 Coliform Drinking Water 10/11/17 13:18 Absent Nitrate/N Drinking Water mg/L Arsenic Drinking Water pg/L Lead Drinking Water I pg/L mg/L e " ; Well No.: 823471 x No samples were subcontracted,or the abovetett�i x with`*""designation wereproduced bye uh�pn�tr, �,..�� Sample pt: well laboratory.'[Laboratory name;address41tF ' � n Well Adr: 500 Willow Drive South;Orono,MN subcontractedlaboratarymainlaln ��V "D 40trtili IodafiirtNe".' Owner: Nor-Sun Inc. fields)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 18°C Discussion: Notes: Approved methods.used ir► nalyzin{( Ltelta}i '# st above have the following reporting,levels- "� '�' � ��a M;Wmum'con ninarit teveis� SM92228-Coliform,l tfu%'10Q mi - �n Coliform-<1 du/100 mlNits"4 EPA 353.2-Nitrate;Nitrogen expresses as.N034 Nt Nitrogen 10.0 mg/L Arsenic,lOA SM3113B-Arsenic,2.0µg/l,Lead,2.0 µg-/L Lead,15 0µg/#. EPA 353.2-Nitrite NItro�en 10 mg/L Nitrite,1 mg/L i^ Y A" k ti yF n�i iit i Sample Collected by: X Client _TCWC Approved By: Bill Van Arsdale Laboratory Manager The results listed in this report apply only to the above listg 5atnple A routine quality assurance procedures were foltgwed unless other wfse ! . noted.This analyticsl report must be reported in its entirety,All methods ana Certified by the Minnesota Departmen#"of health,unless isth rwise noted. TCWD Rev 4.0 Page 1 of 1 Minnesota State LaboratoryID#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: 17-06996 Twin City Water Clinic Inc. Sample Collection Date: 06/18/17 617 13th Avenue South Address: 3841 N Main Street Sample Collection Time: 14:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 06/19/17 Phone: (952)935-3556 Report Issue Date: 06/21/17 Fax:(952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 17-06996 Coliform Drinking Water 06/19/17 12:16 Present 17-06996 Nitrate/N Drinking Water 06/19/17 12:55 <1.0 mg/L 17-06996 Arsenic Drinking Water 06/19/17 9:00 06/20/17 10:52 3.01 itg/L Lead Drinking Water Nitrite/N Drinking Water E.coli Drinking Water Well No.: 823471 X No samples were subcontracted;or the above test result(s) Sample t with"designation were produced by a subcontracted p p well laboratory. [Laboratory name;address;MDH Lab ID#]. The Well Adr: 500 Willow Drive S;Orono,MN subcontracted laboratory maintains MDH Certification forthe Owner: Nor-Son Inc. field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 18 `C Discussion: Notes: Approved methods used in analyzing the samples listed above have the following reporting levels Maximum contaminant levels: SM92226-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 SM31138-Arsenic,2.0 pg/1,Lead,2.0 µg/L Arsenic,10.0 L/L Lead,15.0 ug/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 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 355 217 Q Q WELL AND BORING SEALING RECORD Sealing No. County Name Minnesota Unique Well No. Minnesota Statutes,Chapter 1031 or W series No. Herme in Township Name Township No. Range No. Section No. Fraction(sm. Ig.) Date Sealed Date Well or Boring Constructed Ocono 11-- 23 03 1-311411 mt GPS LOCATION—decimal degrees(to four decimal places) j } C� Depth at Time of Sealing /+ • ft. Original Depth ft. Latitude Longitude AOUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer /�, / 500 Willow Dr S Grano, WELL/BORING Measured Date Measured ❑ stimated Water-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or b 'ri in section grid with"X:' ocation,showing grope ❑Env.Bore Hole ❑Other _ a y ft. below ❑above land surface N line�rds,and buildm s CASINGTYPE(S) Steel ❑Plastic ❑Tile ❑Other ---5-----t-- WELLHEAD COMPLETION RECEIVED W EOutside: 'Iess Adapter/Unit ❑At Grade Inside: ❑Basement Offset �A 'h Mile ❑Well Pit ❑Buried El Well House JAN `I 6 2018 T { ❑Other Ll Well Pit �1 Miley f ❑Buried❑Other CITY OF ORONO PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above 41 in.from to-/-2.5 ft. ❑Yes X No ❑Yes ❑No ❑Unknown 700 East Lake St in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown x`213 Wayzata, ININ. 55391 in.from to ft. ❑Yes [:1 No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE i Well owner's mailing address if different than property owner's address indicated above Screen from /- �.+ toja2 q _ft. Open Hole tram to ft. OBSTRUCTIONS ,! ❑Rods/Drop Pipe ❑Check Valve(s) El Debris E]Fill p[I No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL I COLOR HARDNESS OR FROM TO Obstructions removed? L1 Yes El No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. Not Present ❑Present,Removed Prior to Sealing E]Other U Type METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE Nc Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal Casing Diameter 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 wee f? Q Yes VNo TN# GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) �] Grouting Material/ e-� e-12- '-,-A from to,� 9 ft. yards t 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 YrNo 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. DIM STODM A WML TWILLI'', CO., IM. 1691 Licensee Business Name License or Registration No. -Z;� CvVhfdRbfi?esjntativ&S6nftne Certified Rep.No. Date LOCAL COPY H 352178 Name of Person Sealing Well or Boring HE-01434-15 ID#53159 _, visa