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Home My WebLink Aboutwell info , ,., , .,x,.. _ . - � _ ,. . _ . .,� MINNESOTA UN/QUE WELL ,WELL OI�!70RING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. ounty Name WELL AND BORING RECORD � ��16 Minnesota Statutes,Chapter 103/ To i Township No. Ranqe No. Section No. Frection WELUBORING DEPTH(completed) DATE WORK COMPLETED vi V�l.V �il7 �� J� J6 � �'/, ��L tt� �' '� GPS DRILLING METHOD � Lati[ude degrees minutes seconds LOCATION: --- --- i- t Longitude degrees minutes seconds :�Cable Tool . �.Driven f 1 Dug �—- - _Auger }�'Rotary , ,Jetted House Number,Street Name.City,and Zip Code of Well Location or Fire Number ' � - [R! iJt�.�c L�� VLi1[�[7 55359 DRILLING FLUID WELL HYDROFRACTURED? Li Yes �'�,'No - Show exact location of welVboring in section grid with"X° Sketch map of well/boring location. ++�i+tlRl3t� �F Showing property lines, From ft.To _ft. � N roads,buildings,and direction. USE �Domestic ❑Monitoring `��Heating/Cooling � � � .,___ : __;__.__i_. __,__ ___;_ �✓� �",� ,]Noncommunity PWS �� .Erniron.Bore Hole I�'Indushy/Commercial �� '.. ! ''�,Community PWS , .Irrigation j �Remedial � ' -- --`-- ---`-' �.-.-�.� T . �-� '��. Dr Dewatering �,.� � ,�. ` �_.Elevator - �� e w ; , ; e 1{ � �� CASING MATERIAL ve Shoe? ❑Na HOLE DIAM. � �Y� T � -` �� ., � � ` � { � �Steel ,��.Threaded Welded �ji + 7 , � t '/Mile . ,r �_.., ....�/ , � ,� ; ; � �� ( astic - -- PI � .m -�- -- �--- --�- - : : : -. CASING I . s �f �' "" ��^' Diameter Weight Specifications �1 Mile—� ;,%,� �in.to "��ft. Ibs./ft. '�fgin.to�ft. 4. I r�ar �� in.to____ ___..—ft. Ibs./ft. _ in.to��ft �� PROPERTY OWNER'S NAME/COMPANY NAME --- � R�vinlGeyle Talbot in to ft. Ibs./ft. in.to ft. Property owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE Make From ft. To ft. Type__ Diam. SIoVGauze Length Set between ft.and it. FITTINGS " STATIC WATER LEVEL Measured from _�,�.___ft.;s�Below � 'Above land surface Date measured r� WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) ��_ ft.after � hrs.pumping g.p.m. Well/boring owner's mailing address it different than property owner's address indicated above. WELLHEAD COMPLETION '�Pitless/adapter manufacturer Model Casing Protection .. _ �12 in.above grade �'At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION we �i @' � !� 7t Grout�m taerial_s� fy�t�ent '�ento�Concrete �. ,Other - �� I�om_ To tt. �Yds. J Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. �Yds. `Bags MATERIAL From To ft. (�Yds. ]Bags .. NEAREST KNOWN SOURCE OF CONTAMINATION Cla F)�� ! /.��`` feet �direction ��"�.�1-�.x-.- type - Well disinfected upon completion? {�Yes No t�i �/CI�. b� � PUMP � r(�El$J�TL$�1 F,i� tg{� �„�/ �3,0 ` �Not installed Date installed 7�rl+��Z . . Manufacturer's name e �� Model Numbe� HP�Volts �-` -"'"t� Length of drop pipe__�� ft. Capacity g.p.m. �� g�� 1*� Type:fy�Submersible ' ,LS.Turbine 'J Reciprocating �_'I�et ❑ L71 ABANDONED WELLS gL��c�� $ � ��$�T/ Does property have any not in use and not sealed well(s)? i�Yes ,�No !N1 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 4�25. The information contained in this report is true to the best of my knowledge. Use a second sheet,if needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Ibn Stodols �e2I Drillic� Cc,,, Inc. 1691 Licensee Business Name Lic.or Reg.No. �-11 ' � `f�ji_ �� a rti� d epresent ive Signature Certified Rep.No. Date LOCALCOPY 7 8 3 5 1 6 �� °d°�a -- Name of Driller IC 140-0020 HE-01205-12(Rev.12/08) Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 Client: Don Stodola Well Drilling Co Report Number: ii90 Twin City Water Clinic Inc. Sample Collection Date: o�/zs/ii 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: ia:oo Hopkins, MN 55343 St.eonifacius,MN 55375 Sample Receipt Date: o�/ze/ii Phone: (952)935-3556 Report Issue Date: o�/z�/ii Fax:(952)935-5077 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 11-06903-01 Coliform Drinking Water 07/26/11 16:09 Absent i1-06903-02 Nitrate/N Drinking Water 07/26/11 1224 <1.0 mg/I 1i-06903-03 Arsenic Drinking Water 07/26/11 8:30 07/27/11 11:50 2.51 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water X No samples were subcontracted;or the above test result(s) Well No.: 783516 with'**'designation were produced by a subcontracted Sample pt: laboratory. [Laboratory name;address;MDH Lab ID#j. Well Adr: 80 Luce Line Ridge,Orono,MN The subcontracted laboratory Owner: maintains MDH Certification for the field(s)of testing Owner Adr: Sample Conditions: Sample Temperature: 8 °C Discussion: Notes: Approved methods used in analyzing the samples This Sample meets the listed above have the following reporting levels: rv�aximum contaminant levels: State of Minnesota, SM9222B- Coliform-<1 cfu/100.m1 Nitrate Nitrogen 10.0 mg/I W�Stonsin and EPA Coliform, 1 cfu/100 ml Arsenic,10.0 µg/I guidelines for safe SM4500D-Nitrate Nitrogen, 1.0 mg/I drinking water for the SM 3003-Arsenic,2.0µg/I Lead,15.0µg/I analytes tested. _ , i /,� ,�,��/ `� a-Y 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 v WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 2 g fi 3 5 8 COUnty Name WELL AND BORING SEALING RECORD Mnnlesoa�UniqueWellNo. � i� Minnesota Statutes, Chapter 103I or W-series No. (Leave blenk 11 not known) ? Township Name Township No. Range No. Section No. Fraction(sm.-+Ig.) Date Sealed Date Well or Boring Constructed ' Occmo li8 Z 3I 5� � � r GPS Latitude degrees minutes seconds Depth Before Sealin g �7� ft. Original Depth ft. F LOCATION: Longitude degrees minutes seconds UIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location �Single Aquifer ❑Multiaquifer $0 I�uce Line Ridge� .�r�Q ��Jp� W LL/BORING Measured ❑Estimated Date Measured .�/� nf�� Water-Supply Well ❑Monit.Well . Show exact location of weil or boring � Sketch map of well or boring �Env.Bore Hole �� in section grid with"X." ^� location,showing property � ❑Other �_� ft. �below ❑above land surface N �\ F lines,roads,and buildings. CASING TYPE(S) �C ''� --'---'-- -'`----'-- , Steel ❑Plastic ❑Tle ❑Other___ � --�--' "'�--' "-`-''--`" `�� WELLHEAD COMPLETION W � � � , E � C � __�___ __;___�_____r__ T � i Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset . 'h Miie . �Pitless Adapter/Unit ❑Buried ❑Well Pit L� ❑Buried --- -- � '�, ,. ❑Well Pit S .� ❑Other �-1 Mile—�� v�r✓ ❑Other ' PROPERTY�O/yV NER'S♦NAMEr�/C�.O..MPANY NAME CASING(S) 13/ le iiil�t Diam e�� • Depth//�� Set in over ize hole? Annular space initially grouted? Property owners mailing address if different than well location address indicated above �in.from � to /'��C7 ft. ❑Yes �o ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE i / � Well owner's mailing address it diflereni than property owner's address indicated above SCreen from��t0 `��ft. Open Hole from to ft. � OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ��Debris J 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. r "� � � Iq TyPe �� " U❑Removed �Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No Annular Space Ezists ❑Annular Space Grouted with Tremie Pipe ❑Casing Pertoration/Removal in.from to ft. [�Perforated ❑Removed in.from_ to ft. ❑Perforated U Removed Type of Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite-50 Ibs.) Grouting Materia�/v�/'�� C...L��/ from� ro�,R. yards �t bags � trom [o fl. yards bags trom to R. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? [�Yes No How many? 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 to the best of my knowledge. Dos Stodols We21 I}ciI#.�g Cc>i. It�. 169I • —.__—_ _ — -- -- Licensee Business Name License or Registration No. i ./'' � `' � ��.:.� ��.� - ! / rtif Re esentative Sign�t�ti - Certified Rep.No. Date LOCAL COPY H �`+�^�( /}+(� �"'�t-'.��ti \../''--��w �.p.�s r� 2�o,J�J�4./ Name ol Person Sealing Well oi Boring , HE-01434-12 IC#140-0423 �` siosa A .. .. . . . . .:. . . . . .