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Home My WebLink Aboutwell info M/NNESOTA UNIOUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 7 7� � 5 3 ��ep�� Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED t}rvr�o lI7 23 OS P3F ?�,�NS ,� 229 " — GPS DRILLING METHOD Latitude degrees minutes seconds LOCATION: ' -'Cable Tool � �Driven Dug Longitude degrees minutes __ seconds - � [�Auger ��`Rotary . �Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number '�, .7�JS Gi�i[�;) iii�� Rd� L„riy«{�7 SS3SC� DRILLING FLUID WELL HYDROFRACTURED? �'�Yes C,�1Uo Show exact location of well/boring in section grid with"X" Sketch map of well/boring lo a� ��e Showing propert lin From___. _ft.To ft. roads,buildings,and dir dtiOR. USE Monitorin I-'Heatin /Coolin N �Domestic I� 9 9 9 � � � � �� ❑Noncommuniry PWS �. =Environ.Bore Hole �._�Industry/Commercial --'-- -'------Y-----•-- � �. �-�' �>,,v' _ _Community PWS ��,-,Irtigation L,Remedial ; 1 1 I i -�� `, -,. --- - ---- --- -- � L'�,Elevator �,_ ,Dewatering __, w ; ; ; ; e� � CASING MATERIAL Drive Shoe? ❑Yes ;h�,No HOLE DIAM. --'--- --�""" """�-- ---'-- � �� "Steel �1 Threaded Lj Welded ; ; � : �� e �,� �— �M i � ,�Plastic L I --�-----�--- ---%- --�- 4 . CASING S � Diameter Weight Specifications F--1 Mile-� �' � in.to_.��__fL . Ibs./tt. _____ v# in.to �`n�' ft. PROPERTY OWNER'S NAME/COMPANY NAME � _ in.to ft. Ibs./ft. ��i in.t��7 ft. �=�e� ��$ YL.�..�, in.to ft. Ibs./ft. in.to ft. ;JCi A7 V V SCREEN OPEN HOLE Property owner's mailing address if dif�erent than well location address indicated above. � -- 2�45�J 23cd Ave r� Make� From ft. To ft. {� �T �je�y�L Type ��-�_�� _ Diam.__ : P��=it: 1��'� " - "Y� SIoUGauze .�_ _ _ _Length �� Set between ft.and ITTINGS � p STATIC WATER LEVEL 3�� Measured from��..� L ft. Below ��I Above land surface Date measured �+ '�� +� WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(bel w land surface) �� ft.after___ �� hrs.pumping +�� g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �'- ',-'�• __�-_.. �Pitless/adapter manufacturer -' del ;Casing Protection ._ �'12 in.above grade �At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION G olut m�aterf"'�a s�`��eat cement�$entonit��.�C,oncrete ��Other x �'��I'��`g From 5`3 To � ft. �'�� 1 Yds. �, �Bags HARDNESS OF �� To��._ft. � � j�,Yds. �Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO , From _To_._ ft. �I Yds. �,�Bags ? /� NEAREST KNOWN SOURCE OF CONTAMINATION �.'1��T y��l� ��_ � �tJ �-^.. "�.) feet �" '-f direction ..._.,,��-_ ' type Well disinfected upon completion? �,�'es I�No � clag �;r8y soft 10 14C3 pUMP �� Not installed Date installed �� ,_ '"� "' Y '�� r�� sof t 140 2�?3 ` `, . ,•_ . .� ManufacturePs name " � . t �.i8y {�� ct �� .y�� Model Number ��"HP ,... Votts -�'" � ��1 � 1 U l L . Length of drop pipe '��f� �� ft. Capacity g.p.m. �t�C'� b� �Qf t Z'�,'L ",�,'�� Type:'� Submersible �LS.Turbine []Reciprocating [�Jet ❑ _ ABANDONED WELLS Does property have any not in use and not sealed well(s)? '�.�Yes �No VARIANCE Was a variance granted from the MDH for this well? ��Yes f�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,etc. Z�on Stodol�. �IeII Dril23n,�Ca., Inc Licensee Businyss�Vame Lic.or Reg.No. �� (� i, �`� `�� .1 Y. -I !'� � �':�� ,Eertified Representative Signature Certified Rep.No. Date C�t�k Moore LOCAL C(�PY � � �:.� J � Name of Driller IC 140-0020 HE-07205-12(Rev.12/OB) . � Minnesota State Laboratory ID#027-053-119 Twin City Water Clinic Laboratory Test Report N/isconsin State Laboratory ID#105-10117 Client: Don Stodola Well Drilling Co Report Number: io-oisiz Twin City Water Clinic Inc. Sample Collection Date: o9/Zi/io 617 13th Avenue South AddYess: 38a�North nnain Street Sample Collection Time: ia:oo Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: o9/Zi/lo Phone: (952)935-3556 Report Issue Date: o9/ia/io Fax: (952)935-5077 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 10-09083 Coliform Drinking Water 09/22/10 14:18 Absent 10-09083 Nitrate/N Drinking Water 09/22/10 12:49 <1.0 mg/I 10-09083 Arsenic Drinking Water 09/22/10 9:00 09/23/10 11:49 <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) Sample Conditions/Discussion/Notes: with'**'designation were produced by a subcontracted laboratory. Sample Location-Charles Cudd 3355 Graham Hill Rd.Orono,MN [Laboratory name;address;MDH Lab ID�f]. The subcontracted laboratory maintains MDH Certification for thefield(s)oftesting performed. Sample Temperature: 10 °C Sample Conditions: 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. /�� /,' � ; 'l.C�1<�c..tcl.Ctt-�� ; �.. 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. TCWD Rev 1.2 Page 1 of 1