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Home My WebLink AboutWell Boring & SealingMINNFROTA I1N1011FWF11 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORDg 4 4 7 91 County Name Hennepin Minnesota Statutes, chapter 1031 Township Name Township No. Range No. Section No. Fraction (sm. —. Ig.) WELL/BORING DEPTH (completed) DATE WORK COMPLETED Orono 117 23 06 S�' S'�;? Sw,, 14p a 11-3-19 GPS LOCATION — decimal degrees (to four decimal places). Latitude Longitude DRILLING METHOD ❑ Cable Tool ❑ riven ❑ Dual Rotary ❑ Auger otary ❑ Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location Pineblirst 55364 DRILLING FLUID WELL bentonite From HYDROFRACTURED? ❑ Yes o ft. To ft. Show exact location of well/boring in sec on gri wit Sketch map�f well ring location. ,e hb perly lines, N ✓�= ^^ a "�- ad dirept ! SE Domestic ❑ Monitoring -" ❑ Heating/Cooling y¢ 0 `r ❑ Noncommunity PWS ❑ Irrigation ❑ Industry/Commercial ❑ Community PWS ❑ Dewatering ❑ Remedial ❑ Elevator ❑ w a E T 1� I'� CASING MATERIAL Drive Shoe? ❑ Yes o Q Steel E] Threaded ❑Welded HOLE DIAM. , k Mile l S �— t Mile Plastic ❑ in.To-%)t. 6, in. To 1 -01. CASING Diameter Weight Specifications 4 in. To 140 ft. IbsJft. in. To ft. lbs./ft. PROPERTY OWNER'S NAME/COMPANY NAME Nn r t in. To ft. tbs./ft. in. To ft. SCREEN OPEN HOLE From ft. To ft. Property ownermailing address ddress if different than well location address indicated above. Make Johnson 18215 45th Ave N. Ste D Type stain1pan stl Diarn7~ ly-mouth , tiw 55446 Slot/Gauze -15 Length 41 * 4# Set between =14so= ft. and ft. FITTINGS STATIC WATER LEVEL ft. E] Below ❑ Above land surface n Date measured 11-3-19 Dry hole ❑ Yes ;6No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL (below land surface) 135 ft. after 2 hrs. pumping 35 Q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION 1 itless/adapter manufacturerModel ❑ Casing protection ;K12 In. above grade ❑ At -grade ❑ Well House ❑ Hand Pump GROUT I FORMATIO (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) neqan Material t 0 To ---Q ft. 3 ❑ Yds. Bags Material bet t_ inL�g_From-50—T-. 140 ft. ❑ Yds. ❑ Bags Material From To ft. [jYds. E]Bags Driven casing seal From To Bags One bag = 94 lbs. cement or 50 lbs. bentonite GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO topsoil black medium 0 5 NEAREST KNOWN SOURCE OF CONTAMINATION _ Y Well is feet 1t/ direction from type Well disinfected upon completion? JKYes ❑ No lay/sand brown merlium 5 15 PUMP E] Not installed Date Installed1,21 Clay ;)ray rfledium 15 37 Manufacturer's name vone Model Number HP�� Length of drop pipe ft. Capacity 9 -p.m r_1ay/sanfl dray Soft 37 66 sand i'nIx soft 66 87 Type: YSubmersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS `ine senrj 11rown medium 47 108 Does property have any not in use and not seated well(s)? ❑ Yes o VARIANCE sa 0/ ravel lix Mel iur i 100 150 Was a variance granted from the MDH for this well? E] Yes o TN# WELL CONTRACTOR CERTIFICATION Use a second sheet, it 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. Don Stodola Well Drilling Co. Inc. 1691 REMARKS, ELEVATION, SOURCE OF DATA, etc. Licensee Business Name Lic. or Reg. No. APR 0 3 2020 11-4-19 Cg I'' se to ive S gri " f Certified Rep. No. Date •Rob5torlo1a LOCAL COPY 844791 Name of Driller ID #52603 nwtiwao to d,. u) Twin City Water Clinic Laboratory Test Report Minnesota State LaboratoryID# 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: 19-12019 Sample Collection Date: 11/03/19 Sample Collection Time: 14:00 Sample Receipt Date: 11/04/19 Report Issue Date: 11/06/19 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 19-12019 Coliform Drinking Water 11/04/19 13:02 Present 19-12019 Nitrate / N Drinking Water 11/04/19 12:33 <1.0 mg/L 19-12019 Arsenic Drinking Water 11/04/19 9:30 11/05/19 10:39 <2.0 1 µ9/L Lead Drinking Water µg/L X No samples were subcontracted; or the above test result(s) with'"' designation were produced by a subcontracted laboratory. [Laboratory name; address; MDH Lab ID#]. The subcontracted laboratory maintains MDH Certification for the field(s) of testing performed. Sample Conditions: Sample received on ice. Discussion: Notes: Well No.: 844791 Sample pt: well Well Adr: 690 Pinehurst Court; Orono, MN Owner: Norton Homes Owner Adr: Approved methods used in analyzing the samples listed above have the following reporting levels: SM9222B - Coliform, 1 cfu / 100 ml EPA 353.2 - Nitrate Nitrogen expressed as NO3+ NO2, 1.0 mg / L SM3113B - Arsenic, 2.0 pg / L, Lead, 2.0 pg/ L EPA 353.2 - Nitrite Nitrogen, 1.0 mg/L Sample Temp: 5°C MCL is defined as the Maximum Contaminant Level allowed by the Safe Drinking Water Act. The analyzed parameters have following MCL: Coliform, < 1 cfu /100 ml Nitrate Nitrogen, 10.0 mg/L Arsenic, 10.0 pg / L Lead, 15.0 pg / 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: 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 Minnesota State Laboratory ID# 027-053-119 Twin City Water Clinic Laborator' Test Report Wisconsin 50te.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: 20-00306 Sample Collection Date: 01/08/20 Sample Collection Time: 9:45 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 AnalysisTest Sample IDDate Time Date Time Results Units 20-00306 Coliform Drinking Water 01/09/20 12:51 Absent Nitrate / N Drinking Water mg/L Arsenic Drinking Water µg/L Lead Drinking Water pg/L Well No.: 844791 X No samples were subcontracted; or the above test results) with'**' designation were'produced by a_subcontractetl Sample pt: Well laboratory. [Laboratory name; address; MDH Lab ID#]..The Well Adr: 690 Pinehurst Ct; Orono, MN subcontracted laboratory maintains MDH Certification forthe Owner: Norton Homes field(s) of testing performed. Owner Adr: Sample Conditions: Sample received on ice. Discussion: Notes: SM3113B - Arsenic, 2.0 µg / L, Lead, 2.0 pg/ L EPA 353.2 - Nitrite Nitrogen, 1.0 mg/L Sample Temp: 6°C r < 1 cfu /100 ml , N 10.0 pg / L Li 1 mg/L her information tali yo e Drinking Water Hotlir Sample Collected by: X Client —TCWC Approved By: L/ 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