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Home My WebLink About03/06/2020 - well and boring construction record MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD844815 Minnesota Statutes,chapter 1031 Hein Township Name Township No. Range No. Section No. Fraction(sm.--.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono 118 23 -' 33 5H NS SW'' 1€30 3-6-20 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary ❑Auger 'Rotary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other ', 2970 Lillian Lane, orono 55356 1-DRILLING FLUID WELL HYDROFRACTURED? ❑Yes to Show exact location of well/boring in section grid with"X"' Sketch map of well/boring location. bentoni t n From ft.To ft. 1 Showing property lines, _ roads,buildings,and direction. USE MonitoringHeating/Cooling N 'Domestic ❑ ❑ 9 g t r:—/ • ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial jt p r ❑Community PWS ❑Dewatering ❑Remedial -- --Ft--- Elevator _ w E s ; _, CASING MATERIALDrive Shoe? ❑Yes Arlo HOLE DIAM. ' ' Steel Threaded Welded - '/Mie \ — Plastic ❑ I F CASING S Diameterln Weight Specifications 1— 1 Mile- 4{ in.To 170 ft. lbs./ft. A____in.To 5lft. ial PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. IA in.Toft. Chamberlain Fine Custom Homes in.To ft. lbs./ft. - in.To ft. LrLii�IttiXSCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. t p �. Make Johnson From X111578 Chamberlain Crt Type tE�inles3 Bleat Diar2~ ft. To ft. Eden Prairie, MN 55344 Slot/Gauze -15 Length_d1 & 4t Set between�0—ft.and 130 ft. FITTING STATIC WATER LEVEL 90 ft.g Below Above and surface Date measured 3-6-20 Dry hole ❑Yes D'No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface)) 165 ft.after 2 hrs.pumping 35 q.p.m. WelVboring owner's mailing address if different than property owner's address indicated above. ,Kc�JWEt I HEAD COMPLETION /Pitless/adapter manufacturer Whitewater Model ❑Casing protection ,"12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material h ntni'ti PitFrom 0 To 50 ft. 3 ❑Yds. Jklitags Material cuttings From 50 To 170 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From - To Bags = One bag94 lbs.cement or 50 lbs.bentonite NEAREST KNOWN SOURCE OF CONTAMINATION claybrown medium 0 16 0 clay Well is i feet /1) direction from Q_....--,... type clay gray medium 16 22 Well disinfected upon completion? Yes ❑No clay/sand brown medium 22 36 PUMP sand/gravel mix soft 36 71 ❑Not installed Date installed 4-10-20 clay gray medium 71 106 Manufacturer's namerchaafer fine sand mix soft 106 129 Model Number HP 1.5 Volts 230 sandy clay/gravel reddish 126 Length of drop pipe ft. Capacity g.p.m. brown medium 1299 168 gravel/sand mix medium 168 130 Type:[ Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes k'No VARIANCE Was a variance granted from the MDH for this well? ❑Yes, No 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,if needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Drilling Co, Inc. 1691 Licensee Business Name Lic.or Reg.No. � 4 4-16-20 eC r e epresErifative Signat e Certified Rep.No. Date LOCAL COPY 8 4 4 81 5Rob Stodola Name of Driller -- uc_mont_on iao,.vi m 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 Report Number: 20-02278 Twin City Water Clinic Inc. Sample Collection Date: 03/09/20 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 8:30 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 03/09/20 Phone: (952)935-3556 Report Issue Date: 03/10/20 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 20-02278 Coliform Drinking Water 03/09/20 12:22 Absent 20-02278 Nitrate/N Drinking Water 03/09/20 13:24 <1.0 mg/L 20-02278 Arsenic Drinking Water 03/09/20 10:20 03/10/20 10:58 5.84 µg/L Lead Drinking Water µg/L Well No.: 844815 X No samples were subcontracted;or the above test result(s) with'**'designation were produced by a subcontracted Sample pt: well laboratory. [Laboratory name;address;MDH Lab ID#]. The Well Adr: 2970 Lillian Lane;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Chamberlain Fine Custom Homes field(s)of testing performed. Owner Adr: Sample Conditions: Sample received on ice. Sample Temp: 8'C Discussion: Notes: Approved methods used in analyzing the samples listed above have the MCL is defined as the Maximum Contaminant Level allowed by the following reporting levels: Safe Drinking Water Act. The analyzed parameters have following SM9222B-Coliform,1 cfu/100 ml MCL: EPA 353.2-Nitrate Nitrogen expressed as NO3+NO2,1.0 mg/L Coliform,<1 cfu/100 ml Nitrate Nitrogen, 10.0 mg/L SM3113B-Arsenic,2.0 pg/L,Lead,2.0 pg/L Arsenic,10.0 pg/L Lead,15.0 pg/L EPA 353.2-Nitrite Nitrogen,1.0 mg/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