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Home My WebLink AboutWell/water info � -� - - WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HFALTH Minnesota Well and Boring i --��] � - WELL AND BORING SEALING RECORD Sealing No. H J Councy ame Minnesota Unique Well No. � — � /j Minnesota Statutes.Chapter 1031 or W-series No. (Leevs tlank M nd krawn) Town hip Name ownship No. Range No. Section No. Fr llon(sry.,-�Ig.) Date Sealed Date Well or Boring Consiructed ,��, �� y� � umerical�Street Atldress�Fire Number and Gry of Well or Boring LocaUon � — 1� j� Depih Bebre Seahng f� j N. Original Depth h 1 Show exact location o N�ell orb ing Sketch map of well or bormg AOUIFER(S) STATIC WATER LEVEL in section grid wrth"X'. � location, showing property 'Smgle A�uder � MulUaquAer lines,roads,and buildings. ' N WELUBORING �'Measured ❑ Estimated � �Water Supply Well ❑Monit.Well � -Y- ' ❑ Env.Bore Hole ❑Other _ tt. ❑below ❑ above land surtace W —�- - — -i-- --i— E � -'�\ CASING TVPE(S) � --'-- � � � . , ��.� � —�- ---- -i-- --�- � /1� � �;,Steel ❑ Plastic �Tile �Other ' Y2mile �(/ �"L . i i i � �� —�- -�-- -i-- --�— Y ::_,.; CASIN(i(S) � Diamete� Depth Set in oversize hole? Annular space initially grouted? S /' /` f'�1 Yes No Unknown �r m;�� J f' /.�A(� �_..�! _� m.�rom to,�/L'� n. ❑ ves ❑No ❑ ❑ ❑ .dgF /l�d�y. Yw` PRQP�TV OWNER'S NAME �� in.from to R. ❑ Yes ❑No ❑ �es ❑No ❑ Unknown � .E . Property ownei s ma ng addres's if dIM ent t a`n wel ocafion address intlicated above. in.from to fl. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown f f�� SCREEWOPEN HOLE �o'� � P��.. `�V �f �� Screen from_._.�rG�,J to�� ft. Open Hole from to tt. ;> X�� „ � � �} �� OBSTRUCTIONS WELL OWNER'S N E ❑ Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑ Fill ❑No Obstruction � Well owneYs mailing addreas if diHe�ent than properry owner's atltlress intlicated above. Type ot Obslructions(Describe) Obstruclions removed? ❑Yes ❑ No Describe PUMP /j � TYPe s, f�+. (3EOLOOICAL MATERIAL COLOH HARDNESS OF FROM TO �Removed ❑ Not Present ❑ Other FORMATION N not krawn,indicete estimeted tortnatbn log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: ❑No Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing PerforaHon/Removaf in.from to ft. ❑ FeAorated ❑ Rertroved " in.from to ft. ❑ PeAorated ❑ Removed Type of peRorator ❑ Omer GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) i ' � . ,�a GroutlngMaterial �y��"�"'��from r r ] to f ..� fl. yards �— begs from to ft. yards bags from to tt. yards begs from ta__ ft. yards bags REMARKS,SOURCE OF DATA,DIFFlCULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property7 ❑Yes No How many? LICENSED OR REGISTERED CONTRACTOH CERTIFICATION This well or boring was sealed in accordance with MinnesoU Rules,Chapter 4725. The infortnation contei�ed in this report is true to th�best of my�lowledge. � � /� � � i , � � � �� Contrador Busi ss Neme �' Lioense a Repshe I'vo. ;r� � � i J t � 'ra - ,� i �/� � AuthonzbdYiepre -ntative Signafwe � '�Dete �� ` , r ,f[As � �,,f .'�tl.F.ifrl �_Y�� l LaGAI.�'i9i'Y H 1��0 4 9 Naml o/Pe Sealing Well or Boiing ' � �.... - r MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �� WELL OR BORING LOCATION I � WELL AND BORING SEALING RECORD M;��'e o"a u,,;q„8 we��No. �H County �me -- j Mmnesota Sta�utes,Chapter 1031 or W-series No. � � �Lseve tivJt M nd known) To �,ip Name ownship o. Range No Section No. F�cUon}��m.-i,igi) Date Sealed Date Well or Boring Constructed ' �' I'" .�tf � � � '_ % e�ical Street Adtlress ir Number an Ciry ot, ell or Bonn oc lion ` �- � /� 1 �� , p ��i'� Depth Before Seahng 1� _ft. Oriqinal Depih _ n 1 i ,�. Show exact IOCetiOn Ot w211 Or bOn � SkBtCh map o�well pr boring ApUIFER(S) STATIC WATER LEVEL m section grid wrth"X'. locahon, showing property �.Single Aywfer � MWhaquifer /_ Lnes,roads,and buildings. N C.C�`� WELUBORING �Measured ❑ Esfimated �� l Water Suppry Well ❑Monit.Weu - - -T- -;-- --;-- r 7 Y � � ; I I I I `` , ❑ Env.Bore Hole ❑Olher _ R. ❑ below ❑ above land suriace ' I ' I / ';.,4:^ �l W -�- -�-- -i-- --�— E . � � � CASING TYPE(S) � � � � -�-- -�-- -i-- —�i-- � � eel ❑ Plastic ❑Tile � Other 3�mile �'t+ —�- -i-- -'�-- --�-- I __._.. CASING(S) � _ e� Diameter Depth Set in oversize hole? Annular space initially grouted7 l S �..JJ"�� " �.,,� �(�—r mi�e�f, �.-�/��s4�.l;r�� in.irom `�! to�_ ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown I I PROP�OWNER'S E r in.from ro fl. ❑ Ves ❑No ❑ Yes ❑No ❑ Unknown r i t-t �.-,., :�+j�: f� . .1 ! Prope� owner's maiGng ress It diBe an well ocaGon address indicated above. in.from to k. ❑ Yes ❑No � ❑ Yes ❑No ❑ Unknown !� t� , �� G�, �j� � SCREEWOPEN HOLE �%�� < '� ��% `�P � Screen from_,� �•',y� to 1 x;_ h. Open Hole from to R. . _:r; (_-,�� _�r J . , , ;. . OBSTRUCTONS WELL OWNER'S NAME ❑ Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑ Fill ❑No Obstruction Well owner's mailirp addresa il ditterent than property owner's address mdice�ed above. Typ6 Of ObsVuctionS(DOSCrib6) Obstructions removed? ❑Yes ❑ No Describe PUMP !� TYpe �?�,c(,;`i' 6EOLOf31CAL MATERIAL COLOR HARDNESS OF FROM TO � Removed ❑ Not Present ❑ Other FORMATION Ii rat krawn,indicete estlmated fortnatio�log from nearby well or bonng. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE MOLE: ❑No Annular Space Exists ❑Annular space grouted with tremie pipe ❑Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Rertroved in.irom to ft. ❑ PeAorated ❑ Removed Type oi pertorator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=SO lbs.) i- 1 /, �: f Grouting Matenal ��t� v ft. .yarOs bags from to ft. yards bags from to h. yards bags ,, irom to__ tt. yards bags REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property7 ❑Yes ❑ How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION . This well or boring was sealed in accordance wfth Minnesota Rules,Chapter 4725. The information conteined in Mis report is true to Ihe be�st ot my kno edge. P�:� j , �i...� j / „a,. � � r Conhaclo/�usiness Name ,st' ,,' License or Regi hefion 70. � f � ; -,,� %, - �.,� /(,� �`. ,. Authoirted �Signeture � „ Dare r v � H ��A��O Name of Person, '� ng Well a Bonng L��L��'� � ._ _ _. _ _ '"� WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H — WELL AND BORING SEALING RECORD Sealing No. County Name Minnesota Unique Well No. �Tltle ln Minnesota Statutes, Chapter 103f or W-series No. b (Leave blank I�not known) Township Name Township No. Range No. Section No. Fraction(sm.—�Ig.) Date Sealed Date Well or Boring Constructed � Orono 117 23 23 '' '' '' 1Q-27-O6 Latitude degrees____. minutes seconds 2 �] �, GPS Depth Before Sealing 37 ft. Original Depih_�7� ft. LOCATION: Longitude degrees__ minutes seconds A�UIFER(S) STATIC WATER LEVEL - Numerical Street Address or Fire Number and Ciry of Well or Boring Location �Single Aquifer ❑Multiaquifer ry� WELLIBORING Measured ❑Estimated Date Measured lw Bj'g Isla�� Or�� ;Water-Su I Well pp y ❑Monit.Well Show exact location of well or boring Sketch map of well or boring (� . in section grid with"X" bca' , owing property �..J Env.Bore Hole ❑Other JO k. �below ��=�above land surface li ,roads,a buddings. N �. CASING TYPE(S) a ,.>E _ Steel [_Plastic ❑Tile '. :Other_ _ ___ � � � � �fY --'--- --�--- ---`-----+-- WELLHEAD COMPLETION W � � � � E-r- / __;___ __;___ ___;__ ___r__ I utsid �(�Well House ��At Grade Inside: j-1 Basement Oftset � O ' e: ; � , , , 'h Miie f��- i�Pitless Adapter/Unit ��Buried ^!Well Pit --,- � � _ 1 �� , I--- --f i- - j Buried ' ' S ' ' � L�Well Pit (_]Other �--1 Mile� ��3 T� ❑Oth2f "](�.. PROPERTY OWNER'S NAME/COMPA NAME CASING(S) C�t of Orono Diameter Depth Set in oversize hole? Annular space initially grouted? Properry owners mailing address if dittere than well location ad ess indicated above �in.from�_ to__�_�Q_ .. ft. �Yes ❑No ❑Yes j_;No �]UnknoWn P•�• �$ 66 " in.fromL7o to ��O ft ❑Yes ❑No ❑Yes . ❑No ;r�Unknown Crystal Ba.y, M[�TT 55323 - in.from_, to ft. ❑Yes '..]No �]Yes ❑No (`]Unknown� WELL OWNER'S NAME/COMPANY ME SCREEWOPEN HOLE �" Well owner's mailing address if diRerent than properry ownePs address indicated above SCreen from_____to ft. Open Hole from ��^'____to�� ft. " OBSTRUCTIONS . Rods/Drop Pipe ❑Check Valve(s) [_-��Debris C Fill �j No Obstruction i Type of Obstructions(Describe) iLl�2er pi� & p�p _ GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. drift O no Type ' Removed ❑Not Present ❑Other METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �I Np Annular Space Exists ��nular Space Grgyitg�ith Tremie Pipe �Casing Perforation/Removal LF in.from to 1`j fl. ��Perforated ❑Removed sandstone (jor n) 43 76 - — --- in.from_ _ _ to ft. ❑Perforated [_]Removed Type of Perforator AYdralic 'J'�Other_ GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material neat C�Qt _ from_ � to__�g./L ft.__ yards 17G __ bags __.____ from to ft._ yards______ bags 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 '�,_=�No How many?__ Geology taken f ran Mpls/St Paul LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report area book 1938, pg 158 record 66 is true ro the best of my knowledge. Mpls Suburban RR Big island Park � Stodola Well Drilling Co., Inc. 1691 Iake Mirinetonka _ _-- -_ - — - -- — Contractor Business Name � License or Registration No. 12-18-06 epresentative ignature Certil,%ed Rep.No. Date IMPORTANT-FILE WITH PROPERTY H 2 4 7 5 21 J� �jC� --__ _ __-- - PAPERS-WELL OWNER COPY Name of Person Sealing Well or Boring � � HE-01434-09 IC#140-0423 siosa _ � _ , } � _. � MINNESOTA UNIQUE WELL WELL/BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. CountyName WELL AND �ORING RECORD -�.. .7 3 91 3 H Minnesota Statutes,Chapter 103I ; Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK�COMPLETED R. '/. '/a '/.�;. GPS -' DRILLING METHOD LOCATION: Latitude__ degrees _ minutes seconds �. .Cable Tool I I Driven �..._.Dug Longi[ude.__ degrees__ minutes seconds I '�.Auger �(Rotary �. �.Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number I I 1� B� ISZA�� OrOL1O ``DRILLINGFLUID WELLHYDROFRACTURED? CYes No Show exact location of well/boring in section grid with"X." ��^`^�map of well location;��.. �� From fL To ft. � ��- � owing property lines, � N .p� roads,buildings, USE Domestic �.Monitoring '. I Heating/Cooling � � � � y� and direction. � °�, �Noncommunity PWS � ,Environ.Bore Hole � ;Industry/Commercial --'--- --'--- --`-- --'— � �'. Community PWS I I Irrigation i �.Remedial �r �.Elevator I 1 Dewatering �ti� ' ' ' � CASING MATERIAL Drive Shoe? ��Yes ' No HOI.�DIAM. �� W � � � � E T eel � hreaded ' Welded � . , , , 1 St __�T _ , , , , . --•--- --'--- --�-- ---`— � Plastic �. '/z Mile I ! I ! _ � CASING . � --,--- —,------^-----r- � Dialneter 135 We�hto� Specifications � �n S �� Jv �—1 Mile--{ �ys in.to ft. Ibs./ft. in.t ft. V T �a'M in to ft IbsJft � in.t�ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. in.to ft. City of Orono SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make Johnson From ft.To ft. r•0• 1�Vx 6� � Type SCBItll�s$ Stl � Diam. 2� . t.��7.gt$1 1XSy� MH[�11 55323 Slot/Gauze_;�1�_ _ Length �t � �� Set between ft.and ft. FITTINGS � � STATIC WATER LEVEL 5J ft.�Below I Above land surface Date measured_ P-1-1J6 ^ . . PUMPING LEVEL(below land surface) WEWBORING OWNER'S"NAME/COMPANY NAME . , "' � - '�� ft.aftei` __.2.5 hrs.pumping 1{5 g.p.m. WELL HEAD COMPLETION .� ,. Well/boring owner's mailing address if different ihan property owner'�address indicated above. I. I Pitless Adapter Manufacturer Model -I Casing Protection IK1�2 iTn.above de ��At-grade(Environmental Well and Boring ONLY) a�1 se�� GROUTING INFORMATION Well grouted? �iYes i�No Grout materials I�I Neat cement�8entonite .Concrete C�'.Other__ _ �/ From�To.__�R 3.5 . .Yds. �5 Bags From_��To 1�5 ft. ��_� h�'�c�.l I�..;Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. '�. i Yds. I I Ba s MATERIAL 9 NEAREST KNOWN SOURCE OF CONTAMINATION (.'l�jy br�{�Tjj g�f t Q 'L'L �O feet � direction�� ryPe . Well disinfected upon completion? Yes ❑No sand/gravel brown soft ZZ � PUMP . Not installed Date installed (T7—W clay/cocks gray medium 6Q 120 Manufacturer's name �r�t�r Model Number HP � Volts �� .4�� gray .��ft �GO 1�3 Length of drop pipe 1�5 ft. Capacity g.p.m. Type�Submersible '..LS.Turbine LJ Reciprocating f l Jet I I � ABANDONED WELLS ' Does property have any not in use�and not sealed well(s)? C Yes�tvo VARIANCE Was a variance granted from the MDH for this well? -'Yes�jNo TN# WELL CONTRACTOR CERTIFICATION � This well was drilled under my supervision and in accordance with Minnesota Rules,Chap[er 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,il needed. y REMARKS,ELEVATION,SOURCE OF DATA,etc. � St�O1S YYell DL11I1TIg W�� Inc. 1691 Licensee Business Name Lic.or Reg.No. � I2-1�-Q6 . r p sentati Signat � � Date Chuck I�oore IMPORTANT-FILE WITH PRUPEf37""Y PAPFRS 7 3 913 8 Name of�riner — — WELL OWNER COPY HE-01205-09(Rev.9/05) ic iao-oozo � r �w i�v C i;ty 1Na�t�e� C ' ' , I v��,c� 617 13th Ave So � Fiopkins, Minnesota 55343 � (612) 935 - 3556 06/05/2006 Srodola Well Drilling 3841 North Main St. Boni facius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: 311 BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 06/02/2006 from the following location: City of Orono 100 Big Island Orono,Mn Well #739138 Coliform Bacreria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The resulrs of these tests indicate that this well is producing water thar meets the standavds for F.H.A., V.,4., �r conver,ri�na( lo�r,s. Th.is report is an analysis for coliform and nitrate only anc� r�oec nor incl:!�e a►aalysis of LQad and other contaminants. (Unless as speci fied by client). T�uin City Water Clinic, Inc. �� \ �,_. B�II V ,�rsdale �� ,� Lab CeRification#027-053-119 MIMNESOTA � DE�Allil'iM�4F HEALiII Protecting, maintai�ii�r,�ru�l i�uproving the health of all Minnesotans January 18, 2008 Veteran's Camp-Big Island c/o Gabriel Jabbour 985 Tonkawa Long Lake, MN 55356 Gentlemen/Ladies: We are writing to give you the results of the source water assessment for your water supply system. The assessment is for informational purposes. You are receiving a source water assessment because the Minnesota Department of Health has determined that you operate a transient noncommunity public water supply. A transient noncommunity public water supply,such as yours,has the potential to supply drinking water to at least 25 people for 60 or more days a year. Congress requires that states prepare source water assessments for all public water supply systems. Each assessment for a public water supply must contain the following information: 1)A description of the source of drinking water and the area that provides water to your well(s); 2)A determination of the susceptibility of your well(s)to potential contaminant sources; and 3)The drinking water contaminants of concern to anyone using the source of drinking water. Congress requires that states make source water assessments available to the public,and we intend to do this after presenting assessment results to you.The Minnesota Department of Health will serve assessment results out to the public using its worldwide web site;however, for security reasons,we will provide only the text portion of the assessment and will not show the locations of any wells used to provide drinking water. Please review your assessment, and contact the person listed as the Minnesota Department of Health representative within two weeks if you have any questions. We ask that you contact us if you have information that will enhance the accuracy of the source water assessment for your water supply system. We will be updating your assessment in the future as part of the sanitary survey and water quality monitoring activities we conduct for your public water supply system. Sincerely, C�� Bruce M. Olsen, Supervisor Source Water Protection Unit Enclosure Environmental Health Division, Drinkirtg Water Protection Section, P.O. Box 64975, St. Paul,Minnesota 55164-0975 TDD/TlY.• (651)201-5797 Minnesota Relay Service: (800) 627-3529 ID Number: 5271183 Facility Contact: Gabriel Jabbour (952) 474-0292 Veteran's Camp - Big Island Veteran's Camp-Big Island c/o Gabriel Jabbour 985 Tonkawa Long Lake, MN 55356 MDH Contact: Terry Bovee (507) 389-6597 Nichols Office Center 410 Jackson Street, Suite 500 Mankato, MN 56001-3752 terry.bovee(a�health.state.mn.u s Status of the Source Water Protection Plan: The source water protection area for this facility consists of an inner wellhead management zone that is defined by a 200 foot radius around each well that supplies drinking water. The setback distances from potential sources of contamination that are specified in the Minnesota well construction code must be maintained within this area. The owner or operator of this facility is required under Minnesota public water supply rules (MR 4720.5110) to implement management practices for all potential contamination sources within the inner wellhead management zone. Contact either of the persons listed above to obtain more information regarding the wellhead protection measures that are being used by this facility. Source Water Accessment Area - See accompanying map(s). Wells without accurate locations will not be shown on a map. Description of the source water - The water supply for Veteran's Camp - Big Island is obtained from 1 primary well. Well depth(in feet), well status, aquifer(s) used, and sensitivity of the source(s) of drinking water are listed in the following table. -__ _ � - ---_ Unique Well Aquifer �, *Well ' Well ID I Depth , Well Use Aquifer No ' Sensitivity ! Sensitivity __ _ ___ 00739138 I Well#1 ' 143.0 Primary Glacial 'I Low ' See (2) �! Deposits i Well construction assessment - The water well used by the Veteran's Camp - Big Island meets current standards for construction and maintenance. These factors do not contribute to the susceptibility of the source water to contamination. Well Sensitivity - Well sensitivity refers to the integrity of the well due to its construction and maintenance. It is based on the results of the well construction assessment. It can be one of the following: (1) The well is susceptible to contamination because it does not meet current construction standards or no information about well construction is available, regardless of aquifer sensitivity. (2) The well is not susceptible because it meets well construction standards and does not present a pathway for contamination to readily enter the water supply. Aquifer Sensitivity - Aquifer sensitivity refers to the degree of geological protection afforded the aquifer(s) used by the public water supply. Low - The glacial aquifer is covered by one or more layers of fine-grained material that probably protect it from potential sources of contamination. Source Water Susceptibility - Source water susceptibility refers to the likelihood that a contaminant will reach the source of drinking water. It reflects the results of assessing well sensitivity, aquifer sensitivity, and water quality data. Low - The source of drinking water is covered by one or more layers of fine-grained material that probably protect it from potential sources of contamination. Contaminants of concern - The following statement summarizes the types of potential contamination sources present in the inner wellhead management zone and the potential drinking water contaminants related to them: None of the contaminants regulated under the federal Safe Drinking Water Act for this type public water system have been detected in the source water during required monitoring. A list of regulated contaminants can be found at http://www.epa.�ov/safewater. �� ..�� — � ��,� � �� # „ �, ' � , : . � ;. a � . �. �� , � ; � � � o, �� ' �� . � � ,;�.� � ��► � — � � . �� , � , �� , �'�: s-,°�' ' '+ ` ` � ' � �� ,, � ° � +�z � � � � .� " � � ,- ��` � � � » lF . '��; ° r� � � �� ; � ! . � , , • �� _ x _� ' ° � �,� 1 ' �, -� , � "� * �� , �� , . 1� y ,; � � ... :� �� ,� �� . : .� Y � . ��j , �" �.� � � i `. � �'� � � � � d s � �� v m . # � $,� '� `di'r�: ' �.i..� � '"� . " ,�. w � .� �� , y � r'« �W � � � � �� $,>§ ti � � � 3 �� 4 , �,' � � � � r ap � �V . � x= `� ,��,�' . > � . .. „-,�h �� . T�� ' � `� � Y � k '� t > �` E � �� "��':%°+� �'� � ' P- �}/} p �'' # : � � � ` � i �tlJ��LT3 � � � � r � � . ,# a , .,. q � _ y .' 3 �� Y.� � � .. s � � • �, �,�� N^* "�'[ a � �* � :)E `�. �. �,��, m!:-''£�:.�_{ x . �`'p� �� t . �� g � , � . �` � _'F » .},� * �� fd M �� n� � .. �' . i : d '� e'� �.w'�;. , f 4f F ��. � �{, 2. # � �� ' � � �t�"� ,A # v � � . . '�;�'�S .. � � � �� `t .� � � �w:� y. � y � � � ��M k�� i ,� � � , ` r�. *� . '�� b 4�� , � .. ` � �.i ��'. _ � � �{� � , � '!�� °� , � � �� . � � � � ��, ' � w� �r��ir," � �a* ��' ,� "�,� � _ � ''� � i - � � , u , - � � , �: � �` � , � y, �� .. � � ' ... � ,r ;� ,� �. € # � „.. - , _ ,, � � x � ,,� �,— _ �� "� `� , �, .� `�! x � � - � ^ �� ,� A� ! y � � � . � . � :. .�.��. � � v � _ � � � ��i�;.,, . �n� $�. � � � sk �F � ,. V� �i , n^� � �°�,�, . �"��. , M" + `� � ~ � Scale: 1:2568 M I N N E S 0 T A ' � DEPARTMENToFHEALTH Protectin� maintaining and improving the heulth of all Minnesotans Date: August 19,2008 To: Public Water Supply O n rs/Operators From:��Gerald G. Smith,P.E. Drinking Water Protection Section Noncommunity Public Water Supply Unit Subject: Recent Revisions to Minnesota Rules, Chapter 4725, Department of Health, Wells and Borings You are being sent tYus notice because revisions to Minnesota Rules, Chapter 4725,Department of Health, Wells and Borings(commonly referred to as the"Minnesota Well Code")went into effect on August 4,2008. It is beyond the scope of this notice to inform you of all the changes that have been made in the Well Code; however, there are some revisions that pertain specifically to public water supply wells. These revisions are found in Minnesota Rules,part 4725.5825 and are briefly described below. - 1. Notification of drilling required. A licensed well contractor must notify the Minnesota Department of Health(MDH)of the proposed construction starting time of a public water supply well 24 hours in advance of beginning construction. 2. Additional disinfection or development required. Public water supply wells that are constructed in unconsolidated formations using a rotary or other method that creates an annular space and uses bentonite drilling fluid must eitlaer 1)provide an additional well disinfection after completion of driiling and prior to grouting or, 2) spend at least one hour developing the well by agitating and forcing water out of the well screen. 3. Additional grouting requirements. A public water supply well constructed with a method that creates an open annular space must be properly grouted from within ten feet of the bottom of the well casing to the ground surface or base of the pitless adaptor or unit. This is commonly referred to as"full length grout."An annular space is the void between the well casing and borehole that is created by many commonly used well construction techniques. 4. Sampling faucet required. Each new public water supply well must have a metallic water sampling faucet. The faucet must be installed a minimum of 12 inches above the ground surface,be installed between the well and water storage, and prior to any water treatment devices. � General Informarion: 651-201-5000 • Toll-free: 888-345-0823 • TTY:651-201-5797 • www.health.state.mn.us An equal opportunity employer 5. Conversion to a public water supply well. A well,previously not used as a public water supply well, may be used as a noncommunity or community public water supply well only if the well meets the requirements of Minnesota Rules, Chapter 4725. Plans and specifications must be submitted to, and approved by the Well Management Section of MDH prior to use as a public water supply well. As a public water supplier, it is your responsibility to hire an MDH licensed water well contractor when having a new public water supply well constructed or having an existing public water supply well repaired,modified, or rehabilitated. It is the well contractor's responsibility to perform all well construction or repair work in accordance with the czurent requirements in Minnesota Rules, Chapter 4725. If you are considering having a new public water supply well constructed, it is highly recommended that you discuss any applicable well code revisions inc?uded in th.is l�t±er with your wel? co�tractor pricr to �or�st�uction tc ensu:�that they are properly addressed. If you have any questions regarding the revisions to Minnesota Rules, Chapter 4725,please contact a representative with the Well Management Section of NIDH at one of the offices listed below: Bemidji District Office 218-308-2100 Duluth District Office 218-723-4642 Fer s Falls District Office 218-332-5150 Marshall District Office 507-537-7151 Rochester District Office 507-285-7289 St. Cloud District Office 320-223-7300 St. Paul Office 651-201-4600 GGS:PAF:mal MINNESOTA ' c c DEPARTMENToFHEALTN �c�cl�/E� D�T � 3 g Protecting, maintaini�zg and imProving the I�ealtlz of all Mi�2�iesotans ZQ� October 2, 2oos c/�OFpRONp Big Island Veterans Camp c/o Mr. Tom Robb P.O. Box 598 Excelsior, Minnesota 55331 Gentlemen/Ladies: SUBJECT: Sanitary Survey Report for Big Island Veterans Camp, PWSID 5271000 Enclosed is a sanitary survey report regarding a recent on-site inspection of your public water supply. The pu;�ose of a sanitary survey is #� evaluate the capa�i!ity ef a public �vater system to provide safe drinking water to the public. This is accomplished by identifying sanitary defects within the system, informing the water supply owner of applicable responsibilities, and by providing guidance related to water system operation and maintenance. This sanitary survey report includes the following information: (1) sanitary survey findings, (2)an inventory of potential contaminant sources found within 200 feet of your well(s), (3) recommendations to assist you in effectively managing these potential contaminant sources in order to protect your water supply, and (4) pertinent physical information related to the water system. Please take appropriate action to address any survey findings, including correcting any sanitary defects, noted in this report. This report must be kept on file, and made available for public review for not less than ten (10) years. If you have any questions regarding this report, including actions to address survey findings, please contact me at 651/643-2117. 5incereiy, . �' � , ~,:- �' %'" :.1../� ��,v>, ,�� - ti_..-� �� .��'� , �E�e iel Mark, R. . No�community Public Water Supply Unit Environmental Health Division SOP 1645 Energy Park Drive St. Paul, Minnesota 55108 EM Enclosures cc: Mr. Mike Gaffron General Information(6�1)201-4700 TDD:(6�1)201-5797 Minnesoli2 Relay Service:(800)627-3�39 www.health.state.mn.us For directions to any of the'_�1DH locations,call(6�1)201-�000. An equal opportunity employer. M i N N E s o r A MINNESOTA DEPARTMENT OF HEALTH � Section of Drinking Water Protection Sanitary Survey Findings �--'� DEPARTMENT OF HEALTH ;f�� a waie�e�o System Name: Big Island Veterans Camp PWSID: 5271000 System Contact: Tom Robb Survey Date: 08/27/2008 � Surveyor Signature�� ..z' �/ ��v..�—� ekiel Mar The findings below identify sanitary risks that may impact water quality, inform the water supply owner of applicable responsibilities, and/or provide guidance related to water system operation and maintenance. - -- �111ater Source ' � The well must be properly vented and screened to eliminate negative pressure which occurs when the pump starts and the water level drops. The negative pressure may draw contaminants into the water supply through other openings if the well is not properly vented. [Minn. Rules, part 4725.5450] All water well construction, well sealing, or alteration/repair work, must be performed by a water well contractor who is licensed in Minnesota. The work done must be in compliance with the Minnesota Well Code, P�linn. Ruies, Chapter 4725. [Minn. Statutes, Chapter 1031] �Pumps/Pump Facilities and Controls ' No deficiencies or recommendations reported. � - - -- ___ --- - ---_ --- �Treatment � No deficiencies or recommendations reported. — - --- - --- _ - --_ ------ I�Vater Storage __ ' No deficiencies or recommendations reported. iDistribution ' � No deficiencies or recommendations reported. � 'Monitoring/Reporting Data Verification ,; The operator should keep the following records: a. Bacteriological and chemical test results as required by the Safe Drinking Water Act. b. Maintenance and repair. �ater_System Management/Operation ' Prior to the construction or alteration of a public water supply system, complete plans and specifications must be submitted to the Minnesota Department of Health Drinking Water Protection Section. Plans for treatment, pumping, storage, distribution, and related facilities must be submitted for approval. Contact staff at 651/201-4699 with any questions. [Minn. Rules, 4720.0010] -- -- Operator Compliance with State Requirements No deficiencies or recommendations reported. Page 1 of 2 M I N N E S 0 T A MINNESOTA DEPARTMENT OF HEALTH �- Section of Drinking Water Protection �' Sanitary Survey Findings �� DEPARiMENTOF HEALTH �f��--�� '9 Wale�P�� System Name: Big Island Veterans Camp PWSID: 5271000 � System Contact: Tom Robb Survey Date: 08/27/2008 --- ---- - ---- ----— ---- - -- �1llellhead Protection _ _ In accordance with Minn. Rules 4720.5110 and 4725.4450, a public water supplier must: 1) Maintain the isolation distances for new potential contaminant sources located around a public water supply well(s). 2) Monitor potential contaminant sources that were in existence, recorded, or authorized before May 10, 1993, and are not in compliance with the isolation distances established in Minn. Rules 4725.4450. 3) Implement wellhead protection (WHP) measures for potential contaminant sources located within 200 feet of public water supply wells. WHP measures are methods to prevent the contamination of a public water supply system. Tp accict ��pU Itl Cnmrl�in� With thP �recedino rec��,irPments, the Minnesota Department of Health has inventoried potential contaminant sources within 200 horizontal feet of your public water supply well(s) and provided a list of suggested WHP measures. Potential contaminant sources identified: Drainfield Septic tank Suggested WHP measures include: -Have septic tanks periodically pumped by a licensed pumper. Tank baffles and integrity should be evaluated at the time of each pumping. See Minnesota Rules 7080.0175. (www.revisor.leg.state.mn.us/forms/getrule.shtml) Other WHP measures could be implemented in�luding public education, best management practices, hazardous waste collection, water conservation, plan review, groundwater monitoring, or others. Page 2 of 2 M I N H E S 0 i A MINNESOTA DEPARTMENT OF HEALTH '- 1 Section of Drinking Water Protection � DEPARTMENTOFHEALTH Public Water Supply Inventory Report °�o f�9 wa�oi Name:Big Island Veterans Camp PWSID: 5271000 PWS Type: Transient Noncommunity County: Hennepin District Staff: Ezekiel Mark ---------- -------- – ---- —� SYSTEM INFORMATION Basic Data System Class: Not applicable Population: 30 Service Connections:1 Survey Date:08/27/2008 Service Area Description: Recreation Area Addresses and Locations Type Address Carbon Copy Mr. Mike Gaffron City of Orono PO Box 66 Crystal Bay, MN 55323 Location Ex�eisior, Mi� 55331 Sample Bottles/General Big Island Veterans Camp Correspondence c/o Mr. Tom Robb P.O. Box 598 Excelsior, MN 55331 Contacts Primary Type Name Phone/Email Number/Address 'L� Contact Tom Robb Business Phone 1 612/474-1958 Source Information Name: Well #1 Type: Well Source Type: Groundwater Status: Active Well Data Unique Well No.: 00263655 Year Constructed: Drawdown (ft): Well Depth (ft): Static Depth (ft): Screen Length (ft): Casing Depth (ft): Casing Diameter(in): Pump type: Pump Capacity (gpm): Aquifer(s): Storage Information Name: Hydropnuematic 1400 Type: Storage-Hydropneumatic Capacity: 1400 Gallons Other Facilities Name: Distribution System Type: Distribution System 9/29/2008 Page 1 of 1