The URL can be used to link to this page

Home My WebLink Aboutwell info S JG LOCATION MINNESOTA DEPA�TMENT OF HEALTH MIN AEND BORIN��G NO. ELL WELL AND BORING RECORD 7 919 7 6 � Minnesota Statutes,Chapter 1037 .. ,,,,,,,,,,,,,,,.u,,,., Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED � vrc�r �1T 23 a9 s�e t� �c �,, Zas " fr--I GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds �Cable Tool ❑Driven ]Auger ,�lotary House Number,Street Name,City,and ZIP Code ot Well Location Fire Number ❑p�her �Sl� l�Vt.�.il � iTL O�� S� DRILLING FLUID WELL HYDROFRACTURED? ❑Yes . o Show exact location of well/boring in section grid with"X" Sketch map of welUboring location. �' �t"""�tC From ft.To ft. Showing properry lines;' N buildings,and direction. USE �Domestic ❑Monitoring ❑Heating/Cooling __j__ __!�_ _._�_____�__ "- � '�,_I Noncommuniry PWS ❑Environ.Bore Hole ❑Indus[ry/Commercial �C.f ,J Community PWS ❑Irrigation ❑Remedial :� __�.___; �- ---�-- �r: ,'� ❑flevator ❑Dewatering '] , ; f * � I' `�� yy MATERIA� Drive Shoe? L.��Yes ,,�?No HOLE DIAM. _� ' w e CASWG i - I.J Steel ❑Threaded ❑Welded . , , , , h M e lastic ��_J --;-----.--- ---.-- � 1 CASING � � S � � Diametg r 4 +� Weight Specifications p F--1 Mile-� � " in.To j�r ft. Ibs./ft. --��a--��in.To �v ft PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. Ibs./ft. _' in.To��ft .f� �'f___'� � _ in.To_ _ft. IbsJft. � in.To ft i'![1(Z OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEfJ�_i�_ _ �lf�s Make_��}�� From__ ft. To ft. - � Type g�"�j'•`�" � Diam. �� SIoVGauze_ __�_.. __ _ Length� � �� Set between_11� _ft.and_��ft. FITTINGS� � STATIC WATER LEVEL Measured from �e' �___. ft.�elow ��Above land surface Date measurQd � ��' WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surtace) � ��,rj'_ ft.after_____ _Z hrs.pumping _ ___g.p.m. y Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION �Pitless/adapter manufacturer�� _ Model ❑Casing protection_ `�f'12 in.above grade ❑At-grade '�Well House ❑Hand Pump GROUTING WFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Matenal ��.,�u,4��prom ��/� To �*O ft. � __ ❑Yds. ❑Bags Matenal �6�.�1. ir�� .7�.i To l�� ft. � ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICALMATERIALS COLOR MATERIAL FROM TO Dnvencasingseal From___To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION .. L � ' ��.r-�h.-s.. ,a......r� Y''°�.. � � v *_..�� feet .'`j �"'� direction �type Well disinfected upon completion? ,�Yes ❑No � � � :..� `►� I PUMP [I Not installed Date installed_ �,j��7___ _ C Manufacturer's name .7G.'L7liGl� _Y,� Model Number HP 1�1 Volts.4.7V �u Length of drop pipe �� _ ft. Capacity g.p.m Type:,�Submersible ��, 'I 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 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 true to the best of my knowledge. Use a second sheet,if needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. I'aon Stodol� wel.l Drilling Co., Inc. 2691 __ _ -- __ _ _ _ _ _ Licensee Business Name Lic.or Reg.No. 6-29-l2 ti d rese tativeg, na e Certified Rep.No. Date 6 j , �. LOCAL COPY 7 919�6 �b ��$ — Name of Driller IC 140-0020 HE-01205-13(Rev.11/10) 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: iz-i333 Twin City Water Clinic Inc. Sample Collection Date: 06/13/12 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time:� 13:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: oe/ia/iz Phone: (952)935-3556 Report Issue Date: os/is/iz Fax: (952)935-5077 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 12-06365 Coliform Drinking Water 06/14/12 14:35 Absent 12-06365 Nitrate/N Drinking Water 06/14/12 14:16 <1.0 mg/I 12-06365 Arsenic Drinking Water 06/14/12 7:45 06/15/12 11:31 9.79 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.: 791976 with'**'designation were produced by a subcontracted Sample pt: laboratory. Well Adr: 2515 North Shore Dr.Orono,MN [Laboratory name;address;MDH Lab ID#]. The subcontracted laboratory Owner: Mandeep Sodhi maintains MDH Certification for the field(s)of testing Owner Adr: Sample Conditions: Sample Temperature: 11 °C 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 SM92226-Coliform, 1 cfu/100 ml Wisconsin and EPA Nitrate Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen, 1.0 mg/I qrsenic,10.0 µg/I guidelines for safe SM 3003-Arsenic, 2.0µg/I Lead,15.0µg/I drinking water for the SM3113-Lead,2.0µg/I analytes tested. ,1 n/�' �.��%�i`.:�,�� Sam le Collected by: X Client _TCWC Approved By: ;,� `,�� p 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 WELL OR ORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �H 3 0 515 i ` County Nam� WELL AND BORING SEALING RECORD Minn'e90 a�Unique Well Na �� % �j � t Minnesota Statutes,Cha ter 1031 or W-series No. �nCLiLlGpl� p I�eave oiana e noi knownl _ Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed Ocor� 117 23 09 9$ 1� '- �,� GPS Latitude degrees minutes . seconds Depth Before Sealin / g �t2, ft. OriginalDepth_ ________ft. LOCATION: Longitude degrees minutes _ seconds AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location '. .Single Aquifer ❑Multiaquifer c y r1� WE LIBORING �_�easured I J Estimated Date Measured_V�_�I.__.__ 2J�� rt[1 �� D�� Orana 55391 '�Water-Supply Well ❑Monit.Well Show exact bcation of well or boring Sketch map of well or boring � ' �,/ in section grid with��X." location,showing property __i Env.Bore Hole ❑Other � ft ',�►!V�elow �,_j above land surface N li s, ,and l�dR�fpg/s`.. �CASING TYPE(S) i ��•.,� "'-__'-- --`-- --`- � I�teel ❑Plas[ic ��Tile ❑Other � --''-''-�"" "`-- ---�-- � WELLHEAD COMPLETION ` W 1 i__ ___�__ ___�__ E TMile �. ' _ �_.___,_ Outside: [�Well House ❑At Grade Inside: ❑Basement Offset �� ' � � � I�itless Adapter/Unit I� uried _ ell Pit � B �W ; --.-----:----�-----:-- 1 � ❑Buried S �y,11 ❑Well Pit ? ' f ' �t" ❑Other �-1 Mile� �_.I Other PRlO�PERTY OWNER��S�N,A�MEj�COMPANY NAME CASING(S) i�[[Rl� +JGJ�lii1 Diame er � Depth � Set in oversize hole? Annular space initially grouted? Property owner�s mailing adtlrecs If dllferent�han well location address indicated above ��. r� �_m.from_�_ to_��ft. ;]Yes i o �Yes ❑No ❑Unknown _in.from to ft �_]Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. []Yes ❑No ❑Yes [j No �`J Unknown WELL OWNER'S NAME/COMPANY NAME SCREENIOPEN HOLE f � Well owner's mailing address if different ihan property owner's address indicated above ScreBn from_�__to_.�,_��_,_ft. Open Hole from to ft. OBSTRUCTIONS ❑RodsiDrop Pipe ❑Check Valve(s) ❑Debris ❑Fill �Jo Obstruction Type of Obstructions(Describe) ___ ______ GEOLOGICAL MATERIAL COLOR HaRONEss oR FROM TO Obstructions removed? ❑Yes ❑No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. r � �nf Type _ �`� � J Removed �lot Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �o 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.) s Grouting Material�it�QT(,L�,(/�from�__ to_,_�l�rft. 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 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. Da► staaola well r►rillin�co.�znc. 1692 Licensee Business Na �� License or Registration No. �..---^ ; �j _ �.J ` �...? �fi e r entative Signat�r�„ Certilied Rep.No. Date -- '; yjI�� LOCAL COPY H 3 O��S�r -- _ t -./—`'�/`..c�}`-�y�.. Name of Person Sealing Well or Boring HE-01434-12 IC#140-0423 „ eiosa