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Home My WebLink About08/28/2020 - well and boring construction record - MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Natae WELL AND BORING CONSTRUCTION RECORD8 4 H Jr 4 9Minnesota Statutes,chapter 1031 'tors Din Township Name Township No. Range No. Section No. Fraction(sm.•-Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 `•_ _f 23 '!4 i'''.7 Nr1 11/44 170 n 8-25-?0 GPS LOCATION-decimal degrees(to four decimal places). DRILLING METHOD Latitude _ Longitude Li Cable Tool ❑Driven ❑Dual Rotary ❑Auger Rotary Li Rotasonic House Number,Street Name,City,and ZIP Code of Well Location LI Other DRILLING FLUID WELL HYDROFRACTURED? fl Yes o 3015 Watertown in (pro 5536 a ' Show exact location o well/boring in sec on god wit ketch map of well/boring location. bpntontilt- From ft.To ft. Showing.ro..-rty lines, N • -)ft1road in J n.direction. USE gDomestic III Monitoring ❑Heating/Cooling �. ❑I Noncommunity PWS ❑Irrigation ❑Industry/Commercial . ❑Community PWS ❑Dewatering ❑Remedial ❑Elevator ❑ w - ' - : - ' E �/ t CASING MATERIAL Drive Shoe? LI Yes XTlo HOLE DIAM. r f--- T Steel Threaded ❑Welded S Mile .-_. , ) Plastic YF ❑ ❑T 1 �4 ❑ S (�3' CASING Diameter ` Weight Specifications �/� � 1 Mile---( 1_,.....__ in.To 160 ft. lbs./ft. 8 in.To �/u�ft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.To 170ft. Marc & Kari Newell in.To ft. lbs./ft. in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE same Make * From ft. To ft. Type stainless stl Diam. 2* Slot/Gauze 60,15 Length � Set between 1f ft.and 170 ft FITTINGS Al�i leader STATIC WATER LEVEL 94 ft.›Below ❑Above land surface Date measuled 4820 Dry hole ❑Yes to WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) C!� 155 ft.after 2 hrs.pumping 50T q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION t�{.atter KPitless/adapter manufacturer WLModel ❑Casing protection ...I2 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT 0 INFORMATION� om(specify bentonites,cement-sand,/ neat-cement,concrete,cuttings,or other) Material t>ent°niterTo 50 ft. 3 ❑Yds. Sttags Material Cllttfi r-, From 50 To 160 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags One bag=94 lbs.cement or 50 lbs.bentonite C �f NEAREST KNOWNNOSOURCE OF CONTAMINATION tt�,�.. clay brown soft 23 Well is �°� feet direction from'['-''tA`�+_, type clay ,dray soft 23 40 Well disinfected upon completion? , Yes ❑No \\\\\\ sandy clay gray medium 40 5 PUMP n clay/sand I gray soft P5 93 ❑Not installed Date installed 10-7-20 gravel/sand dark medium 93 105 Manufacturer's name Schaefer sand brown soft 105 123 Model Number HP 1.5 Volts 230 sandy clay reddish soft123 130 Length of drop pipe 126 ft. Capacity g.p.m sandy clay/gravel gray soft 130 144 Type;,Kubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ sand/gravel mix medium 144 170 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 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,. c 1691 Licensee Business Name Lic.or Reg.No. ; 10-27-20 C:''fi-r'epresentati' g ature Certified Rep.No. Date LOCAL COPY 8 4 8 5 4 Rob Stodola Name of Driller ID#52603 HE-01205-18(Rev.3/19) • 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: 20-09421 Twin City Water Clinic Inc. Sample Collection Date: 08/30/20 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 14:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 08/31/20 Phone: (952)935-3556 Report Issue Date: 09/01/20 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 20-09421 Coliform Drinking Water 08/31/20 13:56 Absent 20-09421 Nitrate/N Drinking Water 08/31/20 12:49 <1.0 mg/L 20-09421 Arsenic Drinking Water 08/31/20 9:30 09/01/20 11:07 <2.0 .ig/L Lead Drinking Water pg/L Well No.: 848549 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#i. The Well Adr: 3015 Watertown Road;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Marc Newell field(s)of testing performed. Owner Adr: Sample Conditions: Sample received on ice. Sample Temp: 6°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 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H WELL OR RNa �BORING LOCATION WELL AND BORING SEALING RECORDCe Minling Na Unique Well No. 0 • 6 1 Hennepin Minnesota Statutes,chapter 1031 or W-series No. P (Leave blank it not known) Township Name Township No. Range No. Section No. Fraction(sm.-.Ig.) Date Sealed 'Date Well or Boring Constructed Orono 117 23 04 NW NW NW �I,!j -`;, . O GPS LOCATION-decimal degrees(to four decimal places) • Depth at Time of Sealing /'L.9 ft. Original Depth ft. Latitude Longitude AOUIFER(S) STATIC WATER LEVEL • Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer �I�� . WELL/BORING Measured Date Measured i1'.,,5 - .,J --.,,`-SIJ Estimated 31115 W t rtetan Rd, .I?man 55356 g Water-Supply Well ❑Env.Well - SS��yww exact location of well or boring Sketch map of well or boring invlection grid with"X." loc ion,showing pro•4• Temp.Boring ❑Other (fit✓p ft. �elow ❑above land surface N 1 04141.-•lin r s,and buil.',-• CASING TYPE(S) t - tSteel ❑Plastic ❑Tile ❑Other ' '--'-'-"-'----"`"--'-"' WELLHEAD COMPLETION W y___ �______ E T Outside:19V I�Pitless Adapter/Unit ❑At Grade Inside: El Basement Offset 'h Mile ]❑_Well Pit ❑Buried . '❑Well House •- 1 . ❑Other El Well Pit s ❑Buried I 1 Mile ❑Other For temporary borings,provide additional location CASING(S) information,a site sketch,and geology on a separate page. Diameter �\ Depth r Set in oversize hole? Annular space initially grouted? PROPERTYyOWNER'S NAME/COMPANY NAME - in.from t✓ to ,I/ ft. ❑Yes I(Jo ❑Yes ❑No ❑Unknown. . • MaL�_ &-Tari— t IW Property owner's mailing address if different than well location address indicated above in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown SCREEWOPEN HOLE WELL OWNER'S NAME/COMPANY NAME Screen from /i q to / 3 ft. Open Hole from to ft. OBSTRUCTIONS Well owner's mailing address if different than property owner's address indicated above $Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill ❑No Obstruction . Type of Obstructions(Describe) . -a 1 Obstructions removed? 7,Yes ❑No Describe PUMP GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO FORMATION ❑Not Present [ Present,Removed Prior to Sealing ❑Other If not known,indicate estimated formation log from nearby well or boring. Type , 0 ) 6 3 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE VNo Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal easing Diameter in.from to ft. ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator VARIANCE Was a variance granted from the MDH for this well? ❑Yes (LINO TN# . GROUTING MATERIAL(S) ]]'' c Grouting Material,1 f -} C) to I. 3 ft. yards /9. bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑Yes TX No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING This well or boring was sealed 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 Licensee Business Name License or Registration No. lF fir ./ / //,/r > C,_.,✓� , Certified P)eprese�ative Sift ature Certified Rep.N'o.✓ Date H 3 8 0 6 1 5 \''',--..' sZa.. ..n/Lo LOCAL COPY Name of Person Sealing Well or Boring HE-01434-17 ID#53159 11/198