The URL can be used to link to this page

Home My WebLink About09-24-19 Well & Boring Construction RecordMINNF.St7TA IINIt71 IF WFI I WELL OR BORING _OCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORDg 4 4 7 81 County Name Hennep in Minnesota Statutes, chapter 1031 Township Name Township No. Range No. Section NqW raction (sm. —. Ig.) WELLIBORING DEPTH (completed) DATE WORK COMPLETED Orono 118 23 ,/Sr4F SF 194 .t. 9-24-19 GPS LOCATION — decimal degrees (to four decimal places). DRILLING METHOD Latitude Longitude ❑ Cable Toolriven ❑ Dual Rotary .Rotary ❑ Auger ❑ Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location 50 Cristofori Cr1 Orono 55359 DRILLING FLUID bentoni WELL HYDROFRACTURED? ❑ Yes Lj No e From ft. To Show exact location of well/boring in section grid w' "X" Sketch map of well/boring location. Showing property lines, USE Domestic ❑Monitoring E]Heating/Cooling N �� roads, buildings, and direction. ;___ __i__ __ __ ___;__ ❑ Noncommunity PWS ❑ Irrigation E]Industry/Commercial E] Community PWS E] Dewatering E] Remedial --i--- 4-- ---� ------ t-- - ❑ Elevator W E ---, ❑s o CASING MATERIALDrive Shoe? ❑ YeThreaded Welded ❑ HOLE DIAM. T Mile - I �teel lastic ❑ CASING 1 S Diamgte4r ,fprc7J Weight Specifications 8 50—i Miley (� in. To ft. lbs./ft. f. in. To. 10 To ft. lbs./ft. in. To ft. PROPERTY OWNER'S NAME/COMPANY NAMEin. Alexa Hansen in. To ft. lbs./ft. in. To ft. h o cgr} OPEN HOLE SCREE ftm Property owner's mailing address if dilferent than well location address indicated above. Make _5tai1es_steel From w ft. To ft. Type 1 Diam. SIOVGauze Length Set betweenft. and ft7 FITTINGS X STATIC WATER LEVEL 82 ft. elow El Above land surface A 9-24-19 Date measured Dry hole ❑ Yes LfNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL (below land surface) 180 3 30 ft. after hrs. pumping g.p.m. Well/boring owners mailing address if different than property owner's address indicated above. V LHEAD COMPLETION Pi Pilless/adapter manufacturer hVel ❑ Casing protection 12 in. above grade ❑ At -grade ❑ Well House ❑ Hand Pump GROUT I ORMATION ecify benlonit ement-s neat -cement, rete, cuttings, or oth ) "enton�e i� Malarial tZ From 1:n ❑Yds. Bags Material cutFrom To ft. ❑ Yds. ❑ Bags Material From To ft. E] Yds. ❑ Bags HARDNESS OF GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Drivencasing sea] From To Onebag=94lbs.cement _Bags or 50 lbs. bentonite KNOI�(JJ SOURCE OF CONTAMINQTJON 0 {� claybrown neditma Wallfeet direction from type upon completion? as ❑ No T6pump clay gray medium 32cted cla /<_�ravel brown medium 43claay7, 1alled -ray, mie um Date in- isand cla ?r3y soft 1 80 9 Manufacturer's name course gravel rix radium 92 IM /fine snag clay/fine r1 ray medium 103 17' Model Number HP Volts— oltscla Length of drop pipe ft. Capacityg.p.m gravel, course eqnd MMX mdi-Lyn 178 19 Type:ubmersible ❑ L.S.Turbine E] Reciprocating E] Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes E4 VARIANCE Was a variance granted from the MDH for this well? [:]Yes Elo 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, i/ needed. T Don Stodoia tdell Drilling Co,. TnC. 1691 REMARKS, ELEVATION, SOURCE OF DATA, etc. Licensee Business N e or Reg. No. p�Lic. 3 M-8-19 C epresentative gibnature Certified Rep. No. Date Rob Stodola LOCAL COPY 844781 Name of Driller ID #52603 Ht-Ulzuo-10 (N6v.J/18) Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID# 027-053-119 Wisconsin state Laboratory ID# 105-10117 Wisconsin DNR Lab ID #399073400 Client: Address: Don Stodola Well Drilling 3841 North Main Street St. Bonifacius, MN 55375 Report Number: 19-10592 Sample Collection Date: 09/25/19 Sample Collection Time: 14:00 Sample Receipt Date: 09/26/19 Report Issue Date: 09/27/19 Twin City Water Clinic Inc. 617 13th Avenue South Hopkins, MN 55343 Phone: (952)935-3556 Fax: (952)935-5077 LaboratorV Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 19-10592 Coliform Drinking Water 09/26/19 13:32 Absent 19-10592 Nitrate / N Drinking Water 1 09/26/19 13:57 <1.0 mg/L 19-10592 1 Arsenic Drinking Water 09/26/19 9:45 09/27/19 12:06 5.61 pg/L Lead Drinking Water pg/L Drinking Water mg/L Drinking Water X No samples were subcontracted; or the above test result(s) Well No.: 844781 with'"' designation were produced by a subcontracted Sample pt: well laboratory. [Laboratory name; address; MDH Lab'ID#]. The Well Adr: 50 Cristofori Circle; Orono, MN subcontracted laboratory maintains MDH Certification for the ' Owner: Alexa Hansen field(s) of testing performed. Owner Adr: Sample Conditions: Sample received on ice. Sample Temp: 4°C Discussion: Notes: Sample Collected by: X Client _ TCWC Approved By: ' Bill Van Arsdale Laboratory Manager TCWC Rev 7.0 (9/19) Page 1 of 1 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I I % f -i (� WELL OR BORING LOCATION Sealing No. ( U U 42 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. " Minnesota Statutes, Chapter 1031 torm Uank w r W s r esNol %armepin Township game Township No. Range No. Section No. Fraction (sm. -+ Ig.) Date Sealed Date Well or Boring Constructed 923 1 31 r C GPS LOCATION - decimal degrees (to four decimal places)IF Depth at Time of Sealing , 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 ❑ Mulliaquifer W LL/BORING )tfAeasured Date Measured f1 %i% 1)A W ❑ Estimated d Cristofori Crl prow 5 359 Water -Supply Well ❑ Env. Well Show exact location of well or boring Sketch map of well or boring in section grid with "X:' location, showing property ❑ Temp. Env. Well ❑ Other ft. Wbelow ❑ above land surface N line; r�,As, and buildings. CASINGTYPE(S) y ❑ Steel Plaslic E]Tile ❑ Other i--- --i f WELLHEAD COMPLETION W ET r Outside: XPitless Adapter/Unit ❑ At Grade Inside: El Basement Offset r f le `- Well Pit ❑ Burled a ,k MiHouse _ - --�--- --�--- -- �-- ---%- El Well Pit n Other_ S Jj —t Milan 0-)y �r�"Y,atj For multiple temporary environmental wells, provide additional location information, a site sketch, and geology on a separate page. L] Buried ❑ Other CASING(S) Di er / Depth Set in oversize hole? Annular space initially grouted? m. from_ to �J ft. ❑Yes iNo ❑Yes ❑ No ❑Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown PROPERTY OWNER'S NAME/COMPANY NAME Property owner's mailing address if different than well location address indicated above SCREEWOPEN HOLE 0 Screen from i05 to / 6 ft. Open Hole from to p. WELL OWNER'S NAMEICOMPANY NAME OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill Wlo Obstruction Type of Obstructions (Describe) Obstructions removed? ❑ Yes ❑ No Describe Well owner's mailing address If different than property owner's address indicated above PUMP Present, Removed Prior to Sealing Other /t �fdot Present ❑ g ❑ Type GEOLOGICAL MATERIAL COLOR HARDNESS OR FORMATION FROM TO If not known, indicate estimated formation log from nearby well or boring. 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 asing 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 well? ❑ Yes No TNN GROUTING MATERIAL(S) (One bag of cement = §4 lbs., one bag of bentonite = 50 lbs.) Grouting Material,A/KQri5cof"L//from d to/ ft_ yards bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS 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 3todola Well Drilling Co,. Inc. 1691 REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING Licensee Busines 11Name License or Registration No. � / - t% ' 1 e rdsentati ig a ure Certified Rep. No. Date fn LOCAL COPY H�j r/1 HU 7 0 0 `y' L Name of Person Sealing Well or joring