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Home My WebLink Aboutwell info MINNESOTA UN/QUE WELL WELt OR BOR NG LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. ;: CountyName WELL AND BORING RECORD . �, �} �_, ,�� ,.� TT��n Minnesota Statutes,Chapter 1037 � � � r,.j' � � Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED ntCJxlo 11€3 23 ?.7 ,rSt� ��F; Ss^� r n r•_� GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds �Cable Tool ❑Driven ❑Auger �otary House Number,Street Name,City,and ZIP Code ot Well Location ❑Other { �rJ�� '`Tncth Far� ?t�., �JCOT�O 55356 DRILLING FLUID WELL HYDROFRACTURED? (.._I Yes . o Show exact location of well/boring i ectio id with"X" Sketch map of well/boring location. ?�'T1ttIIl�tQ From ft.To ft. Showing properry lines, --- N roads,buildings,and direction. USE Domestic ''^'Monitorin � , 9 [�Heating/Cooling � , . , i'. . __L____,___ __:__ ___:_ �,� � ' ❑Noncommunity PWS I�Environ.Bore Hole �Industry/Commercial � - ,,Communiry PWS ❑Irrigation �I Remedial ; I I ; I ^ --'----;-- ---;-- ---`-- U Elevator ❑Dewatering ❑_ � `N ; ; ; ; E T ASIN Shoe� �No OLE DIAM. ��;:, --+-- --�--- --�-- --,-- t. MATERIA ve . . - C G L Dri �'Ves , H - I f �'��teel �Threaded [_]Welded a � � , , Mile ._ ,. / � , , , , � �� .1 Plastic --_ ��.' �' --;--- --�-- --�----�- t� CASING ' S � Diameter Weight Specifications ��Miie-�{ �__in.To_��_ft. Ibs./ft. �__in.To�ft PROPERTY OWNER'S NAMEiCOMPANY NAME in.To ft. ._ Ibs./ft. �5.- in.To��r�ft ci-� ��C�+�rrl p�C�tj�g in.To ft. IbsJft. in.To ft SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. y' Make From ft. To ft. 7yPe .�'sta Il �gS .:it� Diam. �n �. SIoUGauze .��_� _Length �{� + cF� Set between�[t�ft.and it RTTINGS �� „ - STATIC WATER LEVEL Measured from C?� _ft.�Below ❑Above land surface Date measured - 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 different than property owner's address indicated above. WELLHEAD COMPLETION Pitless/adapter manufacturer �� Model ❑Casing protection �12 in.above grade ❑Ahgrade [��Well House I�'�Hand Pump � GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material ��tQE1j.C'�Fro+�m' � To ?�1 ft. � U Yds. �Bags - Material__�r�tUral .t�c6�f.. S�To ��#t ft. _ ❑Yds. ❑Bags v GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Matenal From_____To ft ❑Yds. ❑Bags . MATERIAL Driven casing seal From To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION . tt��30�1 hlBC?' �c�fr ^� 2 � � y _ feet ___ 1 direction ry � Well disinfected u on com letion? ` � 1 c P P �1'es ❑No .ti.3..c�.�.a,.�i.. � C1.'?� hCO.�Tl ��]I!1 � �V PUMP � j�Not installed Date installed ��..��'; clay �,c�y rpediwn i5 �2 " ., - Manutacturer's name G�� Yns� ��t� �1 t t 5 Model Number HP � Volts 7 1 1 t Lt Length of drop pipe 1 7G ft. Capacity g.p.m t } -T. tj[$y'Q!}. ��j��':t+l �,aCCI lia �-�'j� Type�'Submersible ❑LS.Turbine ❑Reciprocating ❑Jet [� ABANDONED WELLS Does property have any not in use and not sealed well(s)? [j Yes o VARIANCE Was a variance granted from the MDH for this well? �]Yes o TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. , The information contained in this report is irue to the best ot my knowledge. Use a second sheet,if needed. �� REMARKS,ELEVATION,SOURCE OF DATA,etc. �il �C��$ ��Tell �ril.t�t��; Co., Inc• �C77� . Licensee Business Name Lic.or Reg.No. ,: ;-�' ' 1�'-31-13 Q�rtifie8 Represenrative Signature Certified Rep.No. Date iOCAL COPY ` `-� �., `, 6� PQf' �`CCX�I018 f � �_ Name of Driller IC 740-0020 � � HE-01205-14(Rev.S/12) � . , Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-l0117 ' Client: Don Stodola Well Drilling Co Report Number: 13-13475 Twin City Water Clinic Inc. Sample Collection Date: 30/23/13 617 13th Avenue South Address: asai North nnatr,street Sample Collection Time: ii:so Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: io/za/is Phone: (952)935-3556 Report Issue Date: io/zs/ia Fax:(952)935-5077 Laborato Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 13-13475 Coliform Drinking Water 10/24/13 13:12 Absent 13-13475 Nitrate/N Drinking Water 10/24/13 13:12 <1.0 mg/I 13-13475 Arsenic Drinking Water 10/24/13 10:00 10/25/13 13:08 3.11 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water Well No.: 799022 X No samples were subcontracted;or the above test result(s) with'**'designation were produced by a subcontrected Sample pt: laboretory. [Laboratory name;address;MDH Lab ID#].The Well Adr: 1699 Northfarm Rd Orono,MN subcontracted laboretory maintains MDH Certification for the Owner: Richard Perkins field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temperature: 8 °C Discussion: Notes: Approved methods used in analyzing the samples listed above have the following reporting levels: Maximum contaminant tevels: SM9222B-Coliform, 1 cfu/100 ml Coliform-<1 cfu/100 ml Nitrate Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen, 1.0 mg/I Arsenic,lo.0 µg/I SM3113B-Arsenic,2.0µg/I Lead,15.0µg/I SM31136-Lead,2.0µg/I � '�,,��pr,� �� '""-.l''"E�%` Sample Collected by: X Client _TCWC Approved By: ;� `�`�-'� - Bill Van Arsdale Alan Senechal Laboretory 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 W6LL�R BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„� � �C �o Q � County Name WELL AND BORING SEALING RECORD Mennleso a�Unique Well No. �, J � Minnesota Statutes,Chapter f031 or W-series No. ;r � (Leave blank�il n0�known] Township Name Township No. Range No. Section No. Fraction(sm.-+Ig.) Date Sealed Date Well or Boring Constructed f� c 7 7 ��'." �€? �7 �l� 1.� - � GPS Latitude degrees minutes seconds Depth Before Sealing__ ��! ft. Original Depth____ ft. LOCATION: Longitude _ degrees__ minutes seconds �IPER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Single Aquifer �_]Multiaquifer /� r � •t 1 ?� r �i(vleasured �]Estimated Date Measured `�/��_ '/�Y � �� !�C� ' �`ar'r"; ,�� C�€'�O i�i`�,ti LUBORING Water-Supply Well ��;Monit.Well /� Show exact location of well or boring Sketch map of well or boring .-, in section grid with"X" location,showing property ��._�Env.Bore Hole (.]Other �U fl. '�below ❑above land surface N __, }��•, FN�e�,roads,and buildin�. CASING TYPE(S) .��,s. �..0 --�-----�--- ---�-----�-- . :� s�eei i_�Piast�o []rie Ll ome� , ''"'""-'"-' ---`" '--�-- WELLHEAD COMPLETION W ; : : ; ET �_ �_ - � � � � � Outside: [;Well House ❑At Grade inside: �f Basement Offset �. -'�-----�--- --�-- --%- , , ; ; , � '�e �+ �Pitless Adapter/Unit ❑Buried ❑Well Pit --;-----�--- --�-- --�- Well Pit � (.f Buried ; ; S ; ; �v� ❑ ^-+.., � Other ��Mite� �'�"'�--,�„_, ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) .; .� A •lr Diamet�� Depth` � Set in oversize hole? Annular space initially grouted? ' Property owner's mailing address it diHerent than well location address indicated above / - ' _�_in.irom�� to �� ft. ❑Yes �Na U Yes �__f No ; ]Unknown in.from to ft. ❑Yes j]No ❑Yes ❑No �..i Unknown _in.from to ft. ❑Yes ❑No ❑Yes I No �,Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE r7 � �� / , Well owner's mailing address it diflerent than property owner's address indicated above SCreen from t0 /G/_R. Open Hole ffom to fL y - OBSTRUCTIONS �� ❑Rods/Drop Pipe ❑Check Valve(s) [j Debris ��Fill {�Vo Obstruction Type of Obstructions(Describe) _ GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obshuctions removed? [�Yes �J�No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. � � j TYPe -- -- -- �f�r r4�� I I 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 [i Removed in.from __ _to __ ft. ❑Perforated ��J Removed Type ot Perforator ❑Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) �f i a� Grouting Material/ULlt/ ��I�f�f.{� from�_ to/(.•�/ ft. __. yards__� bags from to ft. yards _. bags _____ _ from _ to ___ ft. __ yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused weli 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. �on "tcxlola ��:�ell �rillin�; Co., Ia�c. I�,'?1 Licensee Businesg'Na�rfe _,` . - t License or Registration No. �' � '__R�..._ r.� r �T i �. r �� .f .�� /�_ �� >.;r :- lL�erti/ie epreserrtative Signatwe�� Certified Rep.No. Date _ ,`, .� J� H � � �g a� �..��. � �.�,,.� ; IOCAL COPY � � Name of Person Sealing Well or Bor%ng � HE-01434-13 IC#140-0423 " sn2a -,....,,. ..._s�.:W.,., _.�: ..:.,..:...�;_..._.. ..,...�:,,..._ .. .,�-.r �...§- .h ..y _._.�,...__. ..�.. ..�.��. »_ ..�.,«..,,... ,.r,�...,�.�...��.�a....r.. ..�,n..� rH .Y.,. -� - -,:. :x�..,. �..�.,....r»_.� ._.�a.y:<,.. �-� . . .. . � �' - __ .. .. .. . ..... ... .: ��r�