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Home My WebLink About08-07-19 Well & Boring Construction Recordee1e1e1c¢n7n r mint 1C IAre1 r WELL OR BORING LOCATION " MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORD 839622 Minnesota Statutes, chapter 1037 County Name Henn in Township Name Township No. Range No. Section No. (sm. —. Ig.) WELLBORING DEPTH (completed) DATE WORK COMPLETED Bran 117 1 23 ]Fraction 16 % NW NW NGTit] 110 8-7-19 GPS LOCATION —decimal degrees (to four decimal places). DRILLING METHOD Latitude Longitude ❑ Cable Tool ❑ Driven ❑ Dual Rotary ❑ Auger WRotary ❑ Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location f 1.600 Bohns Point Rd. Orono 55391 DRILLING FLUID WELL benton1 to From HYDROFRACTURED? [:]Yes )'No ft. To ft. Show exact location _;___ __! __ t t t t i of well/boring in section gid with "X" Sketch map of well/boring location. Showing property lines, N jj ��. roads, buildings, and direction. __ __ ___ __ ( j t f USE X Domestic ❑ Monitoring ❑ Heating/Cooling ❑ Noncommunity PWS ❑ Environ. Bore Hole ❑ Industry/Commercial ❑ Community PWS ❑ Irrigation ❑ Remedial E] Elevator E] Dewatering ❑ w f ~1 E T S k Mite ! > !� CASING MATERIAL Drive Shoe? ❑ Yes No ❑Steel ❑ Threaded ❑ elded Plastic HOLE DIAM. Q C 8 in. To50 ft. 6k in. T110 ft. CASING Diameter Weight Specifications [ T In. To IM ft. lbs./ft. in. To ft. lbs./(t. PROPERTY OWNER'S NAME/COMPANY NAME Nor -Son Inc. in. To ft. lbs./ft. in. To ft. SCREEN HOLE From ft. TO ft. Property owner's mailing address if differentOPEN than well location address indicated above. 1700 E lake St #2 13 TRayzata, M 55391 Make $m Type sta n ess steel Dia / Slot/Gauze .15 Length Jk� ♦ 4 t Set between —1j00 ft. and I ft. FITTINGS 2 - VII ISIMpli STATIC WATER LEVEL 4S ft. gBelow ❑ Above land surface Date measured Dry hole ❑ Yes eNo WELL OWNER'S NAMEICOMPANY NAME PUMPING LEVEL (below land surface) as ft. after hrs. pumping g p m Well/boring owner's mailing address if different than property owners address indicated above. WELLHEAD COMPLETION ❑ Pitless/adapler manufacturer Model ❑ Casing protection ❑ 12 in. above grade ❑ At -grade , Well House ❑ Hand Pump GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Matedal bent note From 0 To 50 ft. 3 E]Yds. )gSags Matedal CUt tinge From5 To 100 ft. [-]Yds. ❑ Bags Material From To ft. E] Yds. ❑ Bags Driven casing seal From To _Bags One bag = 94 lbs. cement or 50 lbs. bentonite r� GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO clay brawn medium 0 27 NEAREST KNOWN SOURCE OF CONTAMINATION ,., _ _.. Well is � feet / `� .direction from type Well disinfected upon completion? XYes [:]No clay gray medium 27 40 PUMP F-1Notinstalled Dale installed � � - � tgravel./sand ix meditEn 40 90 Manufacturer's name Model Number 2 HP ' � Volts a3o sand brown soft 90 110 Length of drop pipe t/ 3 ft. Capacity g.p.m Type: Submersible ❑ L.S. Turbine ❑ Reciprocating ❑ Jet ❑ ABA DONED WELLS Does property have any not In use and not sealed well(s)? [-]Yes o VARIANCE Was a variance granted from the MDH for this well? ❑ Yes Y No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet, if needed. 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. tst Co,,REMARKS, Don Stodola Well Trilling Ca Inc. 1691 ELEVATION, SOURCE OF DATA, etc. Licensee Business Name Lic. or Reg. No. 9-5-19 0,066ine ati ign ure Certified Rep. No. Date Rob Stodola LOCAL COPY 1839622 Name of Driller It) #b2fiu3 HE -01205-17 (Rev. 5/17) Minnesota State Laboratory ID# 027-053-119 Twin City Water ClinicLaboratory Test Report Wisconsin State Laboratory ID# 105-10117 Wisconsin DNR Lab ID #399073400 Client: Don Stodola Well Drilling Address: 3841 North Main Street St. Bonifacius, MN 55375 Report Number: 19-08476 Sample Collection Date: 08/08/19 Sample Collection Time: 17:00 Sample Receipt Date: 08/09/19 Report Issue Date: 08/12/19 Twin City Water Clinic Inc. 617 13th Avenue South Hopkins, MN 55343 Phone: (952)935-3556 Fax: (952)935-5077 Laborator Analyte Client ID Parameter Sample`Peep Sample Analysis Test Sample ID Date Time Date Time Results Units 19-08476 Coliform Drinking Water 08/09/19 14:22 Absent 19-08476 Nitrate / N Drinking Water 08/09/19 15:15 <1.0 mg/L 19-08476 Arsenic Drinking Water 08/09/19 8:20 1 08/12/19 11:21 11.10 Itg/L Lead Drinking Water µg/L Sample Conditions: Sample received on ice Discussion: Notes: Sample Temp: 3'C Sample Collected by: X Client _ TCWC Approved By: " 'r JY Hill Van Arsdale Laboratory Manager The results listed Inthis report apply only to the above listed samples: All routine quality assurance procedures were followed, unless otherwise noted. This analytical reportmust be reported in its entirety. All methods are certified by the Minnesota Department of Health, unless otherwise noted.. TCW D Rev 4.0 Page 1 of 1 Well No.: 839622 X No samples were subcontracted; or the above test result(s) Sample pt: WeII with'**' designation Were produced by a subcontracted laboratory, (Laboratory name; address;'MDH Lab'Ib#b The Well Adr: 1600 Bohns Point Road; Orono, MN subcontracted laboratory maintains MDH Certification for theO Ener: Nor -Son Inc. fields) oftesting performed: Owner Adr: Sample Conditions: Sample received on ice Discussion: Notes: Sample Temp: 3'C Sample Collected by: X Client _ TCWC Approved By: " 'r JY Hill Van Arsdale Laboratory Manager The results listed Inthis report apply only to the above listed samples: All routine quality assurance procedures were followed, unless otherwise noted. This analytical reportmust be reported in its entirety. All methods are certified by the Minnesota Department of Health, unless otherwise noted.. TCW D Rev 4.0 Page 1 of 1