The URL can be used to link to this page

Home My WebLink AboutWell info . � _ , - �, � . :-= �, � ; � � �.;.. � :�. � r , MINNESOTA UNIQUE WELL WELL OR BOFjWG LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. � County Name WELL AND BORING RECORD 7 g 19 8 3 � �p� Minnesota Statutes,Chapter 103I ' Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED .r OrOc�a 27.7 23 20 A�E S$ �Ty, Zf?� n �3"'22-12 GPS DRILLING METHOD : LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool J Driven j�Auger �iotary House Number,Street Name,City,and ZIP Code of Well Location Fire Number �Other i I4/3 � R� il�l, VLLA,p,;► �5�1 DRILLWG FLUID WEL�I'4YDROFRACTURED? ��,.I Yes j o Show exact location of well/boring in section grid th`X" Sketch map of well/boring location. ��(�1r From� ft.To ft. Showing property lines, N roads,buildings,and direction. USE L�omestic ❑Monitoring ❑Heating/Cooling ' __J___ ._j___ ___�_____i_ _J Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial _]Community PWS [J Irrigation ❑Remedial --'-- --;-- --`-----�-- ` _J Elevator ,r]Dewatering ❑ � . w ; ; ; ; E � �" `"' � CASING MATERIAL Drive Shoe? ❑Yes ,�No HOLE DIAM. --,--- --.--- --�-----.-- T . ❑Steel �_�Threaded ❑Welded � � � � Mile StiC [.].. 'h --,--- r --� --.- 1 �f'la ; ; ; CASING S � �. Diam�er �g� WeighL� Specifications � � �', �._y � i . 1 �1 Mile� � t¢}Ex' _ in.To____. ft. Ibs./ft. in.To�ft. PROPERTY OWNER'S NAME/COMPANY NAME � in.To____ ft. Ibs./ft. ,_ �in.To_ ft T� y�� in.To _ft. _ Ibs./ft. in.To ft i'AA � . � � OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN _j ��s Make �tisl�!$�7� From ft. To ft. � Type ___ Diam. j,�� __ SIoUGauze �� /'�� Length_____ ♦ '* Set between � ft.and_.GV�ft. FITTINGS_ i STATIC WATER LEVEL ap Measured from_ J{?_______ ft. Below �_j Above land surface Date measured��'� WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) ` 17�/ ft.after____ 4 _____ __ hrs.pumping� g.p.m. ' Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �+ f�Pitless/adapter manufacturer___lnlit�ter Model y ❑Casing protection __ �72 in.above grade ❑At-grade ❑Well House �Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or olher) - Matenal_��rom�To_�ft � __�__ [ �Yds. �ags Matenal�,�_ �r�i��To�g�ft. ___ ��Yds. ❑Bags ` HARDNESS OF Matenal_ From_ ,_____To__ ft. ❑Yds. ❑Bags : GEOLOGICALMATERIALS COLOR MATERIAL FROM TO Drivencasingseal From To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION _� _ � � �� b.3.�:k �1� �✓ +� ��(.� feet � direction �'-�`s°,� �._,� �,...rype . Well disinfected�upon completion? �Yes ❑No :a�.W, ` ��'`" G� i3LVf�f! �}�t Z �� PUMP -' �Notinstalled Dateinstalled__ .__ ___�6�12__ �� C�8 �� `� �� Manufacturer's name ��e= � � � � Ai��l.� 95 1� Model Number HP�_��Volts Length of drop pipe �g ft Capacity g.p.m �e� �j� �j� �� ` Type:� ubmersible _LS.Turbine 0 Reciprocating ❑Jet ❑ s�� j' � ABANDONED WELLS Does property have any not in use and not sealed well(s)? J Yes �No VARIANCE Was a variance granted from the MDH tor this well? ❑Yes [�Jo TN# WELL CONTRACTOF 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 ot my knowledge. Use a second sheet,if needed. REMARKS,ELEVATION,SOURCE OF DATA..etc. Don Stvclola �k3.1 Drilling Co,. Inc. 2691 . Licensee Business Name -- - � Lic.or Reg.No. �..- ! , <-:�--�� IO-4-12 , _- -�-T— --------___ ; 3 tified Representative Signature Certified Rep.No. Date LOCAL COPY 7 919 8 3 � ��8�— — -- Name of Driller IC 140-0020 HE-01205-13(Rev.U/10) � Twin Cit� UVater Clinie Laboratory Test fteport Minnesota State laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 Clletlt: Don Stodola Well Drilling Co Report Number: i2-o9i69 Twin City Water Clinic Inc. 5ample Collection Date: os/zz/iz 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 13:30 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: os/23/12 Phone: (952)935-3556 Report Issue Date: os/za/iz Fax: (952)935-5077 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 12-09169 Coliform Drinking Water 08/23/12 13:02 Absent 12-09169 Nitrate/N Drinking Water 08/23/12 13:11 2.98 mg/I 12-09169 Arsenic Drinking Water 08/23/12 8:00 O8/24/1Z 14:08 13.70 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water Well No.: 791983 X No samples were subcontracted;or the above test result(s) with'**'designation were produced bq,a submntracted Sample pt: laboratory. [Laboratory name;address;MDH Lab ID#�.The Well Adr: 1473 Bay Ridge Rd,Orono, MN subcontracted laboratory mainf�ins MDH Certification for the Owner: Tom McCune field(s)of testing performed. Owner Adr: Same Sample Conditions: Sample Temperature: 9 °C Discussion: Notes: The arsenic level exceeds the Minnesota MCL for this sample. 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 qrsenic,10.0 µg/I SM3113B-Arsenic, 2.0µg/I Lead,15.0µg/I SM31136-Lead, 2.0 µg/I , ,� ,f 1 ,'} ;;� l.�l 1 �, 4. „�,�,4.t...t4,.f�CA'-f s Sampie 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 ' WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H �o s 2 a o County� me WELL AND BORING SEALING RECORD Minnlego a�Unique Well No. Minnesota Statutes, Cha ter 103/ or W-series No. �$2� �.Q '° �ea�,e o�a�k��o�x�ow�� Township Name Township No. Range No. Sec[ion No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed Oroc�o 127 23 10 1�E � 3 v Igvl� t , GPS Latitude degrees minutes seconds Depth Before Sealing ��0 tt. Originaf Depth ft. LOCATION: Longitude degrees____ minutes _ seconds UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location � Single Aquifer ❑Multiaquifer V �/.R� � nl�pp �� SS�92 WELL/BORING ,Measured ❑Estimated Date Measured��Q! _ ■r� � AZ 6 � '�Water-Supply Well []MoniL Well � Show exact iocation of well or boring Sketch map of well or boring - Q, in section grid with"X." location.showing property . �Env.Bore Hole ��_j Other_.___.,.___ _�=[__ft. �elow �_J above land surface N lines,roads,and building; CASING TYPE(S) � � � � � � t �� Steel []Plastic �Tile ��]Other --�-----'------`-----'-- •, ` o ELLHEAD COMPLETION � W W ; : : � ET � , ' r r Pitless AdapteNUnit C At Grade Inside: ❑Basement Offset " _ _____ ___ __ __ _____ Outside: ❑Well House ❑ , , , , Miie �Buried ❑Well Pit , � . , � , 1 ��' --;-----�--- --�-----%-- „ �') Buried l ' ]Well Pit � S ❑Other �i Mae-� �� ]Other PROPr�ERTY WNERS tNA�ME/COMPANY NAME CASING(S) i{J[ii . �lia � Diametp�� Q � Depth � Set in oversize hole? Annular space initially grouted? Property ownefs mailing address if diMereM than well location address indicated above � in.from to ft. ,_�,Yes o Yes _�� J ❑ ❑No ❑Unknown in.from ro ft. ❑Yes �No ❑Yes ❑No ❑Unknown � ______in.from to ft. ❑Yes []No ❑Yes ❑No U Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE '�� Well ownei's maifing address if differem than property owner's address indicated above SCfeen ffom �v� /_to__/,��•ft. Open Hole ffom to ft. OBSTRUCTIONS :; �Rods/Drop Pipe j�Check Valve(s) ��_'i Debris ❑Fill U No Obstruction Type of Obshuctions(Describe) �,fJf _f'L�7 4 �V�l� GEOLOGICAL MATERIAL COLOR HARDNESS oR FROM TO Obstructions removed? [�'es I No Describe FORMATION -- PUMP If not known,indicate estimated formation log from nearby well or boring. /� /� .f Type SU1� �UM p �". L' r' emoved �]Not Present ❑Other ' f METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: [�lo Annular Space Exists J Annular Space Grouted wiih 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 Ibs.,one bag of bentonite=50 Ibs.) � f Grouting Material �V�AT G�I�N7�m V to��ft _ yards__�� bags from to_ ft. yards bags i 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 �._�o How many?. LICENSED OR REGISTERED CONTRACTOR CERTIFICATION 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 �todola tie21 Drilling Co,. Inc, 1691 Licensee Business Name License or Registration No. /� - y t .� Cert' d re e t tiv Signa r Certified Rep.No. Date 306240 ' ':�..,�. ��+ .�-- LOCAL COPY H � �"'� Name of Person Sealing Well or Boring HE-01434-12 IC#140-0423 �' g,�osrt