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Home My WebLink About08-25-2020 well & boring construction record ° 4 ' 3- ` a4xt * �41;. +fy ,N : , ^ * * MINNESOTA UNIQUE WELL WELL 100 BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD 8 4 8 5 3 0 Hennepin Minnesota Statutes,chapter 1031 Township Name Township No. Range No. Section No. Fraction(sm.—r-Ig.) WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 10 SW NI!; NE ,/, 148 t 8-25-20 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude_ _ Longitude ❑Cable Tool ❑Driven [1 Dual Rotary ❑Auger otary ❑Rotasonic House Number,Street Name,City,and ZIP Code of Well Location ❑Other 1150 Heritage Lane, Orono 55391 DRILLING FLUID a WELL HYDROFRACTURED? ❑Yes 06lo Show exact location of well/borin m sectiongrid with"X." Sk@tch mapof well/borin location. it�nit'_. g From ft.To ft. Showing property lines, r'-, roads,buildings,and direction. USE N i { Domestic ❑Monitoring ❑Heating/Cooling -------,--?-- - --, ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial ❑Community PWS ❑Dewatering ❑Remedial .--'-----'-----`- --`--- `' ❑Elevator El w E CASING MATERIAL Drive Shoe? ❑Yes �No HOLE DIAM. ' ---"---'--" T , ❑Steel ❑Threaded ❑Welded S• Mile �J fY Plastic ❑ I CASING J�� 3 1 Diameter Weight Specifications �p� I - 1 Mile— I 4in_To:_tin ft. lbs./ft.. in.To 50tt. 61/4 PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. in.To x w ft. iWest Bay come inc• n.To ft. lbs./ft.OPEN HOLE in.To ft. Property owner's mailing address if different than well location address indicated above. SCREEN Make Johnson From • ft. To ft. 10425 Bluff Rd Type stainless steel Diarf2« Eden Prairie, MN 55377 t Slot/Gauze .015 Length 4, + 4' Set between__}{ __ft.and Rft. FITTINGS 2 3' leader STATIC WATER LEVEL 148 __19D ft. ijokaelow ❑Above land surface Date measured 8-25-20 Dry hole ❑ Yes i No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 130 ft.after 2 hrs.pumping 40 g.p.m. V Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ❑Pitless/adapter manufacturer Model ❑Casing protection ❑12 in.above grade ❑At-grade ❑Well House ❑Hand Pump i GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bentoniteFrom 0 To 50 ft. 3 ❑Yds. XBags Material Cuttings From 50 To 140 ft. ❑Yds. ❑Bags HARDNESS OF Material �Y� 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 / .,,_,.,� 33 -) ! _ clay/gravel brown medium 0 Well is +5 feet f"'r ) direction from • type clay/fir e'sand gray soft 33 66 Well disinfected upon completion? 1 Yes ❑No et, - :*.5.2 ,J.,-.0- sandy clay gray medium 66 82pPUMP fine sand/silty clay gray soft 82 98 ❑Not installed Date installed sandyclay reddish r� Manufacturer's name [�ro� broWes medium 98 123 Model Number HP Volts fpurse gravel/sand mix medium/ Length of drop pipe ft. Capacity g.p m or] hard 123A 149 Submersible Clay red medium 149 150 Type:DLS ❑L.S.Turbine ❑Reciprocating ❑Jet ,❑ ABANDONED WELL Does property have any not in use and not sealed well(s)? ❑Yes 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. Dan Stodola Well Drilling 1691 Licensee Business Name /Lic,.so�r�Reegg..No. rti R pre(e`ati ig ature Certified Rep.No. Date LOCAL COPY 8 4 8 5 3 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: 20-09373 Twin City Water Clinic Inc. Sample Collection Date: 08/26/20 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 15:30 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 08/27/20 Phone:(952)935-3556 Report Issue Date: 08/31/20 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 20-09373 Coliform Drinking Water 08/27/20 14:46 Present 20-09373 Nitrate/N Drinking Water 08/27/20 13:59 <1.0 mg/L 20-09373 Arsenic Drinking Water 08/27/20 9:20 08/28/20 12:24 8.84 µg/L Lead Drinking Water µg/L Well No.: 848530 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 108]. The Well Adr: 1150 Heritage Lane;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: West Bay Homes Inc. 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 p.g/L,Lead,2.0 µg/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 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: 20-12197 Twin City Water Clinic Inc. Sample Collection Date: 11/04/20 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 14:20 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 11/05/20 Phone: (952)935-3556 Report Issue Date: 11/06/20 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 20-12197 Coliform Drinking Water 11/05/20 13:35 Absent Nitrate/N Drinking Water mg/L Arsenic Drinking Water µg/L Lead Drinking Water µg/L Well No.: 848530 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: 1150 Heritage Lane;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: West Bay Homes 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,2.0µg/L,Lead,2.0 µg/L Arsenic,10.0 lig/L Lead,15.0 mg/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