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Home My WebLink AboutWell Boring & SealingMINNESOTA UNIQUE WELL -1A1-00TA DEPARTMENT AF MFGI T14 AND BORING NO. WELL OR BORING LOCATION WELL AND BORING CONSTRUCTION RECORD 9 County Name Minnesota Statutes, chapter 10.31 [-77:8:4:4 7 9=9 Henne' in Township Name Township No. Range No. Section No. Fraction (sm. — Ig.) WELUBORING DEPTH (completed) WORK COMPLETED Orono 117 7,3 I 10 +�,': `�� "1�u ]DATE 181 n 12 -27-1Q GPS LOCATION — decimal degrees (to four decimal places). DRILLING METHOD ❑Cable Tool ❑Driven L] Dual Rotary Longitude Latitude g ❑ Auger ;-Rotary (] Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location 1QS0 F3erita�,e Lane Orono 55391 DRILLING FLUID bentonite WELL HYDROFRACTURED? ❑Yes o From ft. To ft. Show exact location of we oring in section grid with "X:' Sketch map of welVboring location. Showing property lines, USE Domestic E]Monitoring ❑ Heating/Cooling roads, buildings, and direction. N y� ❑ Noncommunity PWS ❑Irrigation ❑Industry/Commercial --'--- ---`-- ---`-- ---`-- �/T %� ❑ Community PWS ❑Dewatering E] Remedial _ E j� • ❑ Elevator El CASING MATERIAL Drive Shoe? ❑ Yes *0 HOLE DIAM. W , /_„}f{/ M ' tle ❑ Steel E]Threaded ❑ Welded El/z XpIastic -- ---- ---�-- 1 --!--- - T-- CASING Diameter Weighs Specifications s in. To 1771 ft. lbs./ft. �_. in. To S()Lft. 1 Mile{ in. To ft. Ibs./ft. in. To ft. Ibs./OPEN ��11 � p� S r in. Tot " 1 ft. in. To ft. PROPERTY OWNER'S NAME/COMPANY NAME .,Inst Bay tomes Inc • HOLE SCREEN From it. To ft. Property owner's mailing address if different than well location address indicated above. 1(3425 Bluff Rd Make s $ e9s S f'e Diam. ellen Prairie, '`ti+T 55347 Type r + Slo'/Gauze • Length Set between Z]ft. and 1 R1 ft. FITTINGS 7 �leads r STATIC WATER LEVEL %►% ft. Below ❑Above land surface Date measured 12-27-19 Dryhole ❑ Yes K'No WELL OWNER'S NAMEICOMPANY NAME PUMPING LEVEL (below land surface) i 50 ft. after 2 hrs. pumping 40 9 -P.M. Welllboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION wpilless/adapter manufacturer MiteWHter Model ❑ Casing protection K12 in. above grade ❑ At -grade ❑ Well House ❑ Hand Pump GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Material be4g4)njtoFrom_To---50- ft. 3 ❑ Yds. ®'Bags Material .,, tl� �_ r�From.____5jq__T0_ _j_7_jft. E] Yds. ❑Bags Material ------From— To ft. ❑ Yds. ❑ Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TOOne bag = 94 lbs. cement Driven casing seal From To _Bags or 50 lbs. bentonite NEAREST KNOWN SOURCE OF CONTAMIN,A(TIIOON clay/gravel brown .t mef tum n n 12 lr from l�1 JJ type Well is feet direction Well disinfected upon completion? )Yes ❑ Noe�- ctay 6ray sandy clay reddish PUMP ❑Not installed Dale installedI-PY-20 Schaefer fine sand brmm ' mef ltrn ., qr 10q Manufacturers name sandy clay/gravel reddish ._ 121 Model Number HP_I-,5- _Volts Length of drop pipe ft. Capacity 9•P•m Zravel/san,i brmin Tvlivm 171 182 Type:J<Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED 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 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, it needed. Pon Stodola Well Drilling Co., Inc. 16q1 REMARKS, ELEVATION, SOURCE OF DATA, etc. _ Licensee Business Name Lic. or Reg. No. ,9/1,l.rte APR p 3 202 resetur Certified Rep. No. Date Stodola 9Rob LOCAL COPY 8 4 4 7 9 Name of Driller HE -01205-18 (Rev.3/19) ID #52603 K No samples were subcontracted; or the above test result(s) with" designation were produced by a subcontracted laboratory. [Laboratory name; address; MDH Lab ID#j. The subcontracted laboratory maintains MDH Certification for the field(s) of testing performed. Sample Conditions Discussion: Notes: Sample received on ice. Well No.: 844799 Sample pt: well Well Adr: 1080 Heritage Lane; Orono, MN Owner: West Bay Homes Inc. Owner Ad r: 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 µg / L, Lead, 2.0 pg/ L EPA 353.2 - Nitrite Nitrogen, 1.0 mg/L Sample Collected by: X Client _ TCWC Sample Temp: 4°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 mi 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, 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. Page 1 of 1 TCWC Rev 7.0 (9/19) Minnesota State Laboratory ID# 027-053-119 Water Clinic Laboratory Test Report Wisconsin State Laboratory ID# 105-10117Wisconsin Twin City DNR Lab ID #399073400 Don Stodola Well Drilling Report Number: 19-13967 Twin City Water Clinic Inc. Client: Sample Collection Date: 12/29/19 617 13th Avenue South Sample Collection Time: 13:00 Hopkins, MN 55343 Address: 3841 North Main Street Date: 12/30/19 Phone: (952)935-3556 St. Bonifacius, MN 55375 Sample Receipt Fax: (952)935-5077 Report Issue Date: 01/02/20 LaboratorySamalysis Analyte Client ID Parameter ple repS A Test Results Units Dat T me Datele Time Sample ID 12/30/19 12:42 Absent 19-13967 Coliform Drinking water 12/30/19 12:13 <1.0 mg/L 19-13967 Nitrate / N Drinking Water 12/30/19 9:50 01/02/20 10:07 <2.0 µg/L 19-13967 Arsenic Drinking Water µg/L Lead Drinking Water K No samples were subcontracted; or the above test result(s) with" designation were produced by a subcontracted laboratory. [Laboratory name; address; MDH Lab ID#j. The subcontracted laboratory maintains MDH Certification for the field(s) of testing performed. Sample Conditions Discussion: Notes: Sample received on ice. Well No.: 844799 Sample pt: well Well Adr: 1080 Heritage Lane; Orono, MN Owner: West Bay Homes Inc. Owner Ad r: 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 µg / L, Lead, 2.0 pg/ L EPA 353.2 - Nitrite Nitrogen, 1.0 mg/L Sample Collected by: X Client _ TCWC Sample Temp: 4°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 mi 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, 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. Page 1 of 1 TCWC Rev 7.0 (9/19)