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Home My WebLink Aboutwell & Boring WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH MIN AND BORINGTA WELLNIQUE NO. County`Name WELL AND BORING RECORD 792018 : Minnesota Statutes,Chapter 1031 Hennepin Township Name Township No. Range No. Section No.} Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 07 NW SR SE,/ 223 H. 9-12-13 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool ❑Driven ❑Auger Rotary House Number,Street Name,City,and ZIP Code of Well Location Fire Number ❑Other yy V.;.a ,'.- , d,T4-1 .': 4,4 r i: .4'j'. 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes ,cccc,5''''o Show exact location of well/boring in section gri. Sketch map of well/boring location. bentonite From It.To ft. Showing property lines, N roads,buildings,and direction. USE Domestic ❑Monitoring ❑Heating/Cooling __._ I. � ❑Noncommunity PWS ❑Environ.Bore Hole ❑Remedial Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial F t ❑Elevator ❑Dewatering ❑ w ;` E ` CASING MATERIAL Drive Shoe? ❑Yes �'fdo HOLE DIAM. ---1--- ---F------ �h Mlle ❑Steel ❑Threaded ❑Welded lastic ❑ -Y I 1 CASING S Diameter Weight Specifications Q 1 Miie 4 in.To 215 ft. lbs./ft. 8 in.To 50ft. -273 PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.Tott. J Scot ty; Builders in.To ft. lbs./ft. in.To ft. � OPEN HOLE Property owner's maili g address if different than well location address indicated above. SCREEN Johnson 7935 Storamtreek Dr Make •�. From � tt. To ft. Type stainless steel Diam. G t WI 55317 Slot/Gauze .010 Length 4' + 4. Set between 415_ft.and_4123 ft. FITTINGS g 5 STATIC WATER LEVEL Measured from !f. 50 tttelow❑Above land surface Date measured 9-12-13 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 180 ft.after 4 _hrs.pumping 20 g.p.m. )ell/boring owner's mailing address if different than property owner's address indicated above. WE LHEAD COMPLETION y,ltd %itless/adapter manufacturer Rhi Model ❑Casing protection ,..1<12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUTINGINFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentonite From 0 To A�SOft. 3 ❑Yds. Bags Material natural ft(1r1...__SQ21To ltt. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags NEAREST KNOWN SOURCE OF CONTAMINATION fill/sand It brown soft 0 2 625 feet LAdirection Well disinfected upon completion? ,lYes ❑No - � ...L.I. clay brown soft 2 28 PUMP 10-1-13 clay pip ❑Not installed Date installed 1.:.L� gray l Manufacturer's name e� �ravel�sand varied medit�/soft 44 57 Model Number ®� HP leg_Volts_ l Length of drop pipe 84 tt. Capacity g.p.m. silt/sand gray soft 57 156 Typeubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS clay gray soft 156 187 Does property have any not in use and not sealed well(s)? ❑Yes�'No VARIANCE clay/send grey soft 1877 q 211 Was a variance granted from the MDH for this well? ❑Yes jgNo TNIt WELL CONTRACTOR CERTIFICATION {{,, �� q� This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. sand/gravelse a secon CJa ded. medium 211 223 The information contained in this report is true to the best of my knowledge. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola WellDrilling Co,. Inc. 1691 Note: Adrees was changed after permits wer@Licensee Business Name Lic.or Reg.No. tt• change 4199 North Shore Dr, Orono to S' / � f1-18-13 1565 Fairview Cottage Lane, Orono Re resentative = -t re Certified Rep.No. Date Ryan LOCAL COPY 792018 Name of Driller gaard IC 140-0020 HE-01255-13 IRev.11/10) Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 ' Client: Don Stodola Well Drilling Co Report Number: 13-11425 Twin City Water Clinic Inc. Sample Collection Date: 09/15/13 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 14:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 09/16/13 Phone: (952)935-3556 Report Issue Date: 09/17/13 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 13-11425 Coliform Drinking Water 09/16/13 12:23 Absent 13-11425 Nitrate/N Drinking Water 09/17/13 14:21 <1.0 mg/I 13-11425 Arsenic Drinking Water 09/16/13 9:00 09/17/13 11:23 13.60 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water I Drinking Water Well No.: 792018 X No samples were subcontracted;or the above test result(s) with'**'designation were produced by a subcontracted Sample pt: laboratory. [Laboratory name;address;MDH Lab ID#].The Well Adr: 1565 Fairview Cottage Ln;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: J Scotty Builders field(s)of testing performed. Owner Adr: . Sample Conditions: Sample Temperature: 11 °C Discussion: Notes: • Approved methods used in analyzing the samples listed above have the following reporting levels: Maximum contaminant levels: SM9222B-Coliform, 1 cfu/100 ml Coliform-<1 cfu/100 ml Nitrate Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen, 1.0 mg/I Arsenic,10.0 µg/I SM3113B-Arsenic,2.014/I Lead,15.0µg/I SM3113B-Lead, 2.0µg/I /) ^ , Sample Collected by: X Client _TCWC Approved By: Bill Van Arsdale Alan Senechal Laboratory Manager Senior Analyst 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. TCWD Rev 1.2 Page 1 of 1 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H. 31202 3 WELL OR BORING LOCATION WELL AND BORING SEALING RECORD Minnesota o aUnique Well No. County Name Minnesota Statutes,Chapter 1031 orr W s eries No wno. Hennepin Township Name Township No. Range No. Section No. Fraction(sm.-.Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 93 NW SW SE 8 mew /.3 , GPS Latitude degrees minutes seconds Depth Before Sealing 7v ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds ��A��O{[UIFER(S) STATIC WATER LEVEL Nurt1561jree � iF6tpu retiat of We4ifer g'lattigglo WELLngle/BORING Nuifer ❑Multiaquifer Measured ❑Estimated Date Measured .5.9lYIc I�YQ}J L]1�A bT.....U C•t�..r.. acLLdds�Cr^LLddIIl/�� vt U 5 5 364 'Water-Supply Well ❑Monit.Well / Show exact location of well or boring Sketch map of well or boring ,—, Bore Hole SC below ❑above land surface in section grid with"X." location,showing property ❑ ❑Other H. in:.,roadsa .buildu N r r . CASING TYPE(S) XSteel ❑Plastic ❑Tile ❑Other ---',-----+-----f------- WELLHEAD COMPLETION W ET ,() Outside: ❑Well House ❑At Grade Inside: Basement Offset 'h Mile ❑Pitless Adapter/Unit ❑Buried ❑Well Pit --- --r- 1. 11 :10 Well Pit ❑Other F t Mile I ❑Buried S ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) J Scotty Builders Diameter/ _ Depth�y r Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above C//// in.from S F to /2 ft. ❑Yes Al ❑Yes ❑No ❑Unknown 7935 Stonecreek Dr in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Chanhassen, MN 55317 in.from to _ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNERS NAME/COMPANY NAME SCREEN/OPEN HOLE Well owner's mailing address if different than property owner's address indicated above Screen from • to -760ft. Open Hole from to ft. OBSTRUCTIONS %Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction Type of Obstructions(Describe) /4.4.4)Lf1 /2 Pf e Puii Q GEOLOGICAL MATERIAL COLOR FORMATION 7`HARDNESS OR FROM TO Obstructions removed? 1❑I Yes ❑No Describe / PUMP If not k own,indicate estimated formation log from nearby well or boring.cl !2 p / Type SUV 1 tj(nifol go gRemoved ❑Not Preset ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: RIVo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal ^^ in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) I Grouting MaterialA,47 mMAfr from S to 7d, ft. yards 7 bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION Mote: Address was changed after This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report permits were taken out. is true to the best of my knowledge. Don Stodola Well Drilling Co,. Inc. 1691 chanbe 4199 North Shore Dr, Orono to Licensee Business NameLicense or Registration No. 1565 Fairview Cottage Lane, Orono Coed el resentative Signature - Certified Rep.No. Date P 9 P -,..t125-4-‘42.-41W--`--# LOCAL COPY 11 312 0 2 Name of Person Sealing Well or Bo ng HE-01434-13 IC#140-0423 5n2R i