HomeMy WebLinkAboutWell Boring & SealingMINNESOTA UNIOUE WELL
WELL ORB, i ING LOCATION
MINNESOTA DEPARTMENT OF HEALTH
WELL AND BORING STRUCTION RECORD
Minnesota Sta utes, chapter 1031
AND BORING NO.
839605
County Name
Pin
Township Name
Township Name
Orono
Township No.
117
7
Range No.
23
Section No.
11
Fraction (sm. — Ig.)
NNW �W ,
WELUBORING DEPTH (completed)
245 n.
DATE WORK COMPLETED
12-30-18
GPS LOCATION — decimal degrees (to four decimal places).
Latitude Longitude
DRILLING METHOD
❑ Cable Tool Driven ❑ Dual Rotary
❑Auger Rotary. E] Rotasonic
❑ gjlter � *
House Number, Street Name. City, and ZIP Code of Well Location
1300 Bracket t s Point Rid. Orono 55391
DRILLING FLUID WELL
HYDROFRACTURED? ❑ Yes No
bentonite From
ft. To
Show exact location
y❑
of well/boring in section grid Sketch map of well/boring location.
Showing property lines,
road ings, and direction.
N .
USE Domestic ❑Monitoring ❑Heating/Cooling
Noncommunity PWS ❑Environ. Bore Hole ❑ Industry/Commercial
J'' ��
❑ Community PWS ❑ Irrigation ❑ Remedial
❑ Elevator ❑ Dewatering ❑
w
--
'
, --
TS
— iMiie�
E
--- "'; ' T
'h Mlle
— � �
CASING MATERIAL Drive Shoe? Yes E]No
Steel Threaded ❑ Welded
❑ Plastic ❑
HOLE DIAM.
^
L in. To Stft.
6k in. To 1941.
37 To 24'Tt.
IP
CASING
Diameter AL Weight Specifications
4 in. To 194 ft. lbs./ft.
in. To k. lbs./ft.
in. To ft. lbs./ft.
PRPROPERTY OWNER'S NAMEICOMPANY NAME
Welch Forsman
SCREEN
OPEN HOLE
y q�
From �# ft. To 245 It
Property owner's mailing address if different than well location address indicated above.
6026 Pillabnry Ave S
Minneapolis, M 55449
Make
Type
Length _
Slot/Gauze Length
Set between ft. and ft. FITTINGS
STATIC WATER LEVEL 38 ft. Below ❑ Above land surface
o
Dale measurts�q—31-18 Dry hole ❑ Yes XNo
WELL OWNER'S NAMEICOMPANY NAME
PUMPING LEVEL (below land surface)
120 ft. after 4 his. pumping 50 o.P.m.
Wellfboring owner's mailing address if different than property owner's address indicated above.
WELLHEAD COMPLETION
Pitless/adapter manufacturer L Model
❑ Casing protection 2 in. above grade
[-]At-grade[:]Well House ❑ Hand Pump
GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other)
Material bentonite From 0 To50-- ft. 4 ❑ Yds. XBags
Material L`�i tti ngs From--J(L—To194 ft. ❑ Yds. ❑ Bags
Material —From—To—ft. E) Yds. 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
NEAREST KNOWN SOURCE OF CONTAMINATION
sand/cla
mix
soft
0
13
"'�— !'
Well is ! 1aJ feet direction from ''
Well disinfected upon completion? kes ❑ No��~'
clay
clay/sand
iiffto
gray
SO13
medium
25
25
36
PUMP /
❑ Not installed Date installed //
Manufacturers name
Model Number HP � Volts a?30
Length of drop pipe—� ft. Capacity g.p.m
sandy clay
sand/clay
gray
gray
—medium—
soft
50
93
sandy clay
shale/sandstone
gray
green
medium
hard
190
192
Sandstone
rown
ahard!
medlium
192
245
Type: E] Submersible ❑ L.S. Turbine ❑ Reciprocating ❑ Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑ Yes XNo
VARIANCE
Was a variance granted from the MDH for this well? ❑ Yes TN#
1XNo
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 Stodola Well Drilling Co• , Inc • 1691
Use a second
sheet, if needed.
REMARKS, ELEVATION, SOURCE OF DATA, etc.
� e=
�. L `J ""
Licensee Business N me Lic. or Reg. No.
AN 0 3 2020
! " 9-26-19
"rtifW Rbpresenta1J4`SfgnrLr(r Certified Rep. No. Date
Rob Stodol8
LOCAL COPY ,
83,9605
Name of Driller
IU #b'2(jW
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: 19-00042
Sample Collection Date: 01/02/19
Sample Collection Time: 14:00
Sample Receipt Date: 01/03/19
Report Issue Date: 01/04/19
Twin City Water Clinic Inc.
617 13th Avenue South
Hopkins, MN 55343
Phone: (952)935-3556
Fax: (952)935-5077
LaboratbrV Analyte Client ID
Parameter Sample Prep
Sample Analysis Test
Sample ID
Date Time.
Date Time Results Units
19-00042 Coliform
Drinking Water
01/03/19 13:06 Absent
19-00042 Nitrate / N
Drinking Water
01/03/19 13:28 <1.0 mg/L ,
19-00042 Arsenic
Drinking Water 01/03/19 10:00
01/04/19 11:24 <2.0 ltg/L
Lead
Drinking Water
jig/L
Sample Conditions: Sample Temp: 8'C
Discussion:
Notes:
Sample Collected by: X Client _TCWC Approved
Bill Van Arsdale
Laboratory Manager
The results`_) sted in chis report apply only to the above listed samples. All routine quality assurance proc04rq$ 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.
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