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HomeMy WebLinkAbout03/30/2020 Well & Boring Construction RecordWELL OR 30RING LOCATION MINNESOTA UNIQUE WELL MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORD=848555 County Name it e n a ct �i i n Minnesota Statutes, chapter 10131 Township Name Township No. Range No. Section No. Fraction (sm. —+ Ig.) WELUBORING DEPTH (completed) DATE WORK COMPLETED u r o u u 1117 I 2 3 4 /Ir i SE SSE 131 ft. 9-3p-20 GPS LOCATION — decimal degrees (to four decimal places). DRILLING METHOD Latitude Longitude ❑ Cable Tool ❑ Driven ❑ Dual Rotary ❑ Auger Rotary ❑ Rotasonic ❑ Other House Number, Street Name, City, and ZIP Code of Well Location L 5 5 J F O X 6 L r e e t U r o n 0, &N 37/ DRILLING FLUID P.COt?1C._ WELL HYDROFRACTURED? ❑ Yes ro From ft. To ft. Show exact location of well/boring in section grid with "X" Sketch map of wellfboring location.o Showing property lines, N roads, buildings, and direction. USE 4Domestic ❑ Monitoring ❑ Heating/Cooling �I �, MEN IMM ❑ Noncommunity PWS ❑ Irrigation ❑ Industry/Commercial A �odQ ❑ Community PWS ❑ Dewatering ❑ Remedial ' ❑ Elevator ❑ E T CASING MATERIAL Drive Shoe? ❑ Yes �No HOLE DIAM. E] Steel ❑ Threaded ❑ Welded 'k Mile Iastic ❑ CASING s - Diameter Weight Specifications -1 Mile 4 in. To _�%ft. 123 lbs./ft. 11 Lan. To-3gft. in. To ft. lbs./ft. in. Tol tt. PROPERTY OWNER'S NAMEICOMPANY NAME ,Joe oelano in. To ft. lbs./ft. in. To ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE Make Johnson 939 -Sa d Willow Pass From ft. To ft. Type Dlam. 2"W4 f .* 4 Driftwood, TX 76619 Slot/Gauze stainless ste8 Length Set between 1� ft. and 131 ft. FITTINGS 2"x3l loader STATIC WATER LEVEL35 fL XBelow ❑ Above land surface rt Date measured 9-3LT2Vn Dry hole ❑ Yes o WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL (below land surface) 45 ft. after 1 hrs. pumping 70 a.p.m. Wellfboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer WhitMater Model ❑ Casing protection X12 in. above grade ❑ At -grade ❑ Well House ❑ Hand Pump GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Material ben t()n j t m From____l To --- 3()-- ft. S_ ❑ Yds. >rBags Material ruttl^Ro From -50 -To -472 -1 -ft. [:]Yds. ❑ Bags Material From To ft. ❑ Yds. ❑ Bags One ba 94 lbs. cement Driven casing seal From To g - GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO _Bags or 50 lbs. bentonite NEAREST KNOWN SOURCE OF CONTAMINATION clay 30 Well is feet L__j direction from- type Well disinfected upon completion?Ix Yes ❑ No clay/sand 30 75 PUMP �1 E] Not installed Date installed 10-2- 75 90 L,ravel/clay Manufacturer's name Model Number HP 1 Volts 230 Length of drop pipe 63 ft. Capacity 9 -p.m clay/sand 90 110 sa; nd 110 131 Type: Submersible ❑ L.S. Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS Does property have any not in use and not seated well(s)? ❑ Yes X<o VARIANCE Was a variance granted from the MDH for this well? ❑ Yes o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules, chapter 4725. Use a second sheet, if needed. The information contained in this report is true to the best of my knowledge. REMARKS, ELEVATION, SOURCE OF DATA, etc. %O,�i S'TODOLA WELL DRILLING CU INC Licensee Business Name Lic. or Reg. No. 1691 11-25-2 558 rf idtl Aepresen0itive Signature Certified Rep. No. Date Rob Stod©1a LOCAL COPY �848555Name of Driller ID #52603 HE -01205-10 (Rev.3/19) Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID# 027-053-119 Wisconsin State Laboratory ID# 105-10117 Wisconsin DNR Lab ID #399073400 Client: Address: Don Stodola Well Drilling 3841 North Main Street St. Bonifacius, MN 55375 Report Number: 20-10807 Sample Collection Date: 09/30/20 Sample Collection Time: 14:00 Sample Receipt Date: 10/01/20 Report Issue Date: 10/02/20 Twin City Water Clinic Inc. 617 13th Avenue South Hopkins, MN 55343 Phone: (952)935-3556 Fax: (952)935-5077 LaboratorV Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 20-10807 Coliform Drinking Water 10/01/20 13:13 Absent 20-10807 Nitrate / N Drinking Water 10/01/20 13:01 <1.0 mg/L 20-10807 Arsenic Drinking Water 10/01/20 11:20 10/02/20 11:54 9.64 µg/L Lead Drinking Water µg/L Well No.: 848555 - 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: 2555 Fox Street; Orono, MN subcontracted laboratory maintains MDH Certification for the Owner: Joe Delano field(s) of testing performed. Owner Adr: Sample Conditions: Sample received on ice. Discussion: Notes: Approved methods used in analyzing the samples listed above have the following reporting levels: SM9222B - Coliform, 1 cfu / 100 ml EPA 353.2 - Nitrate Nitrogen expressed as NO3+ NO2, 1.0 mg / L SM3113B - Arsenic, 2.0 µg / L, Lead, 2.0 pg/ L EPA 353.2 - Nitrite Nitrogen, 1.0 mg/L Sample Temp: 6°C MCL is defined as the Maximum Contaminant Level allowed by the Safe Drinking Water Act. The analyzed parameters have following MCL: Coliform, < 1 cfu /100 ml Nitrate Nitrogen, 10.0 mg/L Arsenic, 10.0 pg / L Lead, 15.0 µg / 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