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Home My WebLink About08-22-19 Well & Boring Construction RecordMINNESOTA UNIQUE WELL WELL OR Bt ,G LOCATION County Name _ MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORD ifenne in Minnesota Statutes, chapter 1031 839-595 Township Name Range No. Section No. Fraction (sm. —+ Ig.) WELUBORING DEPTH (completed) DATE WORK COMPLETED �Tb_wnshipNp. Orono L 117 23 02 NE '/,SW 238 GPS LOCATION — decimal degrees (to four decimal places). Latitude Longitude DRILLING METHOD ❑ Cable Tool W1 Driven ❑ Dual Rotary [:] Auger Rotary ❑ Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location 1390 Fox St. Orono 391 DRILLING FLUID , ! WELL ye bentonite From HYDROFRACTURED? ❑ Yes o ft. To ft. Show exact location of well oring in section grid N i__ __ __ --_;__ ith "X" Sketch map of well/boring location. Showing property lines. roads, buildings, and direction. USE Domestic ❑Monitoring ❑ Heating/Cooling jF ❑ Noncommunity PWS ❑Environ. Bore Hole ❑Industry/Commercial ___ __ ___ ___-__ ❑ Community PWS ❑ Irrigation ❑ Remedial ❑ Elevator ❑ Dewatering ❑ T � CASING MATERIAL Drive Shoe. Yes ❑ No Steel Threaded E] Welded HOLE DIAM. 'h Mile t ❑ Plastic ❑ __T -- -CASING ---'- '1 S ;---{ I Mile - �fn. To _ 22St. SLfl. � in. To Q 37/0.T.To 23$t. CASING Diameter qq Weight Specifications 4 in. To 225 ft. lbs./ft. in. To ft. lbs./ft. in. To ft. lbs./ft. ra r PROPERTY OWNER'S NAME/COMPANY NAME Elevation Fames SCREE OPEN HOLE From ft. To ft. Property owners mailing address if different than well location address indicated above. 18312 Minnetonka Blvd Wayzata, MM 55391 Make �� Type stainless steel Diam. 2" I' SloVGauze .010 Length49 .j 41 Set between ft. and 29 ft. FITTING ", "! STATIC WATER LEVEL ft. ;KBelowtr❑ Above land surface Date measured — Dry hole ❑ Yes XNo WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL (below land surface) x� 220 ft. after 3 hrs. pumping 40 g.p m Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ❑ 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 entoeite From 0 To 50 ft. 3 {, ❑ Yds. XBags Material Cutting From 50To 225 ft. ❑ Yds. ❑ Bags Material From To ft. ❑ Yds. ❑ Bags Driven casing seal From To Bags g -One ba 94 lbs. cement or 50 lbs. bentonite GEOLOGICAL MATERIALS COLOR FROM TO sandy clay broom LHARDNESSOF O 23 NEAREST KNOWN SOURCE OF CONTAMINATION 1 4+�3 �,z /J 1'. r'Well is Ji feet f' direction fromclay Well disinfected upon completion?Yes E] No clay/sand gray- gray soft 138 138 141 PUMPsandy 1 Q — Not installed Date installed 0 - Manufacturers name ) a Model Number HP Volts Length of drop pipe �QS ft. Capacity g.p.m clay redd brown soft 141 152 sandy clay n ;;ray tmt1,52 Ireedium C] 18 6 186 200 brown soft 2W 218 Type: XSubmersible ❑ L.S. Turbine ❑ Reciprocating ❑ Jet ❑ ABA DONED WELLS sticky shale C@ toe t]ITI sands -bone/ shale £;Cay hard 224 226 Does property have any not in use and not sealed well(s)? ❑ Yes No VARIANCE sandstone whitee soft 226 238 Was a variance granted from the MDH for this well? ❑ Yes XNo 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. - REMARKS, ELEVATION, SOURCE OF DATA, etc. Dan Stodola Well Drilling Co,. Toe. 1691 Licensee Business Name 1- or Reg. No. `tiff 'R presentative Signature Certified Rep. No. Date Rob Stodols LOCAL COPY 839595 Name of Driller ID #52603 HE -01205-17 (Rev. 5/17) Client: Don Stodola Well Drilling Report Number: 19-09210 Twin City Water Clinic Inc. Sample Collection Date: 08/22/19 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 11:00 Hopkins, MN 55343 St. Bonifacius, MN 55375 Sample Receipt Date: 08/26/19 Phone: (952)935-3556 Report Issue Date: 08/27/19 Fax: (952)935-5077 Coliform Drinking Water Nitrate / N Drinking Water mg/L 19-09210 Arsenic Drinking Water 08/26/19 10:00 08/27/19 13:47 4.82 µg/L Lead Drinking Water I Sample Conditions: Sample received on ice. Sample Temp: 5`C Discussion: Notes: Sample Collected by: X Client _ TCWC Approved By:� r - Bill Van Arsdale Laboratory Manager TCWD Rev 4.0 Page 1 of 1 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: 20-00301 Sample Collection Date: 01/08/20 Sample Collection Time: 9:30 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 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units . 20-00301 Coliform Drinking Water 01/09/20 12:46 Absent 20-00301 Nitrate / N Drinking Water 01/09/20 12:54 <1.0 mg/L Arsenic Drinking Water µg/L Lead Drinking Water µg/L Well No.: 839595 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: 1390 Fox St; Orono, MN subcontracted laboratory maintains MDH Certification for the . Owner: Elevation Homes 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 foil wing reporting levels: Safe Drinking Water Act. The analyzed parameters have following SM9222B - Coliform, 1 cfu / 300 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 pg/ 1 Arsenic, 10.0 µg / L' Lead' 15.0 µg / L I EPA 353.2 -Nitrite Nitrogen, 1.0 mg/L. Nitrite, 1 mg/L For further 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:��:� h' 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