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Home My WebLink Aboutwell info .-�-yJ9sw'4�c T�..CM�"e° .. +7YS:J@�'nr.-_��... l�a{.+R�'.sY�IM."'Q,^X� _ , �.. ,� MINNESOTA UNIQUE WELL ` ELL-OFs BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD � �•�� 9 t Minnesota Statutes,Chapter 103/ Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED / - '/< �� .. GPS ' DRILLING METHOD Latitude degrees minutes � seconds LOCATION: � — Longitude degrees _ minutes�� _ seconds ❑CableTool .Driven �,Dug — �_Auger �'Rotary L]Jetted Houps�e Number,Street Name,City,and Zip Code of Well Location or Fire Number — (70F/ �CCt! tiL[3( !�L� vL�IIO J��L3�# DRILLING FL�U,IyD WELL HYDROFRACTURED? ❑Yes � No Show exact location of well/boring in sec�on grid with"X° Sketch ap of well/boring bcation. �}j`��e From ft.To ft. Showing property lines, N . �...�rr ds,buildings,and direction. USE �,Domestic �,_I Monitoring I.-]Heating/Cooling __1___ __;___ __�__ ___t_ � �` �]Noncommunity PWS '��Environ.Bore Hole , �j Industry/Commercial ��.-''�� y�" �'. ;Community PWS , i Irrigation � �Remedial --�--- --- --� � "��f �-`� �__J Elevator � .Dewatenng � � . � .' `N , 1 r r E� �'r,,,*� CASING MATERIAL �-i readed �Yes We�'N�o HOLE DIAM. � � Drive Shoe. I l�, ,� \ :' Steel , _Th � , , , 'h Miie , . --;--- --;---S--r-- ---�- � \ Damleter�Plastic Weight� � �. � � � Specifications �1 Mi�e---� � _I,F__in.to. _��ft �_,t�IbsJft. �in.to__�,Q. .� PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. Ibs./ft. _��in.to_z��. R(� iK�n'ie�� in.to ft. Ibs./ft. in.to ft. SCREEN_ OPEN HOLE Property owner's mailing address if different than well location address indicated above. --- �� . � Make__��,�� t From . �ft. To ft. Type '34Cil�t�`gs �� Diam. /� SIoUGauze •�%�� _ _Length__�Fi__'�'� Set between��_�ft.and ��r�tt. FITTINGS ��Y'7�i� STATIC WATER LEVEL Measured�from �� ft.'*- Below ',_�I Above land surface Date measured ��'��n..__ WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) �� ft.after__�______hrs.pumping � g.p.m. Well/boring owner's mailing address if diflerent than property owner's address indicated above. WELLHEAD COMPLETION {�?.Pitless/adapter manufacturer_j' ___ Model � �Casing Protection �}�12 in.above grade �..�At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION e Well g�� I j No Q �� 4 y[ Grout�ma�te,[ial��t _��tonit�oncrete ❑Other . E rom o ft. ❑Yds. �, ;Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To ft. 'J Yds. �. �Bags MATERIAL From To ft. --..Yds. � ',Bags NEAREST KNOWN SOURCE OF CONTAMINATION �� t ,•/—+ feet �/ direction `��'.__e_.'."—.. ......::�.J--...s3YC6 w.r.. Well disinfected upon completion? jjc]�Yes �, �No .a PUMP ' J Not installed Date installed �� ' Manufacturer's name Model Number HP 3�`t Volt�� Length of drop pipe �� 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 �'No VARIANCE Was a variance granted from the MDH for this well? �]Yes No TNri 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. �1� �+ REMARKS,ELEVATION,SOURCE OF DATA,etc. �1�A1 JC�Od.S WQi� �`y�l�� Q�• IL1C. 2691 Licensee Business Name �•�' Lic.or Reg.No. ' 4-i5-1� p sentative Sigrrature Certified Rep.No. Date 7 � ��i 5 � ctn�c�c ��re LOCAL COPY � Name of Driller IC 140-0020 H60120512(Rev.1Z08) Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin State laboratory ID#105-10117 Client: Don Stodola Well Drilli Report Number: io-asi Twin City Water Clinic Inc. Sample Collection Date: oa/oa/io 617 13th Avenue South Address: 3841 North Main Stree Sample Collection Time: 11:00 Hopkins, MN 55343 St.Bonifacius,MN 553 Sample Receipt Date: oa/o5/io Phone:(952)935-3556 Report Issue Date: oa/oe/io Fax:(952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 10-02879 Coliform Drinking Water 04/05/10 11:52 absent 10-02879 Nitrate/N Drinking Water 04/05/10 12:38 <1.0 mg/I 10-02879 Arsenit Drinking Water 04/05/10 9:00 04/06/10 13:00 4.13 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 iaboratory. Sample Location-#776859 860 No.Arm Drive, Orono, MN [laboratory name;address;MDH Lab ID#J. The subcontracted laboretory maintains MDH Certification for thefield(s)oftestingperformed. $dfT1pI2T2I'Y1p2CdtUfe: H °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, Coliform-<1 cfu/100 ml SM9222B-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.oµg/I drinking water for the SM3113-Lead,2.0µg/I analytes tested. ^, � � � �� 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 . . f . . . . . . . . . _ . . , . _ MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I �Q�(�O� _ WELLORBORINGIOCATION WELL AND BORING SEALING RECORD Minnesoa�UniqueWellNo. v V County Name �g�/� Minnesota Statutes,Chanter 1031 or W-series No. ili Y (Leave blank i nol known) Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed �� Orac� 117 23 i I�J 1�►T 1�B d GPS Latitude_ degrees____ minutes__ seconds Depth Before Sealing �� , ft. Original Depth ft. LOCATION: Longitude__ degrees___ minutes_ seconds QUIFER(S) STATIC WATER LEVEL Numerical Sheet Address or Fire Number and City of Well or Boring Location Single Aquifer ❑Multiaquifer �^�t �� 860 North Arm Ds VLVLA�r SS�{ W �UBORING Measured ❑Estimated Date Measure I"�! �"' _ � Water-Supply Well ❑Monit.Well t � i Show exact location of well or boring * Sketch map of well or boring �Env.Bore Hole Q �_ in section grid with"X." � locatio�,showing property �� ]Other V` ft. �below ❑above land surface N `� Iines,Ybads,and buildings. CASING TYPE(S) � � .. --'--- --i----`-' --'- � � � teel ❑Plastic ❑Tile ❑Other ,� --1--- --;------;-----`-- y,� WELLHEAD COMPLETION ..�� ;. W � I f 1 E �', . �� _;__ __r T� Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset b ___ _____ �� Pitless Adapter/Unit ❑Buried ❑Well Pit 1 ❑ ❑Buried S Well Pit ❑Other �1 Mile—� L��Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) � . � Diarr��q � De� Set in oversize hole? Annular space initialty grouted? Property owner's mailing address if diflerent than well location address indicated above �/ � I in.irom O t� ft. ❑Yes �No �J Yes ❑No ❑Unknown in.trom to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.trom to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELLOWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE � � Well owner's mailing address if diflerent than property owner's address indicated above Scfeen ffom��_to��ft. Open Hole ffom_. , to ft. OBSTRUCTIONS ods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill �No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HAaDNEss OR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. � St/` TYPe t---�- ".) f �;Removed �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 ben�nite=50 Ibs.) � 9 I!-�'�! �J�'�-JIr `,^' Y 9 Groutin Materia om to._��,�ft. ards��_ ba s from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,OIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? �]Yes o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATfON 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. Licensee usme s a e ! � e or Registration No. /," � C% /%'_ /�"J � �d re entative Sigriat e � Certified Rep.No. Date LOCAL COPY H �V�O O� '`\�� ' �--4 _J�.S,�,,.�y'��.� Name of Person Sealing We/l or Boring 1 HE-01434-11 IC#140-0423 � voaa �._-.�..:...._.... �.. .-_ ..,.: ._ ....,..��. . .-t., .. .� .. . , _