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Home My WebLink About10-11-19 Well & Boring Construction RecordMINNESOTA UNIQUE WELI WELL OR BORING -OCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORD _ County Name r Ifennenin Minnesota Statutes, chapter 1031 839620 Township Name Township No. Range No. Section No. Fraction (sm. —+ Ig.) WELUBORING DEPTH (completed) DATE WORK COMPLETED P y n_10-11-19 GPS LOCATION — decimal degrees (to four decimal places). Latitude Longitude DRILLING METHOD ❑ Cable Tool ❑ Driven ❑ Dual Rotary ❑ Auger Rotary ❑ Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location 799 Old Crystal Fay Rd, Orono 55391 DRILLING FLUID WELL HYD,ROFRACTURED? ❑ Yes 7No water Fro ft. To ft Show exact location of well/boring in section grid with 'X.' Sketch map of well/boring loc i . Showing property I as, N roads, buildings, and dire M) USE Domestic E]Monitoring ❑ Heating/Cooling ❑ Noncommunity PWS ❑ Environ. Bore Hole ❑ Industry/Commercial - E] Community PWS I-] E] Remedial w T �—t Mile :__ E 33 h tone s _� Elevator ❑ Dewatering El E] ASING MATERIAL Drive Shoe? ❑ Yes /y�� No Steel Threaded Welded ❑❑ Plastic ❑ ❑ HOLE DIAM. in. To SQt. in. To 125, CA SING Diameter 7 Weight Specifications 4 in. To 11l ft. Ibs./ft. in. To ft. lbs./ft. PROPERTY OWNER'S NAME/COMPANY NAME Streeter his Assoc. in. To ft. Ibs./ft. in. To ff. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make 18312 Minnetonka Blvd Dee haven M 55391 Deephaven, From fl. To ft. Type stainless steel Diann., Slot/Gauze .1() Length f 41 ' Set between ft. and h. FITTINGS h f 1pqelpr STATIC WATER LEVEL ft. X Below E] Above land surface /� Date measu 1ed'"(}.1117 Dry hole ❑ Yes No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL (below land surface) 105 ft. after 3 hrs. pumping 50'f g.p.m. WelUboring owner's mailing address if different than property owners address indicated above. W LLHEAD COMPLETION Whitewater Pitless/adapter 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) Material entOnit%om To 50 ft. 3 ❑ Yds. XBags Material CUt t in.,4S From _To 111 ft. ❑ Yds. ❑ Bags Material From To ft. ❑ Yds. ❑ Bags Driven casing seal From To _Bags One bag = 94 lbs. cement or 50 lbsbentonite -GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO NEAREST KNOWN SOURCE OF CONTAMINATION Clay brown medium 0 p 1$ Well is .4feet Aj t -i direction from '"0type Well disinfected upon completion? XYes ❑ No clay/sand gray mediuj 18 96 PUMP ❑ Not installed Date installed 11-6xm 9 Manufacturer's name Schaefer Model Number HP 5 Volts 230 Length of drop pipe ft. Capacity 9 -p.m sandy ealy brown soft 96 1103 sand grown soft 103 125 Type: oSubmrsible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes YNo VARIANCE Was a variance granted from the MDH for this well? ❑ Yes No 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. Don Stodala Vell Drilling Co,. Inc. 1691 Use a second sheet, it needed. REMARKS, ELEVATION, SOURCE OF DATA, etc. Licensee Lic. or Reg. No. ��Bu/sinessa 12-5-19 rtifi Representative Signature Certified Rep. No. Dale Rob Stodola LOCAL COPY �839625 Name of Driller ID #52603 1C -U ICVYIf \(IBV. O/IlJ 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 Address: 3841 North Main Street St. Bonifacius, MN 55375 Report Number: 19-11332 Sample Collection Date: 10/13/19 Sample Collection Time: 14:00 Sample Receipt Date: 10/14/19 Report Issue Date: 10/16/19 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 Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 19-11332 Coliform Drinking Water 10/14/19 12:55 Present 19-11332 Nitrate / N Drinking Water 10/14/19 13:57 <1.0 mg/L 19-11332 Arsenic Drinking Water 10/14/19 12:40 10/15/19 13:05 11.50 119/1- g/LLead Lead Drinking Water µg/L Nitrite/N Drinking Water mg/L E. coli Drinking Water K No samples were subcontracted; or the above test result(s) Well No.: 839625 `vith"" designation were produced by a subcontracted Sample pt: Well laboratory, (Laboratory name; address; MDH Lab ID#I. The Well Adr: 799 Old Crystal Bay Road; Orono, MN subcontracted laboratory maintains MDH Certification for the Owner: Streeter & Associates field(s) of testing performed. Owner Adr: pie Conditions: Sample received on ice. Sample Temp: 6°C Discussion: Notes: Sample Collected b : X Client TCWC p y _ Approved By: Bill Van Arsdale Laboratory Manager TCWC Rev 7.0 (9/19) Page 1 of 1 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: 20-00307 Sample Collection Date: 01/08/20 Sample Collection Time: 9:00 Sample Receipt Date: 01/09/20 Report Issue Date: 01/10/20 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 AnalysisTest Sample ID 799 Old Crystal Bay Rd; Orono, MN Date Time Date Time Results Units 20-00307 Coliform Drinking Water 01/09/20 12:52 Absent Nitrate / N Drinking Water mg/L Arsenic Drinking Water µg/L Lead Drinking Water µg/L (Sample Conditions: Sample received on ice. Sample Temp: 6°C Discussion: Notes: Approved methods used in analyzing the samples, listed above have the MCL is defined as the Maximum contaminant Level allowed by the following reporting levels: Safe Drinking Water Acta The analyzed parameters have following'; SM92229 - Coliform,1 cfu / 100 ml MCL: EPA 353.2 - Nitrate Nitrogen expressed as NO3+ NO2,1.0 mg'/ L Coliform, < 1 cfu /100 ml Nitrate Nitrogen, 10.0 mg/L' SM3113B - Arsenic, 2.0 µg / L, Lead, 2.0 µg/ L Arsenic,.10.0 11g / L Lead, 15.0 Vg / L EPA 353.2 - Nitrite Nitrogen, 1.O mg/L Nitrite, 1 mg/L Forfurther information call your state health department or call the EPA Safe Drinking Water Hotline 1-800-426-4791. 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. TCWC Rev 7.0 (9/19) Page 1 of 1 Well No.: 839625 X No samples were subcontracted; or the above test results) with'**' designation were produced by a subcontracted Sample pt: well laboratory". {laboratory name; address; MDH Lab ID#], The Well Adr: 799 Old Crystal Bay Rd; Orono, MN subcontracted laboratory maintains MDH Certification forthe '- Owner: Streeter field(s) of testing performed. Owner Adr: (Sample Conditions: Sample received on ice. Sample Temp: 6°C Discussion: Notes: Approved methods used in analyzing the samples, listed above have the MCL is defined as the Maximum contaminant Level allowed by the following reporting levels: Safe Drinking Water Acta The analyzed parameters have following'; SM92229 - Coliform,1 cfu / 100 ml MCL: EPA 353.2 - Nitrate Nitrogen expressed as NO3+ NO2,1.0 mg'/ L Coliform, < 1 cfu /100 ml Nitrate Nitrogen, 10.0 mg/L' SM3113B - Arsenic, 2.0 µg / L, Lead, 2.0 µg/ L Arsenic,.10.0 11g / L Lead, 15.0 Vg / L EPA 353.2 - Nitrite Nitrogen, 1.O mg/L Nitrite, 1 mg/L Forfurther information call your state health department or call the EPA Safe Drinking Water Hotline 1-800-426-4791. 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. TCWC Rev 7.0 (9/19) Page 1 of 1