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Home My WebLink AboutWell info . - .. _. , .._.. u.: �<_. �.. .�. .__ ,.�. . _., T ... . ,. . .., . , .- .. . . : .. MINNESOTA UNIQUE WELL � ' WELL OR BORI�OCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. : co,,,,tY Name�"- ,, � WELL AND BORING RECORD 7 8$2 4 O Minnesota Statutes,Chapter 1037 Township Name Township No. Range No. Section No. Fraction WELL/BORWG DEPTH(completed) DATE WORK COMPLETED � Zt7 23 os ,sw �,B riE,, 1s5 n 4-2�-12 GPS DRILLING METHOD LOCATION: Latitude degrees minutes _ seconds _ Longitude degrees minutes seconds ❑Cable Tool riven ❑Auger �Rot�ry House Number,Street Name,City,and ZIP Code of Well Location Fire Number ❑p�her DRILLWG FLUID �"'�'WELL HYDROFRACTURED? ❑Yes No Show exact location of welUboring in section grid with"X:' Sketch map of well/boring locati . �te� From ft.To ft. Showing praperty lin s, - roads,buildings,and direcf n. USE f .' N Domestic U Monitoring ❑Heating/Cooling �� __j___._i____;__ ___;__ i �Noncommunity PWS n Environ.Bore Hole ❑Industry/Commercial i ,,:. , � � _ � Community PWS [.�Irrigation �]Remedial � __�_____; < <__ � [�Elevator U Dewatering - w ' ; ; E T � �� CASING MATERIAL Drive Shoe? ❑Yes �No. HOLE DIAM. �- - ' -�-----� I .. "t�.�Steel- i�Threaded �'Welded , , � '/e Mlle � -_, Plastic ❑ ` --�--- --�--- ---%-----�- ; ; ; ; CASING S Diameter Weight Specifications i �1Mile-� � in.To�� ft. Ibs./ft. � in.To �� ft PROPERTY OWNER'S NAME/COMPANY NAME ____in.To ft. Ibs./ft. �in.T�ft �vpL. &�ld�rp __ in.To ft. Ibs./ft. in.To ft j... ..� SCREE OPEN HOLE Property owner's mailing address if different than well location address indicated above. -- $� J�i35 Ct'� Ra 1�1 Make From _ft. To ft. " �(�tV[liV;e� �+I 55345 TYPe--$t�inless atee Diam. / - `. SIoVGauze ____. .OiO_ Length 4! "�'��___ Set between ft.and ft. FITTINGS R * �� STATIC WATER LEVEL Measured from ft.�Below ��Aboveland surface Date measured � WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �� fl.afler � hrs.pumping �� g.p.m. Well/boring owner's mailing address if different than properry owner's address indicated above. �LLHEAD COMPLETION ' Pitless/adapter manufacturer��-- Model ❑Casing protection �12 in.above grade � ❑At-grade ❑Well House ❑Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Matenal �r��rom O To_5" ft. � ❑Yds. �.'Bags Material natucsl f��. 50 To 1� ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOR MATERIAL FROM TO Drivencasingseal From To Bags NEAREST KNOWN SOURCE OF CONTAMINATION a �/C.l feel w direction ��. �a-e4' type Well disinfected upon completian? �Yes ❑No PUMP A +�f ❑Not installed Date installed_ �`��L ___ Manufacturer's name �`�I�� _____ Model Number HP 1�5 Volts �� Length of drop pipe �9L ft. Capaciry_ g.p.m i Type:�Submersible ❑LS.Turbine ❑Reciprocating ❑Jet U ; 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? f�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. JUN Don Stodola Well Dri113 Co . Inc. 1691 CITYOF ORONO Licensee Business Name ic or Reg.No. _--- � if' epresentative Signa e, Certified Rep.No. Date 7 8 8 2 4 0 �rt st«�o18 ` ,-�rv;� ,�,,; _- -- � Name of Driller � IC 140-0020 HE-01205-13(Rev.11/10) � � Y Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 Client: Don Stodola Report Number: iz-�os Twin City Water Clinic Inc. Sample Collection Date: oa/Zs/iz 617 13th Avenue South Address: 3841 N Main St Sample Collection Time: io:oo Hopkins, MN 55343 st,Bonifacius,MN 55375 Sample Receipt Date: oa/z6/ii 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 12-04305 Coliform Drinking Water 04/26/12 12:23 Absent 12-04305 Nitrate Drinking Water 04/26/12 12:03 <1.0 mg/I 12-04305 Arsenic Drinking Water 04/26/12 9:00 04/27/12 10:04 <2.o 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.: 788240 with'**'designation were produced by a subcontracted Sample pt: laboratory. [Laboratory name; Well Adr: 75 Leaf St Orono,MN address;MDH Lab ID#). The subcontracted laboratory maintains MDH Certification for the field(s)of testing Owner: BOyer Bldg performed. Owner Adr: Sample Conditions: Sample Temperature: 7 °C Discussion: Notes: Approved methods used in analyzing the samples This Sample meets the listed above have the foliowing 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. 1 � \ � � � /�///Jj� ` I 'V//� / L:4�GOHJ'�5�^GS��f��_ Sample Coilected by: X Client _TCWC Approved By: ,,� " � Bill Van Arsdale Afan 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. 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