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Home My WebLink Aboutwell info WELL OA BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH MIN AEND BOR/N��G NO. ELL ' co��tY Name WELL AND BORING RECORD 7 g g 2 3 8 v_�� Minnesota Statutes,Chapter f037 [7Ci�iC Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED 4rono 217 23 S 1� NR,2�E ,, 230 n 4-2G-12 GPS DRILLING METHOD ` �OCATION: Latitude _ degrees minutes seconds Longitude degrees minutes seconds ❑Cable Tool ❑Driven - ❑Auger �otary House Number,Street Name,City,and ZIP Code of Well Location Fire Number ❑Other 3.7�� C�R�I� 1'�ill 1�.� Ot�b Sg3�b �DRILLING FLUID � LL HYDROFRACTURED7 ❑Yes _ o �� Show exact location of well/boring in sectio with"X° Sketch map of well/boring location. Q$ter From ft.To ft. Showing property lines, roads,buildings,and direction. USE N ,�Domestic ❑Monitonng ❑Heating/Cooling __J__ __�_____________ �� ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial �� f Community PWS ❑Irrigation ❑Remedial --1--- --;-----F—--f— �._,l Elevator ❑Dewatering ❑ '� '- W , , , ; E � CASING MATERIAL Drive Shoe? ❑Yes ,�No HOLE DIAM. �� , , , T ��: --,-----.------�-----:-- '4�-[��-�Steel�.� ❑Threaded ❑Welded � � � � � � , , , , '/Mile .'��.PI �] , , , , I astic � --;-----�------�-----�- 1 ` F CASING � � S � � � Diameter Weight Specifications �7 Miie� ��y(�,�, � in.To `lv ft. ---+� Ibs./ft. � in.To �ft �� PROPERTY OWNER'S NAME/COMPANY NAME _in.To___ft.�� Ibs./ft. �in.To��ft . -.,;� S�� **/+ __in.To ft. Ibs./ft. in.To ft ZY'�� OPEN HOLE . Property owner's mailing address if different than well location address indicated above. SCREEN _ -�- 7�4V1 ��r�t� �� +7�f� �iJV Make— •��t -_ From ft. To ft. y '' �tt / t Type St8�I1.[��' _��1 Diam. i'7LL��1�.4� � ��1�4 -- ��[�. _ Length 1}� ♦ � . SIoVGauze ___ � Set behveen ft.and tt. FITTINGS * ! �••�t� IQl� STATIC WATER LEVEL Measured from �� _ft.,�3elow j]Above land surface Date measured�� WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �� ft.after � hrs.pumping_ �" g.p.m. WelUboring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION sj t�t�r Pitless/adapter manufacturer��lYl Model ❑Casing protection __ �12 in.above grade ❑At-grade ❑Well House L]Hand Pump GROUTING INFORMATION(specify bentonite,cemenbsand,neat-cement,concrete,cuttings,or other) z_ Material[�a�tVf,iite From � To SO n. 3 ❑Yds. �ags Matenalffit 4lAl '��_��To��ft. ❑Yds. '�_J Bags HARDNESS OF Material From To ft. ❑Yds. L;Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To Bags NEAREST KNOWN SOURCE OF CONTAMINATION �0 i1 bl� ��t Q ` �� feet � direction ""r�a� type ^ Well disinfected upon completion? �Yes ❑No �� j$� G � PUMP ❑Not installed Date installed ��_�� :.,. C28 I��t�!! �� Manufacturer's name �� ___ ___.__ C� � �� Model Number HP 1.5 Volts__ Lengih of drop pipe �C77 ft. Capacity g.p.m �� a �2� ��L ��C Type:�Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ��=3 •�E� � qgANDONED WELLS �7 —_�i � �ij� 1 c! Z•�/� Does property have any not in use and not sealed well(s)? ❑Yes�No 1 :f�iAd �lj• 1'» '�� VARIANCE Was a variance granted from 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 il needed. REMARKS,ELEVATION,SOURCE OF DATA,g�c��'*/�B R � Don Stodals i�ie1.1 Dtillft��, Ccs,. It�. 164�_ 20�� Licensee Business Name Lic.or Reg.No. F�B � � � _ 8-22-22 C.�/ ORONO -- — - = j'� I � resetitative�6Cgnat re ` Certified Rep.No Date Rob Sttadola �_��L��.:,, 7�8 2 3 8 - Name of Driller IC 140-0020 HE-01205-13(Rev.11/10) 1 . � Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#305-30117 Client: Don Stodola Report Number: i2-�oe Twin City Water Clinic Inc. Sample Collection Date: oa/is/iz 617 13th Avenue South Address: 3841 N Main St Sample Collection Time: i6:oo Hopkins, MN 55343 St,sonifacius,MN 55375 Sample Receipt Date: oa/z6/i2 Phone: (952)935-3556 Report Issue Date: oa/z�/iz Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 12-04306 Coliform Drinking Water 04/26/12 12:24 Absent 12-04306 Nitrate Drinking Water 04/26/12 12:05 <1.0 mg/I 12-04306 Arsenic Drinking Water 04/26/12 9:00 04/27/12 10:52 <2.0 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water X No samples were subcontracted;or the above test result(s) Well No.: 788238 with'**'designation were produced by a subcontracted Sample pt: laboratory. [Laboratory name; Well Adr: 3340 Graham Hill Rd Orono,MN address;MDH Lab ID#]. . The subcontracted laboratory maintains MDH Certification for the field(s)ofYesting Owner. Stonewood LLC performed. Owner Adr: Sample Conditions: SampleTemperature: 7 �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, SM92226-Coliform, 1 cfu/100 ml Coliform-<1 cfu/100 ml Wisconsin and EPA Nitrate Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen,1.0 mg/I Arsenic,10.0 µg/I guidelines for safe SM 3003-Arsenic,2.0µg/I Lead,15.0µg/I drinking water for the SM3113-Lead,2.0µg/I analytes tested. �7 ,�� . � � n/� ' i / �..'. 1 . v �:fs r_-c.�l� Lc.t�.Li'�./ . Sample Collected by: X Client _TCWC Approved By: ' '� 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.