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Home My WebLink About04-18-2019 Well & Boring Construction RecordAA1A1A19:QlITd IIMIn11F IAIFI I Vj ELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORD Minnesota Statutes ch1.apter 1031 839621 ounty Name ntkpin Township Name Township No. flange No. Section No. Fraction (sm. —. Ig.) WELUBORING DEPTH (completed) DATE WORK COMPLETED Orono 117 23 08 '-M. = SE v 192 4-0-19 GPS LOCATION —decimal degrees (to four decimal places). Latitude Longitude DRILLING METHOD ❑ Cable Tool Llrnriven ❑Dual Rotary ❑ Auger Rotary ❑ Rotasonic ❑ Othpr House Number, Street Name, City, and ZIP Code of Well Location 3260 North Shore Dr, Orono 55391 DRILLING FLUID WELL HYDROFRACTURED? ❑ Yes No bentonite From ft. To ft. USE Domestic ❑ Monitoring ❑Heating/Cooling Show exact location of well/boring in section grid with "X:' Sketch map of well/boring location. Sho. i r ert Mines, N[gads, biyl a 2lcdch�IT' __ -_ ------ ------- ❑ Noncommunity PWS ❑ Environ. Bore Hole ❑ Industry/Commercial 4 ❑ Community PWS ❑ Irrigation ❑ Remedial --- -- --- -- -- --- -- ❑ Elevator ❑ Dewatering 11W I CASING MATERIAL Drive Shoe? ❑Yes No HOLE DIAM. --�--- --�--- -- ------t-- Steel ❑Threaded Vlelded 1 1 Plastic ❑ T . 1 Mile > s �� .} � in. To__ %ft. CASING Diameter Weight Specifications in. To 83 ft. lbs./ft. in. To ft. lbs./ft. in. ToMft. PROPERTY OWNER'S NAME/COMPANY NAME R A Antler ` Pro rt i.es f�V LLC J n. To ft. lbs./ft. in. To ft. SCREEN Make OPEN HOLE From ft. To ft. Property owner's mailing a res if different than well location address indicated above. 3�a�0�5�}Cayat� ��3gld J "p SType lot/Gauze a n esB steel Diam. 0 Length 4' + 4' ( . ' Set between _— ft. and 1 q2 ft. FITTINGS 2!x33 leader -- eaderSTATIC STATIC WATER LEVEL 34 .)<Below ❑ Above land surface Date measured 40*8-19 Dry hole ❑ Yes No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL (below land surface) 185 ft. after 2 hra. pumping o.p.m. Welliboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer W Model Casing protection 12 in. above grade ❑ At -grade ❑ Well House [-]Hand Pump 7� GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Material1�n�njjte�From... *__ To__50_ ft. _ 3 ❑ Yds. XBags Material f�From� To -183— ft. L]Yds. ❑ Bags Material , From To ft. ❑ Yds. ❑ Bags Driven casing seal From To _BagsOne ba - 9 94 lbs. cement .r501bs. bentonite GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO Peat black soft 0 7elay/send NEAREST KNOWN SOURCE OF CONTAMINATION r - Well is feet direction from �J 4—) -3tt.-iyp Clay sandlelay clay/sand gray gray gray gray 90ft medium. soft Medium 25 65 90 25 65 90 133 Well disinfected upon completion? Yes ❑ No PUMP ❑Not installed Date Installed gravel/clay Uray 11}edtAI 166 174 Manufacturer's name Model Number HP Volts elay sandstone/shale gray white meditri, soft 174 fr33 183 192 Length of drop pipe ft. Capacity , 9 -p.m Type. Submersible ❑ L.S. Turbine ❑ Reciprocating ❑ Jet ❑ ABA DONED WELLS Does property have any not in use and not sealed well(s)? ❑ Yes 4N. 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 DrilliTig Co. Inc. 1691 Licensee Business Name Lic. or Reg. No. 00, 9-26-I CgVNle&ffepriKemattve signature Certified Rep. No. Date Stodola LOCAL COPY 6 3 9 6 21Rob Name of Driller IU #526U3 Ht-uleua-1I lHev. on 1) Client: Don Stodola Well Drilling Report Number: 19-03889 Twin City Water Clinic Inc. Sample Collection Date: 04/09/19 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 15:00 Hopkins, MN 55343 St. Bonifacius, MN 55375 Sample Receipt Date, 04/10/19 Phone: (952)935-3556 Report Issue Date: 04/11/19 Fax: (952)935-5077 19-03889 1 Coliform Drinking Water 04/10/19 12:51 Absent 19-03889 Nitrate / N Drinking Water 04/10/19 12:50 <3.0 n... g/L 19-03889 Arsenic Drinking Water 04/10/19 8:35 04/11/19 11:56 2.07 µg/L Lead Drinking Water _ lag/L Sample Collected by: X Client _.TCWC Approved By: Bill Van Arsdale Laboratory Manager TCW D Rev 4.0 a Page 1 of 1 Well No.: 839621 X Nb samples wire stlbcbntracted or the above test Fesult�s) With`**desigr��d�on were producedy a subbbntracted Sample pt: Well laboratb taEbfagi"y name, addre$5,(vl0a Lati CU#] rite Well Adr:3260 North Shbre Drive; Orono, MN sub oftt>acta ]a oratory mamt msMDKCertilic tion�forthe ;Owner: North Shore Marina field�s)b�testii�gp0tfotrtied, � �' � r , , r . Owner Adr. Sample Collected by: X Client _.TCWC Approved By: Bill Van Arsdale Laboratory Manager TCW D Rev 4.0 a Page 1 of 1