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Home My WebLink AboutWell Record MINNESOTA UNIQUE WELL WELL OR 30RING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BOR/NG NO. County Name� WELL AND BORING CONSTRUCTION RECORD g�3 4 6� Minnesota Statutes,Chapter 103I Township Na e Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED �� " 2-15-17 GPS LOCATION—decimal degrees(to tour decimal places). DRILLING METHOD � Latitude Longitude ❑Cable Tool ❑Driven ❑Auger �otary House Number,Street Name,City,and ZIP Code of Well Location �Other DRILLING FLUID WELL HYDROFRACTURED? ❑Yes �No a Show exact ocation o well/bonng in section r with"X:' Sketch map of well/boring location. ��t��t� From ft.To ft. Showing property lines, N roads,buildings,and direction. USE �/Domestic ❑Monitoring ❑Heating/Cooling __j___ __j___ _.!_____;__ ❑Noncommunity PWS ❑Environ.Bore Hole �]Industry/Commercial ` � ❑Community PWS ❑Irrigation �Remedial _ _---- -- �YT� �Elevator C�Dewatering ❑ _ w E t� *� CASING MATERIAL Drive Shoe? ❑Yes �IQo HOLE DIAM. : � ; ; T r --,-- --:----�- ---:- ; [;Steel ❑Threaded ❑Welded p 1 I � � ne 'h M' �Plastic ❑ � -� - � 1 ; - .- ;--- - � - .- ; ; ; ; CASING S Diameter Weight Specifica[ions a /� : ; �Miie ,r_ . ` � in.To 139 ft. Ibs./ft. v in.To �`'ft. ` �— --� � ��,� ,-�..�.,.__,_,... -�-�,,�,_ b% 15j'� PROPERTY OWNER'S NAME/COMPANY NAME in.To tt. Ibs./ft. 4 in.To `'lt. in.To ft. Ibs./ft. in.To ft. PFop r wne's mai mg dress if different than well location address indicated above. SCREEN OPEN HOLE Make T..l+..e.... From ft. To ft �., I8225 4Sth Ave N, .�St� �} Type Diam. w P1S1fMy�th+ t'u'� SJf-F[�V SIoVGauze 4 Length ',y 1�}�� Set between � � ft.and ft. FITTINGS 'r' STATIC WATER Measured from ft.y�elow ❑Above land surface Date measured � WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) RECEIVED LJ� ft after � hrs.pumping � g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION APR 0 4 2017 Pitless/adapter manufacturer �� Model ❑Casing protection �(2 in.above grade Y ❑At-grade ❑Well House [�Hand Pump C�TY OF ORONO GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material LCX3tv�i1t�From � To 5� ft, 3 ,J Yds. ,�'�8ags Material(„`(��t f(�s From�O To 13� ft. ❑Yds. ��.Bags HARDNESS OF Matenal From To ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOR MATERIAL FROM TO Dnvencasirgseal From To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION �1gy Vr�� `� � �� >= �7"�� feet �--'�.. direction ��--<... type .�e C/�Well disinfected upon completion? es ❑No .�SIKi C1Sy gC�p ��L�R .?C�.� JV PUMP t� r n n❑Not installed Date installed �� 1'r� �it �t�� v Manufacturer'sname Madel Number HP 1.5 Volts Ll Length of drop pipe 1L/� ft. Capacity g.p.m. Type:� ubmersible ❑LS.Turbine ��Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes o VARIANCE ;� Was a variance granted from the MDH for this well? ❑Yes o 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 hue to the best of my knowledge. Use a second sheet,il needed REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodola Well Dcilling Co�. Inc. 1t9I Licensee Business Name Lic.or Reg.No. i ��7 .--�'" r t ' d� epresentative ig ature Certified Rep.No. Date r � 8 2 3 61 Rob scoao�.8 LOCAL COPY a Name of Driller ID#52603 HE01205-15(Rev.8/13) p Minnesota State Laboratory ID#027-053-119 Twin City Water Clinic Laboratory Test Report Wisconsin State Laboratory ID#105-10117 Wisconsin DNR Lab ID#399073400 Client: Don Stodola Well Drilling Report Number: 17-01863 Twin City Water Clinic Inc. Sample Collection Date: 02/15/17 617 13th Avenue South Address: 3841 North Main Street Sample Collection 7ime: 16:0o Hopkins,MN 55343 st.Bonifacius,MN 55375 Sample Receipt Date: 02/16/17 Phone: (952)935-3556 Report Issue Date: 02/17/i� Fax:(952)935-5077 laborato Analyte. Client ID Parameter Sample Prep Sample Analysis Test Sample;ID Date Time Date Time Results Units 17-01863 Coliform Drinking Water 02/16/17 12:51 Absent 17-01863 Nitrate/N Drinking Water 02/16/17 12:40 <1.0 mg/L 17-01863 Arsenic Drinking Water 02/i6/17 9:00 02/17/17 11:12 3.37 µg/L lead Drinking Water µg/L mg/L well No.: 823461 X No sampies were subcontracted;or the above test�esult(s) Sample pt: Well with'*"designation were produced by a subcontracted laboratory: [Laboratory name;address;MDH Lab ID#]. The Well Adr: 770 Lakeview Parkway;Orono,MN sub�ctntraCted lebor�tory maintains MDH Certification for the Owner: Norton Homes field(s)oP testing performed. Owner Adr. Sample Conditions: Sample Temp: 10'C Discussion: Notes: Approved methods used in analyzing the samples listed Maximum contaminant levels: �tioYe hav�'the following reporting levels: Coliform-<1 cfu/100 ml SM92226-Coliform;1 cfu/100 ml Nitrate Nitrogen 10.0 mg/L SM45bOF or EPA 353.2-.Nitrate Nitrogen,1.O mg/L Arsenic,10.0 µg/L SM�S139-Arspnic,2.0µg/I,Lead,2.0 µgJ t Lead,15.0µg/L �PA 353.2-Nitrite Nitrogen,1.0 mg/L Nitrite,1 mg/L Sample Collected by: X Client _TCWC Approved By: ��,y-"�"��`� Bill Van Arsdale Laboratory Manaqer The tesulu listed in this report apply onlyto the abovelisted samples.All routine quality assurance procedures were followed,unless otherwise nofed.This analytical report must be reported in iu entirety.All methods are certified by the Minnesota Department of Health,unless otherwise noted. TCWD Rev 3.0 Page 1 of 1