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Home My WebLink About12-28-2021 Well and Boring ConstructionAAIAIAIF QnTA I IAIIniW IA/FI I WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. WELL AND BORING CONSTRUCTION RECORD 860839 County Name Hennepin Minnesota Statutes, chapter 1031 Township Name Township No. Range No. Section No. Fraction (sm. —. Ig.) WELLBORING DEPTH (completed) DATE WORK COMPLETED Orono 117 23 06 NE NE SW 105 12/7A/21 GPS LOCATION — decimal degrees (to four decimal places). DRILLING METHOD Latitude Longitude ❑ Cable Tool 1 Driven ❑ Dual Rotary ❑ Auger [Rotary ❑ Rotasonic E] Other House Number, Street Name, City, and ZIP Code of Well Location` O �b 415 North Arm Drive O ro W DRILLING FLUID WELL BentoniteFrom HYDROFRACTURED? E]Yes No ft. To ft. Show exact location » of well/boring in section grid with "X" Sketch map of well/boring location. Showing property lines, N roads, buildings, and direction. USE ® Domestic ❑ Monitoring ❑ Heating/Cooling L__ ___�__ ❑ Noncommunity PWS ❑ Irrigation E]Industry/Commercial ❑ Community PWS ❑ Dewatering ❑ Remedial --i--- -- ,'-- -- ------ -- ❑Elevator El w E T CASING MATERIAL Drive Shoe? ❑ Yes N No HOLE DIAM. I I I ❑ Steel ❑ Threaded ❑ Welded �—t Mile kMile s [� Plastic ❑ in. T.5 0 ft. CASING Diameter Weight Specifications 4 in. To 100 ft. lbs./ft. in. To ft. lbs./ft. C • J in. Tot 10ft. PROPERTY OWNER'S NAME/COMPANY NAME Morton Homes in. To ft. lbs./ft. in. To ft. SCREEN-�e$_ OPEN HOLE From ft. To ft. Property ovfners mailing address if different than well location address indicated above. I 1845 -45th Ave No Ste D Flyviouth, MN 55446 Make Johnson Type $ta nes$ Dia.. Z Slot/Gauze 0 10 Length Set between ft. and 108 ft. FITTINGS 3T ea STATIC WATER LEVEL ft. [T -Below, E] Above land surface Date measured 12/28/21 Dry hole ❑ Yes [*No WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL (below land surface) r� 95 ft. after 2 hrs. pumping 40 — g-p.m-Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION - Pitless/adapter manufacturer - CAL- 4a t.0 , Model ❑ Casing protection ` 12 in. above grade ❑ At -grade ❑ Well House ❑ Hand Pump GROUT INFORMATION (specify bentonite, cement -sand, neat -cement, concrete, cuttings, or other) Material Cutting $From 100, 50 ft. ❑ Yds. ❑ Bags Material bent on tK%m— ff. ❑ Yds. [Bags Material From To ft. ❑ Yds. ❑ Bags Driven casing seal From To _Bags One bag = 94 lbs. cement or 50 lbs. bentonite GEOLOGICAL MATERIALS COLOR HARDNESS OF MATERIAL FROM TO NEAREST KNOWN SOURCE OF CONTAMINATION top soil/clay t. U 1 k/ Y r m 0 7 Well is ' Q feet G direction from type Well disinfected upon completion? Pq Yes ❑ No clay brown m 7 16 PUMP [j Not installed Date installed Manufacturer's name Model Number HP Volts "u Length of drop pipe �` ft. Capacity----:)09-p.m C l al Gra 16 L 6 2 Sand/clay (;ray S 62 81 Sand Brown S til 110 Type: V] Submersible ❑ L.S.Turbine ❑ Reciprocating ❑ Jet ❑ ABANDONED WELLS 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? [j Yes jt] No TN# WELL CONTRACTOR CERTIFICATION Use a second sheet, if needed. 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. REMARKS, ELEVATION, SOURCE OF DATA, etc. Don Stodola Well Drilling; Co 1691 Licensee Business Name Lic. or Reg. No. ~' = 558 12/28/21 (Mniffdd ftepresirntaflVe Si nature Certified Rep. No. Date Rob Stodola LOCAL COPY Name e of Driller ID#52603 HE01205-18(Rev.3/19) � I 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: 22-03059 Sample Collection Date: 04/06/22 Sample Collection Time: 15:00 Sample Receipt Date: 04/06/22 Report Issue Date: 04/07/22 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 22-03059 Coliform Drinking Water 04/06/22 12:32 Absent 22-03059 Nitrate / N Drinking Water 04/06/22 13:08 <1.0 mg/L 22-03059 Arsenic Drinking Water 04/06/22 9:00 04/07/22 11:46 3.23 pg/L Lead Drinking Water pg/L X No samples were subcontracted; or the above test result(s) with'"' designation were produced by a subcontracted laboratory. [Laboratory name; address; MDH Lab ID#]. The subcontracted laboratory maintains MDH Certification for the field(s) of testing performed. Sample Conditions: Sample received on ice. Discussion: Notes: Well No.: 860839 Sample pt: Well Well Adr: 415 North Arm or Orono, MN Owner: NorSon Owner Adr: Approved methods used in analyzing the samples !isted above have th following reporting levels: SM9222B - Coliform, 1 cfu / 100 ml EPA 353.2 - Nitrate Nitrogen expressed as NO3+ NO2, 1.0 rng / L SM3113B - Arsenic, 2.0 µg / L, Lead, 2.0 µg/ L EPA 353.2 - Nitrite Nitrogen, 1.0 mg/L Sample Temp: 6°C Iv1CL 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 µg / L Lead, 15.0 pg / 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 c`