HomeMy WebLinkAbout04-30-2019 Well & Boring Construction Recordr
AAIAIAIFQr) IIAII(II IF IA/FI I
WELL OR BORING LOCATION
MINNESOTA DEPARTMENT OF HEALTH
WELL AND BORING CONSTRUCTION RECORD
AND BORING NO.
County Name- -
Hennepin
Minnesota Statutes, chapter 1031
839620
Township Name
Township No.
Range No.
Section No.
Fraction (sm. — Ig.)
WELLIBORING DEPTH (completed)DATE
WORK COMPLETED
I
152
403019
Orono
117
23
06
SW SW SW,/,
GPS LOCATION — decimal degrees (to four decimal places).
DRILLING METHOD
Latitude Longitude
❑ Cable Tool ❑ riven ❑ Dual Rotary
❑ Auger _at. Rotary E]Rotasonic
E]Other r
House Number, Street Name, City, and ZIP Code of Well Location
471 O to St Q� 555 "
/ 7V`lSketch
DRILLING FLUID
t� bentonite WELL
bentonite
HYDROFRACTURED? ❑ Yes No
Show location
"X.""
in map of welWoring I f n.
exact
of well/boring section grid with
Showing proper!_, s,
-, x roads, bu'I ' nd dir n.
N /'
From
fl. To ft.
USE Domestic ❑Monitoring ❑Heating/Cooling
__ ___ __ 5z_
❑ Noncommunity PWS ❑ Environ. Bore Hole ❑ Industry/Commercial
_j___ __i__
__
��
❑ Community PWS ❑ Irrigation ❑ Remedial
❑ Elevator ❑ Dewatering ❑
W
E j
CASING MATERIAL Drive Shoe? ❑ Yes No
Steel ❑ Threaded ❑ Welded
HOLE DIAM.
❑
h Mile
XPlaslic ❑
Ts
- -:-1
CASING
Diameter Weight Specifications
4 142,
8 Soft.
�— t Moe
in. To lbs./ft.
in. To ft. lbs./ft.
in. To
6'y in. To 152fI.
PROPERTY OWNER'S NAME/COJvIPANY NAME
Ham" q
H
Norton '
in. To ft. lbs./ft.
in. To ft.
SCREEN
n
OPEN HOLE
Property owner's mailing address i different than well location address indicated above.
1.8215 45th Ave N, Ste T)
Make
From ft. To ft.
Type stainless Steel Diam.
Plymouth, M 55446
Slot/Gauze .010 Length 41 + 41
Set between_ ft. and FITTINGS R t
STATIC WATER LEVEL ft."XBelow ❑ Above land surface
4-3-19
Date measured Dry hole ❑Yes No
WELL OWNER'S NAME/COMPANY NAME
PUMPING LEVEL (below land surface)
ITS ft. after 2 hrs. pumping Ail g.p.m
Well/boring owner's mailing address if different than property owner's address indicated above.
WELLHEAD COMPLETION Whitewater
Pitless/adapter manufacturer Model
❑ Casing protection 112 in. above grade
❑ At -grade [:]Well House [:]Hand Pump �`'
GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other)
Material bentoniteFrom 0 T 50 ft. 3 ❑Yds. YBags
Material cuttinAS From 50 To 142 ft. [_]Yds. ❑Bags
Material From To ft. ❑ Yds. E] Bags
HARDNESS OF
GEOLOGICAL MATERIALS
COLOR
MATERIAL
FROM
TO
One 94 s. cement
Driven casing seal From To _Bags bag =
or 5f) lbs. ben orate
NEAREST KNOWN SOURCE OF CONTAMINATION
c lay
medium
_
Welt is 7 feet El direction from type
Well disinfected upon completion? Yes ❑ No V.
—brown
PUMP
6�1 S-1
q lay
ray
medium
F-1NotInstalled Date installed
ravel San
mix
Manufacturer's name Schaefer
1
Model Number HP 1.0wts 230
r a
line sand
1.
brown
soft
97
Length of drop pipe 126 ft. Capacity g.p.m
Type -)(Submersible E]L.S. Turbine [-]Reciprocating C-]JetE]Sand
rSV@1
Mix
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes No
VARIANCE
_
Was a variance granted from the MDH for this well? ❑ Yes No TN#
WELL CONTRACTOR CERTIFICATION OF
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, if needed.
REMARKS, ELEVATION, SOURCE OF DATA, etc.
Dnn Stodola well Drillin Co,. Inc. 169
Licensee Business Name Lic. or Reg. No.
6-19-19
Representative ignature Certified Rep. No. Date
er ed
Rob Stodola ,
I
LOCAL COPY
83962 0
Name of Driller
IV ifOZOui
Client: Don Stodola Well Drilling
Report Number:
19-09641
l
Twin City Water Clinic Inc.
Absent
Sample Collection Date:
09/03/19
Drinking Water
617 13th Avenue South
Address. 3841 North Main Street
Sample Collection Time:
12:54
;Owner:
Hopkins, MN 55343
St. Bonifacius, MN 55375
Sample Receipt Date:
09/03/19
Lead
Phone: (952)935-3556
Drinking Water
Report Issue Date:
09/04/19
µg/�
Fax: (952)935-5077
19-09641 1 Coliform
Well No.:
Drinking Water
x No samples were Subcontracted, or the"above test result($) .
09/03/19 14:46
Absent
19-09641 Nitrate / N
Sample pt:
Drinking Water
laboratory., [Laboratory name; oddress; MDN b, 0#].Jhe
09/04/19 12:53
<1.0 mg/L
19-09641 Arsenic
;Owner:
Drinking Water 09/03/19
13:44
09/04/19 13:59
2.32 µg/L
Lead
Owner Adr:
Drinking Water
µg/�
Sample Conditions: Sample received on ice. Sample Temp: 16 °C
Discussion:
Notes:
Sample Collected by: X Client _TCWC Approved By:
Bill Van Arsdale
Laboratory Manager
TCWD Rev 4.0 Page 1 of 1
Well No.:
839620
x No samples were Subcontracted, or the"above test result($) .
7.
with"*�'desgnation Were produced by a'subcohtracted
Sample pt:
Well
laboratory., [Laboratory name; oddress; MDN b, 0#].Jhe
Well Adr:
4710 Augusta Street; Orono, MN
subcontracted laboratory maintains, DH Certificatfon for the ,
;Owner:
Norton Homes
field($) of testmg'perfotmec):
Owner Adr:
Sample Conditions: Sample received on ice. Sample Temp: 16 °C
Discussion:
Notes:
Sample Collected by: X Client _TCWC Approved By:
Bill Van Arsdale
Laboratory Manager
TCWD Rev 4.0 Page 1 of 1