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HomeMy WebLinkAboutWell info . �__. MINNESOTA UNIQUE WELL WELL O�i BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORWG NQ ,. County Name WELL AND BORING RECORD 7 g 19 8 8 - Minnesota Statutes,Chapter 103I F, Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED ,, ,, 331 n &-20-12 GPS DRILLING METHOD LOCATION: Latitude _ degrees __ minutes _ _ seconds Longitude __ degrees _ minutes _ _ seconds � 'Cable Tool �Driven ❑Auger �lotary � House Number.Street Name,City,and ZIP Code of Well Location Fire Number ❑Other ' IZ7O r�lif�� LrEG�C �� viaA7V S� • DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o s Show exact location of well/boring in section grid with"X" Sketch map of well/boring lo 171�i���te From ft.To ft. Showing prope n — N roads,buildings, dir c�. USE �(jomestic '. .Monitoring ❑Heating/Cooling � __j___ __._____�__ ___l__ � �Noncommunity PWS I�Emiron.Bore Hole ❑Indushy/Commercial t ! ! ! ! Communiry PWS ❑Irrigation ❑Remedial ; , � � � � --=-----=------;-- ---`-- 1 ❑Elevator ❑Dewatering ❑ � " `N ; ; ; ; E� CASING MATERIAL rive Shoe? �Yes ❑No HOLE DIAM. , . , � � ` -�'-�---'- -� -' �teel �Threaded ❑Welded ' 'h Miie � �_plastic ❑ ; ; : : 1 � --.--- --r--s--.-- --.-- � : ; ; ; ; CASING Diameter Weight Specifications �-7 Mile--� ��, � in.To �7Z7 ft. Ibs./ft. 8t �_in.To_5� ft. PROPERTY OWNER'S NAME/COMPANY NAME � ____in.To___._ ft. Ibs./ft. _ �4 Qin.T��7 ft F �1.� ��'1� . in.To_. ._ _ft. IbsJft ���M To���_.ft SCREEN_ OPEN HOLE Property owner's mailing address if different than well location address indicated above. - — � Make �_ From ft. To ft. Type atainlesa �tl Diam. _ _ _ _ SIoVGauze _(��O Length_��__} [�t Set between ft.and ft. FITTINGS • 1 STATIC WATER LEVEL Measured from �-e� �� ft.[�'Below ❑Above land surface Date measured__��1� WELL OWNER'S NAME/COMPANY NAME PUMPWG LEVEL(below land surface) 27� ft.after �+ hrs pumping � q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION ys��At�r = Pitless/adapter manufacturer����Z ____ _._._ Model r ❑Casing protection �12 in.above grade ❑At-grade ❑Well House i_J Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Matenal_��t�From V To__ JQft. � ❑Yds. �Bags Matenal�{$[liCtli 13�rj,_�To__�i�ft. ❑Yds. ❑Bags HARDNESS OF Matenal _ From To_____ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOR MATERIAL FROM TO Dnvencasingseal From To _ Bags NEAREST KNOWN SOURCE OF CONTAMINATION �''1 / J <_� `—� � �� � � / /�.�' feet r direction .�Y� ��t�-�✓ type � � �� � � Well disinfected upon completion? rLy Yes ❑No � PUMP :'� ❑Not installed Date ir.stalled _ _ ��`+l� =- �Y ��Y 8�Y �ft 30 240 3rh��er - - — ` Manufacturer's name ���!�� Cc � A� �� Model Number _ HP I.S Volts .2�_. � L +� Length of drop pipe 1,0� ft. Capacity __._____g.p.m a�iR1E'���� yeil�o�v y�yyj� x� `j�'� Type: Submersible ❑LS.Turbine ❑Reciprocating ❑Jet [, ___ _,_ ABANDONED WELLS �$�� te �� 3L1 �3�, Does property have any not in use and not sealed well(s)? ❑Yes �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. 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. � �t��� ��� ���� R_•' T �s �� \�V 1�1C; : _. -- -- — -- -- --.. __ __—___ _. _. _ . , FL[� d .. 2013 Licensee Business Name y Lic or Reg No. C�i � CITY OF ORONO ,:�" ,,, � �' 1(}-25-IZ - ert � epresentative Si ature � Certified Rep.No. Date Rd�! St4f�0�.e LOCALCOPY 7 g �g�g Name of Driller IC 140-0020 � �� � � HE-01205-13(Rev.11/10) � Twin City VVater Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 CIIE11t: Don Stodola Well Drilling Co Report Number: iz-oss6o Twin City Water Clinic Inc. Sample Collection Date: os/zi/ii 617 13th Avenue South ACI(IYE55: 3841 North Main Street Sample Collection Time:, �:oo Hopkins, MN 55343 St.eonifacius,MN 55375 Sample Receipt Date: os/z1/i2 Phone: (952)935-3556 Report Issue Date: os/Zz/iz Fax: (952)935-5077 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 12-08860 Coliform Drinking Water 08/21/12 13:05 Absent 12-08860 Nitrate/N Drinking Water 08/21/12 14:12 <1.0 mg/I 12-08860 Arsenic Drinking Water 08/21/12 10:00 08/22/12 13:18 10.5o µg/I Lead Drinking Water µg/I Drinking Water Drinking Wafer Drinking Water Well No.: 791988 X No samples were subcontracted;or the above test result(s) with"`�"designation were produced by.�subcontracted Sample pt: laboratory. [Laboratory name;address;MDH Lab ID#].The Well Adr: 1270 French Creek Drive Orono,MN subcontracted laboratory maintains MDH Certification forthe Owner: field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temperature: 17 °C Discussion: Notes: This sample exceeds the Minnisota MCL for Arsenic. Approved methods used in analyzing the samples listed above have the following reporting levels: Maximum contaminant levels: SM92226-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, 2.0 µg/I Lead, 15.0µg/I SM3113B-Lead, 2.0µg/I , ^ � ? ;,���7 v, * �'� ��.�.<..�,;�;;�,.<.,�_d�;�- _.. Sample Collected by: X Client _TCWC Approved By: , " J� 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�R BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I �O� /r ('� Q dounry Wamg WELL AND BORING SEALING RECORD M nn'eso a�Unique Well No. '} �,O P °�raW-series No. C'`..,: ���j`� Tttecmepin Minnesota Statutes, Cha ter 1031 Township Name Township No. Range No. Section No. Fraction(sm.-+Ig.) Date Sealed Date Well or Boring Constructed 4rono 117 23 10 �� �d � Z j �/ / � f� GPS Latitude degrees minutes seconds Depth Before Sealing ���� , ft. Original Depth -%�/ � ft. ° LOCATION: Longitude degrees minutes seconds pQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location {�( _ Single Aquifer U Multiaquifer ,�}/y /� ,�,.,I 1270 Freach Creek Dr, OrQI� 5�3�1„-' W��ORING r }�Measured ❑Estimated Date Measured�/'/��` �r,/ ' QQ Water-Supply Well ���,MoniL Well � Show exact location of well or boring Sketch map of well or �f in section grid with"X:' locati n showin ro rt� ��Env.Bore Hoie ❑Ofher __ ___ •� ft. �below [�above land surface es,roa s, n w i gs V N X CASING TYPE(S) � —'----'-- --`-----'— � � � ' ' � � f�Steel ❑Plastic [� ❑Other -,: j , , ; ; �� �Tile � , , � � � ._• --------� --- :' --';-----j-- ---;`--"""j"- � � WELLHEAD COMPLETION W : ; ; ; ET e � ` � � � ; _ I �f Outside: ;]Well House ❑At Grade Inside: ❑Basement Offset `; 'hI nniie �� �J Pitless Adapter/Unit ❑Buried L Well Pit --- 1 � ❑Buried S []Well Pit i 1 Mile—� � �.]Other _ ❑Other PROP�RTXCW�N�ER' A / OMPANYNAME CASING(S) xr�ct .�"cie"�ier Diam �/ � Depth � Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different Ihan well location address indicated above � in.from d to 32�/ ft. ❑Yes �jVo ❑Yes ❑No �`'�,UnknOwn in.from to ft. ❑Yes �j No ❑Yes ❑No ',�Unknown in.from ro ft. ;]Yes U No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � / Weil owner's mailing address if different than properry owner's address indicated above Sc�een from ��to 3�2 ft. Open Hole from t0 _ ft. OBSTRUCTIONS (J Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill �No Obstruction Type o(Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? [.]Yes []No Describe FORMATION PUMP I(not known,indicate estimated formation log from nearby well or boring. � f >. TYPe— �'' � � '�'z❑Removed �lot Present ❑Other � METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe �_j 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.) Grouting Material���i�/�N1 from_�_ to �� ft. yards__�"� bags ___ from to fl. 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 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 ihe best of my knowledge. Ikan Stodola t�ell Drilling Co,. I�tc. Ib91 Licensee Busin ss me License or Registration No. d: -,�� .f,� �' � �I- � � e Representative Signature Certified Rep.No. Date LOCAL COPY H .� Q ; '-�t�4J �.� ,' 4_�' —�t--�-` , �C�S_��("''�—+ Name of Person Sealing Well ar Boring . HE-01434-13 IC#140-0423 . 5n2R , -�.:.. ... . . . . . .,, . . . w...:.,- .. ,... . . . .... t .. . . . . . . .. . ,. � . . ._ ...... _,.. ......., ....