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Home My WebLink Aboutwell info .. ,,., ;; --��,,,,,.,.,.. �,� ` MINNESOTA DEPARTMENT OF HEALTH M/N AND BORINI�G NO. ELL WELL OR BORING LOCATION � County Name WELL AND BORING RECORD � � p 0 4 6 �� Minnesota Statutes,Chapter 1037 Township Name �. Township No. Range No. Section No. Fraction WELUBORING DEPTH(comple[ed) DATE WORK COMPLETED Orcmo 117 23 07 � Nt� P�3�, lI0 f� 12-32-49 GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds , � Longitude degrees minutes seconds . ��Cable Tool '��.I Driven �_J Dug . �'Auger ��Rotary �. �Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number L..I DRILLING FLUID WELL HYDROFRACTURED? i___J Yes �.Ao Show exact location of well/boring in ction grid with"X" Sketch map of well/boring I cation. �'�intonite From ft.To ft. Showing proper linea�� --- N roads,buildings,and di ection: USE i=ynomestic , �., �,. ❑Monitoring ��Heating/Cooling ,� _J__ ._1.___L__ ._:__ `,, ��{�' ',_Noncommunity PWS ❑Environ.Bore Hole U Industry/Commercial �� •' � .,._ ,��.''��'''''''''�'`'^''�"� , ,^Community PWS �,�1 Irrigation ❑Remedial - - - �'.~1 y� I �Elevator n Dewatering ',� '�'� E T r } CASING MATERIAL Drive Shoe? [_Yes �No HOLE DIAM. I � _'Steel I`Threaded ❑Welded 'h Mile '' —'Plastic ' - - -- 1 �� CASING. ��` _ g 4 1 , Diameter Weight Specifications j..� �i M;ie� �_in.to__jj�fl. �Ibs./ft. __ _�in.to�� PROPERTY OWNER'S NAME/COMPANY NAME in.to fL Ibs./ft. in,to ft. �2` Tw� L, in.to ft. Ibs./ft. in.to ft. .tEl7 JtJCJ I� � OPEN HOLE Property owner's mailing address if difterent than well location address indicated above. SCREEN _ � Make ��t'�]$Q[i From _ft. To ft. TYPe ��.��1deS e�1 Diam.��» -- rcrrc � �'r�— SIoUGauze h1 n Length • Set between ft.and ft. FITTINGS � STATIC WATER L Measured from --—....---_-__— .: __�_______tt.��' elow ❑Above land surface Date measured 12�31�9 ' WELL OWNER'S NAME/COMPANY NAME PUMPWG LEVEL(below land surface) 93 ft.after 2 hrs.pumping Z� g.p m. Well/boring owner's mailing address if different than property owner's address indica�ed above. WELLHEAD COMPLETION [�Pitless/adapter manufacturer — Model a[ �S`S�l-��.�-�"i'" ��Casing Protection � I„�-2 in.above grade �At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well grouted ,�CYes �J No Grout materials ��=J Neat cement �'Bentonite L]Concrete !�Other_ From�To�ft. _� U Yds. [�Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From�__To_�.ft.�},�$��'�s. ❑Bags MATERIAL From To ft. ❑Yds. ❑Bags NEAREST KNOWN SOURCE OF CONTAMINATION �0 ��f A ��`�S. .�L� Q � � t=....� feet -,.3.> direction F ��-� . ..,-:.tS,�. Well disinfected upon completion? �'Yes ❑No .;�,_, �„�,�.,,;..._,;$ G�.B e��.C1Ed (f�s� et PUMP ❑Not installed Date installed �;�-�'� C�a •� �r8 �� 'K, 7S Manufacturer's name "`-- .. ,�`=,� /� t Model Number HP�Volts � �'~ ` �� l7�1'� 7" j�O Length of drop pipe �i U ft. Capacity g.p.m. Type:�� ubmersible ❑LS.Turbine ❑Reciprocating ❑Jet ❑ ABAN ONED WELLS � Does property have any not in use and not sealed well(s)? �_.J Yes ��- No VARIANCE Was a variance granted(rom the MDH for this well? U Yes �� No TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. ' The�f-rID'tigP:o ine�i jn th��Ro��th�be�s�t.f m�no�'w:edge�. �ivisic� of Use a second sheet,if needed. � S j j i VS) . ' REMARKS,ELEVATION,SOURCE OF DATA,etc. !�j .7todola i�ell Dc3llirt� C�,. ��..'• 1��1 Licensee Business Name Lic.or Reg.No. � � ,�� :� �, :� Re�re�entative Signature i Certified Rep.No. Date LOCAL COPY 770046 J� ��'I� Name of Driller �C 140-0020 HE-01205-11(Rev.3/07) Laboratory Test Report Engel Water Testing, Inc. 9300 County Rd. 15 * Minnetrista, MN 55359 Phone: (952) 955-1800 Fax: (952) 955-1806 Minnesota State Certified Laboratory#027-003-105 * Wisconsin State Certified Laboratory#105-10115 Don Stodola Well Drilling Co., Inc. 3841 North Main Street St. Bonifacius, MN 55375 Water Test Location: Report Issue Date: January 28, 2010 Tim Ertmer Year: 2009 1027 Linden Lane Date/Time: Sample Collection: 1/18 3pm Orono, MN 55364 Date/Time: Sample Recd.in Lab: 1/19 7pm Well Unique Number: 770046 Laboratory Test Number(s): 10-7617 & 10-7617A �Required when critical to the validity and application of the results LaUoratory �atslTune Dat�/'�'im� 'T�s€R�s�tlt� ' 'T"�st l*Ta:: l�afnx' � ; t��Zpraverll�Etlioi� ;... Sa� .e�'i'e .,...;. Cu�a�s? ;: ; Aual sls: .. u a , Coliform SM 9223 B 18'�ED 10-7617 gacteria 1/19 7pm 1/20 7pm *Positive Colisure<C1 10-7617 Nitrate 1/20 4 m 1/20 4 m 1.0 m per ISE Methoa SM 4500- P P �' NO3 D 18 ED 10-7617A **Arsenic 1/22 10:40am 1/25 12:30pm <0.002 mg/L SM 3113 B-99 Allowable Limits: ➢ Nitrate Nitrogen,mg/L: Maxunwn allowable lunit is 10.0 mg/L or Less ➢ Coliform Bacteria: Allowable L'unit is NEGATNE A Lead,mg/L:Maximum allowable limit is 0.015 mg/L or Less h Y Arsenic,mg/L: 0.010 mg/L or Less—(0.010 mg/L or more exceeds the NIDH-recommended health limit for long-tenn consumption of arseiuc n�drinkuig water. Subcontracted test results: O No samples were subcontracted;or G�The above test result(s)with"*'"designation were produced by Stearns DHIA Laboratories,825 12�'St. S.,Sauk Ce�iter, MN 56378(MN Cert.No.027-145-378).The subcontracted laboratory maintains MDH certification for the field(sl of testing performed. *Discussion/Notes: These test results are not within the allowable limits for Coliform Bacteria. Report authorized by: � Date: January 28, 2010 Kathryn M. Engel, Laboratory Dir ctor The results listed withui the report relate only to the samples received on the dates indicated. This report must not be reproduced,except in full,without the written approval from Engel Water Testing,I�ic. Created by Engel Water Testing,Inc.October,2008 Page 1 of 1 � . 82�121h St.So.,P fl Booc 227, m !3�----� Stea r�ns Q H fA �abor�far�es �r Sauk CenEre,MN 5fi37&0227 � MN Lab ID#4Z7-145-3i8 324.3522026 Pbo�e � 806.369.2697 Toll Free 320.8528163 Fax a � R 8 O R A�`O�t I E S s earnsdhlalab�sbearnsdh9alab,ccan Repo�-t of Analysis Sample IDllnvoice#: 071G13 Name: ENGEL V4'ATER TESTING INC Aceount#: aa3?32 9300 OOUIti'T'Y RD 15 Internal�D�: 894t2 � MIl�ijhiETRISTA,MN SS359 Sample T�pe: 1�4'atea� � Clieat Sampde ID: 10-7617A,ERTMER,102?LINDERf LN,�JRdNd MN Sarr�ple Date: 1/18.+2410 3:00 PNI � Report Dare: 11261201{I Sampler: STODdLA A Date: 1126R010 Receipf Date: 1l22�2010 8;4Q A?►�[ Z Receipt Ternp: iriane w Analyte A�proved Method Repartiog Sample Unif� Sample Prep Anal��sts Anal�•st' MDH � �imit Result r Datell�me Date,'Time Ree�omrn.�nded m ' Lirnit Arsenic SIvI 3II3 B-99 O.UO2 9D.OU2 mg�J. t/2:l201010:40 1l25/2010 i2,34 ab� 0,41 � N m � N lfl m m N m r N Cammeats• � � �� i ` m Report Appra►��ed bY• � �, m - cti Angela Scherpl�fg, nulronmental nist � Laude Peler�on, bTech �� w N tyf�elnda Ma�oai,Lab Tech � m - Aote: 7be results listed u�ithin the repoM relate only to khe sempte re�ei��rn the d�tes indicated_ Vv'e do not a�ccept an��1 iabilitp for u�of these r,esuits. 77i is re�ort must no!be neproduc�,except in full,uzthout t�e�tritten approval from Steams DHIA La6oratories. Paee I of 1 . , Twin City Water Clinic Laboratory Test Report ��nnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 Client: Don Stodola Well Drilling Co Report Number: io-oza�2 Twin City Water Clinic Inc. Sample Collection Date: it/Zi/io 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: ia:so Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: iz/iz/io Phone: (952)935-3556 Report Issue Date: iz/za/io Fax: (952)935-5077 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 10-11749 Coliform Drinking Water 12/22/10 14:12 Absent Nitrate/N Drinking Water mg/I Arsenic Drinking Water 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-well#770046 1027 Linden Lane Orono,MN [Laboratory name;address;MDH Lab ID#]. The subcontracted laboratory maintains MDH Certification for the field(s)of testing performed. Sample Temperature: 15 °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, 2.0 /I drinking water for the µg Lead,15.0µg/I SM3113-Lead,2.0µg/I analytes tested. �J :� �` /� � Sample Collected by: X Client _TCWC Approved By: ,;' °Z�� Bitl 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 MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring !1 WELL OR BORING LOCATION H �� o��,y;a;e WELL AND BORING SEALING RECORD Minnleso a�Unique Well No. �j Minnesota Statutes, Chapter f031 or W-series No. �[j�j��E�� (Leave blank il not knownJ Township Name Township No. Range No. Section No. Fraction(sm.-�Ig.) Date Sealed Date Well or Boring Constructed RONO 11? 23 OT F! NW I'E �j (� � GPS Latitude __ degrees___ minutes___ seconds Depth Before Sealing �v ft. Original Depth ft. LOCATION: Longitude _ degrees__ minutes____„ seconds IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ❑Multiaquifer /�/'y� n��y W LUBORING ,Measured ❑Estimated Date Measure�i f!•�� l t � � �Water-Supply Well ❑Monit Well �,,. Show exact location of well or boring C G�S ketch map of well or boring —. in section grid with"X." J 3 V`iocation,showing Pr�perty ._;Env.Bore Hole ❑Other �ft.x]below ❑above land surface ines,roads,and�i+ddings. N �� ,_�� CASING TYPE(S) ,pr.,,. �,�'y_e..>�.�.i .' __'___ __'___ ___`_____'__ Steel [�Piasno ❑rie ❑Other � --;--- ; ; ; --�----'`-'---`'- WELLHEAD COMPLETION " W ; ; ; ; ET � __�___ _;.___�_____r__ � `� Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset ? 'fz Mile „� b/ �Pitless Adapter/Unit ❑Buried ❑Well Pit ' --�-----�------%-----�-- "� ♦7' ❑Buried S . ❑Well Pit �-1 Mile � ❑Other ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diammmjjj t��{ � Depth t Set in oversize hole? Annular space initially grouted? Property owner's mailing if ocation address indicated above C�/ �,/ �in.from_��_ to��ft. ❑Yes JtiL No ❑Yes ❑No ❑Unknown —1 $$j�Q in.from _ to ft. ❑Yes ❑No ❑Yes (]No ❑Unknown 952-472-0854 in.from to ft. ❑Yes ❑No ❑Yes []No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � t Well owner's mailing address if different than property owner's address indicated above SCreen�rom�_to�R. Open Hole ffom, to ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill �No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. , Type � ��Removed �y Not Present ❑Other / \ METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal - in.from to ft.- ❑Perforated ❑Removed in.from to ft. ❑Perforated ❑Removed Type of Perforator ❑Other � � GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) w��. �y ...�� '7,.� . { Grouting Materi��%/�,L.'/from� to� ft. yards_�_ bags � from to ft. yards bags 6 ? from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes o How many? j, LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true ta the best of my knowledge. DON STODOLA NELL DRILLING CO., INC. 1691 Licensee Busi es �ame License or Registration No. / y ✓'.�.ir �l � f' �� / �!' !L� rtified Representative Signature Certified Rep.No. Date � , LOCAL COPY H 2 Q 5 7 O i. � �'`_` i `J Name o/Person Sealing Well or Boring HE-01434-11 IC#140-0423 . 2/oea '��