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Home My WebLink AboutWell info T MINNESOTA UNIQUE WELL WELL OR BORING LOCATfON MINNESOTA DEPARTMENT OF HEALTH AND BORING NO co„�tv Name WELL AND BORING RECORD -7 8 8 2 2 7 Minnesota Statutes,Chapter 1037 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED �� 23 � — — GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longi[ude degrees minutes seconds ❑Cable Tool I�Driven -- ❑Auger �Rotary House Number,Street Name,City,and ZIP Code of Well Location Fire Number ❑pther � 3315 Grat� FIi21 �td, Orcyno 5535b DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well/boring in section grid with"X° Sketch map of well/boring loca n. �teC From ft.To ft. Showing property li s, N roads,buildings,and direc n. USE �Domestic ❑Monitoring ❑Heating/Cooling __�___ _J______L__ ___t__ [��Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial � ,. � � � � y �_! ommun y WS Irrigation emedial {�y� C it P ❑ ❑R �"�'� --i-----;-----F-- ---�– � []Elevator ❑Dewatering ❑ � � � ' ' / '�'� , � � , E T / CASING MATERIAL � � HOLE DIAM. , , , , �S Drive Shoe. ❑Yes No , --;-----;-----�–---%-- ' / 4 '�•'�❑Steel ❑Threaded ❑Welded , � , , 'h Mile / stic . i J�Pla ❑ ', --�-----T–--�-- --�-- / � f � � . CASWG � � � g � � i / � � ; Diameter Weight Speci(ications 1 / s� f� �—iM�,ie� � � � � ( � � in.To�l`� ft. �� IbsJft. ��"in.To �ft � / � PROPERTY OWNER'S NAME/COMPANY NAME in.To_ ft. Ibs./ft. in.To�ft tfiarle$ t�dd DF�vo in.To ft. Ibs./ft. in.To ft SCREEN � OPEN HOLE Property owner's mailing address if different than well location address indicated above. . 1�0 �"'�� A� � Make ��n��t�� From To ft. � p2�ti�f � SJ��7 TYPe__— -- -- Diam. , ' – ' ' SIoUGauze sd20 Length� ____ ; Set between_ ft.and it. FITTINGS��_ P�343f,-04500 STATIC WATER LEVEL Measured from__ ft. Below [�Above land surface Date measured__ � WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 2� ft.after � hrs.pumping � q.p.m. Well/boring owner's mailing address i(different than property owner's address indicated above. W LLHEAD COMPLETION �te�ater Pitless/adapter manufacturer__.._____ ___ Model �;.. > ❑Casing protection �12 in.above grade ` ❑A4grade ❑Well House �]Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,coLncrete,cuttings,or other) Mffierial �MtV[iit�r�omt �0q To_ S�q ft. `f ❑Yds. �Bags Material �tYiSl ��il Rl To �2.? ft. ❑Yds. ❑Bags HARDNESS OF Matenal___ _ _From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To _Bags �n NEAREST KNOWN SOURCE OF CONTAMINATION ♦ C�a�1 ye12{� �i� � `� �� feet � direction �tiC type t Well disinfected upon completion? _,Yes �.No C�Sy �lU� �JLL� � � PUMP 1 CI.+II �� $� l9CU.1� 80 lb5 I�Not installed Date installed �—j�� ___ _ Y " � Manufacturer'sname �'�{`�1$efP_C__ _ C��/�� ir� 1___y �S� 4�yC Model Number HP 3 Volts 2.31T J u iKrLT7. a�7 Length of drop pipe Z� ft Capaciry g.p.m g«Qe1f=� bt•�Y �� lgs ZI1�' Type�(''I Submersible ❑LS.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS s��a�ypl b�l I�Clti� 'Li� �I Does property have any not in use and not sealed well(s)? ❑Yes �No ��• , VARIANCE Was a variance granted trom 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 Stcxiolaf[�eil Dcilling Co.i Icu. 1691 Licensee Business Name Lic.or Reg.No. ,,, � 1-12-I2 -� --_ _ _ -- 'resentative Signature �Certified Rep.No. Date . 7 8 8 2 2 7 �`k s`°�°lg �o;x+L C.��P`� - --- Name of Driller IC 140-0020 HE-01205-13(Rev.11/10) r � Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin_State Laboratory ID#105-10117 Client: Don Stodola Well Drilling Co Report Number: ii-ozos� Twin City Water Clinic Inc. Sample Collection Date: ii/oz/ii 617 13th Avenue South ACIdYe55: 3841 North Main Street Sample Collection Time: io:oo Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: is/oa/ii Phone: (952)935-3556 Report Issue Date: ii/oa/ii Fax: (952)935-5077 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 11-10624 Coliform Drinking Water il/03/11 12:31 Absent 11-10624 Nitrate/N Drinking Water 11/03/11 11:56 <1.0 mg/I 11-10624 Arsenic Drinking Water 11/03/11 9:50 11/04/11 13:08 s.nz µg/I Lead Drinking Water µg/� Drinking Water Drinking Water Drinking Water X No samples were subcontracted;or the above test result(s) Well No.: 788227 with'**'designation were produced by a subcontracted Sample pt: laboratory. Well Adr: 3315 Graham Hill Rd Orono,MN [Laboratory name;address;MDH Lab IDtt]. The subcontracted laboratory Owner: maintains MDH Certification for the field(s)of testing Owner Adr: Sample Conditions: Sample Temperature: 9 °C Discussion: Notes: Approved methods used in analyzing the samples This Sample meets the listed above have the following reporting levels: Maximum contaminant levels: State of Minnesota, SM9222B- Coliform-<1 cfu/100 ml Wisconsin and EPA Coliform, 1 cfu 100 ml Nitrate Nitrogen 10.0 mg/I / guidelines for safe SM4500D- Nitrate Nitrogen, 1.0 mg/I Arsenic,10.0 µg/I drinking water for the SM 3003-Arsenic, 2.0 /� Lead,15.0µg/I µg analytes tested. , � �^ �/ i� a.G Sample Collected by: X Client _TCWC Approved By: ,,� ' `�L` 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