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Home My WebLink Aboutwell info a MINNESOTA UN/QUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. ' County Name WELL AND BORING CONSTRUCTION RECORD ��3� 3� � J R Minnesota Statutes,Chapter 103I �— � � Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED 23 t32 NE ?V� SW�� 172 " 27-1.6 � GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven `�Auger '6dRotary House Number,Street Name,City,and ZIP Code of Well Location []Other �� DRILLING FLUID WELL HYDROFRACTURED? ❑Yes o Show exact location of well/bonng in section grid with"X" Sketch map of well/boring loc tion. �t�C From ' fl.To ft. Showing property ines, N roads,buildings,and dir tion� USE No cosmmunit PWS ❑Env ronl Bore Hole'�� Heating/Cooling I I I I ��Industry/Commercial - -- --- ---- --- - +� Y ❑ -'--- , � _ . _ ; � ; � ��Communiry PWS ❑Irrigation ❑Remedial , � , , � , (=;Elevator Dewatering � w ; ; ; ; e T CASING MATERIAL Oeo HOLE DIAM. Drive Sh ❑Yes o --'-"" "-�--- ---�-- -"'''" I "'� ❑Steel []Threaded ❑ elded ; ; : ; ,1M ; ; ; ; w� �� Plastic ❑ ";'____�___ __;"___�_ ile ` � � , � r CASING � � S � � � �`� Diam/eter Weight Specifications �--1 Mile----i � `i' in.To �� ft. Ibs./ft. � in.To�� ft. PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. Ibs./ft. "'� in.��ft. '��eC Tj�s in.To ft. Ibs./ft. in.To ft. Property owner's mailing address if ditferent than well location address indicated above. SCREEN OPEN HOLE (i4W �1��1� T�� S Make �?��n�� From ft. To ft. �i� MMt�II 55340 r.. TYPe �_s—t _�_1 Diam. .N � ... .; ._� .gLii.LiTr�.� 3iC� ,.�.,, :�� SbUGauze Length Set between � � .and it. FITTIN STATIC WATER L� �;,` `� va ��q� �� Measured from i ft. � Below n Above land surface Date measured WELL OWNER'S NAME/COMPANY NAME n PUMPING LEVEL(bel w land surface) `��eP �`.r ��;E� ��ft.after � hrs.pumping '� q.p.m. i Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �j Pitless/adapter manufacturer Model ❑Casing protection �12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-�ement,concrete,cuttings,or other) Material ��tQ�t�rom v To ��✓ft. � ❑Yds. �j(Bags Material natueal ��1 Sa To 1� ft. �Yds. ❑Bags HARDNESS OF Material__ From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS CO�OR MATERIAL FROM TO Driven casing seal From To T Bags NEAREST KNOWN SOURCE OF CONTAMINATION I, clay brc�en mec�3.wn 4 38 , `� ' / A ..� feet /V direction'._�_�`-" �•:.:-�..1.-s-r1y .��j�•18�' b��Z �d�� `+5 b� Well disinfected upon completion? Yes ❑No .�:.� �+..j a PUMP �[A�.f��el 6.11aL+Li $Q�t 7C� C�[� ❑Not installed Date installed f' Manufacturer's name �'i(`�;Q��L ��/Ci��/ �rr�y ��t �Lf� LG� ModelNumber HP 1NJ Volts {' Len th of dro i e 1�1C ft. Ca acit m t ,��.�71 11 tG 9 PPP�� p Y 9P C1$J�`S$� t)�� 1'l�f�t�11 LSV 1V� Type: Submersible ❑LS.Turbine ❑Reciprocating �Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? �Yes No VARIANCE Was a variance granted from the MDH for this well? [�Yes No TN# WELL CONTRACTOR CERTIFICATION '�. This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,il needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. tkm Stadola �de11 Drilli = Dnc. 1691 Licensee Business Name Lic.or Reg.No. / . . _.--� .�', 12—$�-16 C ie e n ative Sign ure " +'' C�rtified Rep.No. Date Rab Stodola � L06AL COPY H 2 3 4 3 O Name of Driller � ID#52603 HE-01205-15(Rev.e/13) y `4 : Minnesota State Laboratory ID#027- 53-119 ' TWII7 Cltyj WBtI'i''C�It11C �8�J01'�tOP�►TeSt_REpOf't wisconsin State Laboratory IDq 105- 0117 � - `� ` ' _{Nisconsin DNR!;Lab ID#399073400 �, . .. . ... . _ ,. .. . Client: on Stodola Well Driliing Report Number: 16-13439 Twin City Water Clinic inc. Sampie Collection Date: 09/27/16 617 13th Avenue Sou h Address: Sai North Main Street Sample Collection Time: 15:00 Hopkins,MN 55343 t.eonifacius,MN 55375 Sample Receipt Date: oe/zs/�6 Phone:(952)935-355 Report Issue Date: 09/29/16 Fax:(952)935-5077 Laboreto Ana�yte Client,ID Paramefer ', :;Sart�ple:;Prep^�;, ,Sample"Analysis '; Test` Sample,ID - ,,,Date � �Time,;', Q,ate „ ''�Time 'Results nits 16-13439 Coliform Drinking Water 09/28/16 13:01 Absent 16-13439 Nitrate/N Drinking Water 09/28/16 1639 <1.0 g/L 16-13439 Arsenic Drinking Water 09/28/16 8:50 09/29/16 12:04 12.60 g/L Lead Drinking Water g/L Nitrite/N Drinking Water g/L Drinking Water Drinking Water :"Weli No.: 823430 X No samples w, e subcontrec�ed•or tl�e�aboye.test reSult(s);` Sam le t with"`*`designa on were produced by;a subcori#racted _ P P � Well laboratbry. [Lab ratory na'me,a�ddress;.MDH LabjlD#j The �.Well Adr. 525 Keen Avenue;Orono,MN subcoritratted la qratory maintains MDH CeR�cation fortlie ; Owner: Zehndu HomeS field(s)of testing performed.! . �' Owner Adr: � Sample Con�litions: Sample Temp: 12°C Discussion: ', Notes: ,. _ ._. -. �„- , . . . Approved met ds used in�nalyzing the samp�es�i ted Maxim m co ta�'nmant levels � A� � � � above have the following r,epq�t�n8;le�els ;,�'�"��,,��x Gp�if;arl,r'+��fij f�1�QOfm(' � ' SM�22�B Coli arrn,1 cfu J��00 ml: ;�{, „ ,,1 r Nit�at��Il�t�Q gr��,p�ng/IL , �f� ,�y! fk -�� i;�iw^wa e �.t t ' � SM4500�or EP r353 2 Nifrate`Nrtrogeln,��.O,kr�p��/L��+ Q,��s�ruc�� /�` ,,� 4 � � ��" ' � ' SM3113B Ars ttiC 20. ��/1 L2a�I;2q �`L "�;`� � � �� r�'��` �� }lg(y, E ��'� ��! r C2ld,��,t�4 4@�G rx��J s �� EPA 353':2 Nit ite NitFogen,l0 r11�/L '��"'� ��N�t�t�esl�rr��►.� '�5' ��` �, �� ` 3 � �� ' �� , �: Sample Coll�cted by: X Client _TCWC Approved By: `i�'''3�� G��.�s��c�r =�-� � Bill Van Arsdale lan Senechal Laboratory Manager nior Analyst The results listed n this report apply only to th�e above listed�sdj�p�es��40 rqutjoe qual�Ey�aSs�wdncR procedure6,;wgre followed�urilesf of erwise . � ; noted.This anal ical rep'ort must be reported i�its�entirety�All�net�qS�s ar�ce�t�ed�by tH�,��V11�qe�ota Departme�t of Health,,unless o erwise � � ' � � ;s�`' '' K`:'� w# Zt�y� n� f-;fj 1 � dr�i�''� re a hOtBd f �� (;`.�q � t! v" � h k . � ,.7��,I�, ��tni! y't�f�. k�.� ,i TCWD Rev 2A Page 1 of 1