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Home My WebLink Aboutwell info i Y � MINNESOTA DEPARTMENT OF HEALTH MIN AND BORIN'�G NO. ELL WELL OR B�i :�vu LOCATION co�ntY N,,�„ WELL AND BORING RECORD 7 g 2 0 21 �n Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELLJBORING DEPTH(completed) DATE WORK COMPLETED t�ca�o !17 23 d5 �i 1� N�� 195 n (r25-I3 GPS DRILLING METHOD ` LOCATION: Latitude degrees minutes seconds Longitude degrees minutes __ seconds ❑Cable Tool ❑Driven ❑Auger �iotary House Number.Street Name,City,and ZIP Code of Well Location Fire Number ;�Other �Zl� GLa[7CWi Is1Z� � tkac�o 5y3 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes . o - Show exact location of well/boring in section grid with"X" Sketch map of well/boring loca n. ��t��it� �� `; Showing property li s, From ft.To ft. N roads.buildings,and direc n. USE �Domestic ❑Monitoring ❑Heating/Cooling __._____�__ ___�_____l_ �_�Noncommunity PWS ❑Erniron.Bore Hole ❑Industry/Commercial , `�Community PWS ❑Irrigation ❑Remedial ` --i-----;--- --F-- ---i-- ']Elevator ❑Dewatering ❑ �� `/d , , , � E T _ CASING MATERIAL ' � HOLE DIAM. , , , , ; -� Drive Shoe? L;Yes �Vo ' -. --�--- —�--- --�-----%-- �'Steel ❑Threaded ❑Welded . � � � i Mile � lastic ,� `, � --:--- --T-- ---�-- ---.-- 1 � ; ; ; ; CASING S Diamett�er Weight Specifications �—iM,ie—� . �� u�� " in.To��" ft. Ibs./ft. � in.To�Oft Fl jL�� PROPERTY OWtNER'S NAMEiCOMPANY NAME � in.To ft. Ibs./ft. � in.To ft �1� �� 1�lla in.To ft. Ibs./fl. in.To fl Property owner's mailing address if different than well location address indicated above. SCREEN� OPEN HOLE � I5050 23rc1 Ane N Make_ From ft. To ft. 1. f /�7 ' ��ti�+ � JS'f'i/ TYPe— �� $$ Diam. ;. n � —_ SIoUGauze •�V Lengih `f T� : Set between___�7_ft.and 195 tt. FITTINGS � � STATIC WATER LEVEL Measured from 97 ft. elow ❑Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �,.�� ft.after__.� _ hrs.pumping 3� g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �t �Pitless/adapter manufacturer 3[llt�t�r Model _ �Casing protection___ __ ,�2 in.above grade ❑At-grade I !Well House ❑Hand Pump � GROUTING W FORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Matenal "—"��'Fromr O To__ �ft. � ❑Yds. ,(�ags Material �� j �To �ft. ❑Yds. ❑Bags HARDNESS OF Material From To_ ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOA MATERIAL FROM TO Drivencasingseal From To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION ' C� �� f� � � feet � direction � �«:.Sl..� niyRle Well disinfected upon completion? �Yes �, J No � ,$'�� PUMP ��y� ❑Not installed Date installed_______ ��,______ �'+��/ �1 varied �� Manufacturer's name .�I�c�QL'� � Model Number HP � Volts �� Length of drop pipe �7 - ft. Capacity g.p.m Type: ubmersible I�L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes �IVo VARIANCE _..... , Was a variance granted from the MDH for this well? r J 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 hue to the best of my knowledge. Use a second sheet,ii needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. don Stcadoia well Dtillic�g Co,. inc. 1691 - -——--__- - - _-_ ___ -_ Licensee Business N e Lic.or Reg.No. ! �. 9-12-13 esentative 9 gnatur Certified Rep.Na Date _.: ' LOCAL COPY 7 9 2 O 2 1 _ �� r�-- — _ _ Name of Driller IC 140-0020 HE-01205-13(Rev.11/10) � . - � � Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 CI12t1t: Don Stodola Well Drilling Co Report Number: is-�9�9 Twin City Water Clinic Inc. Sample Collection Date: oe/is/is 617 13t�h Avenue South ACIdfE'SS: 3841 North Main Street Sample Collection Time: is:oo Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: o5/z5/i3 Phone: (952)935-3556 Report Issue Date: o6/z�/is Fax: (952)935-5077 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 13-7979 Coliform Drinking Water 06/26/13 14:54 Absent 13-7979 Nitrate/N Drinking Water 06/26/13 13:16 <1.0 mg/I 13-7979 Arsenic Drinking Water 06/26/13 8:40 06/27/13 15:18 <2.0 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water Well No.: 792021 X No samples were subcontracted;or the above test result(s) with'**'designation were produced by a subcontracted Sample pt: laboratory. [Laboratory name;address;MDH lab ID#j.The Well Adr: 3210 Graham Hills Rd;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temperature: 10 °C Discussion: Notes Approved methods used in analyzinQ the samples listed above have the following reporting levels: Maximum contaminant levels: Coliform-<1 cfu/100 ml, SM9222B-Coliform, 1 cfu/100 ml Nitrate Nitrogen 10.0 m_g/I SM4500D-Nitrate Nitrogen, 1.0 mg/I Arsenic,10.0 µg/I SM3113B-Arsenic,2.0µg/I Lead,15.0µg/I SM3113B-Lead,2.0µg/I ? ;� ,� ��..�,�t c_r;��8-f'f �;� >`'. Sample Collected by: X Client _TCWC Approved By: �,'' k ��- 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