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HomeMy WebLinkAboutwell info MINNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name WELL AND BORING RECORD 792017 Minnesota Statutes,Chapter 1031 Towns Ip Township No. Range No. Section No. Fraction �j WELL/BORING DEPTH(completed) DATE WORK COMPLETED Latitude degrees minutes seconds DRILLING METHOD LOCATION: ❑Cable Tool XEI n Longitude degrees minutes seconds ❑AugOther Rotary House Number,Street Name,City,and ZIP Code of Well Location Fire Number ❑Other ft ore Mirth ore Dr OCOM 553" DRILLING FLUID WELL HYDROFRACTURED? [-]Yes o Show exact location of well/boring in secti d with'X:' Sketch map of well/boring location. bentonite From ft.To ft. Showing property lines, Nleads, i ings,and direction. USE Domestic F1Monitoring ❑Heating/Cooling ______ ____ _______ �+ ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial l l �1 ❑Community PWS ❑Irrigation ❑Remedial a____ _;_;__ ❑Elevator ❑Dewatering ❑ _ w i E T CASING MATERIAL Drive Shoe? Yes ❑No HOLE DIAM. --T----1- ---:-- I ,,,l//////-��- teel Threaded ❑Welded h Mile Plastic lCASING S Diameter Weight Specifications �/� F —1 Mile ( in.To +�.7V ft. lbs./ft. in.To__% PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. QIn.To_ X330 Colson custom in.To ft. lbs./ft. 37 yin.To_ #E �+t1s SCREEN OPEN HOLE Prope=rty owner's mailing address if different than well location address indicated above. 216 Water 5t Make From ft. To ft. Type eiaior, MN 55331 Slot/Gauze0 �tl Le fticLength Ole 40 # At Set between ft.and ft. FITTINGS2R"# STATIC WATER LEVEL Measured from 84 tt. Below ❑Above land surface Date measured — 13 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) ec�n 50 31" ft.after hrs.pumping _g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION 1't��t� ��yJ(Pitless/adapter manufacturer �j Model Casing protection X2 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material be t0ildt!From Tom ft. 4_— ❑Yds. [ags Material n&tU=l f jrjj_W To—_13()—ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. El Yds. Ll Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Driven casing seal From To _Bags NEAREST KNOWN SOURCE OF CONTAMINATION ClaY s brown soft © 4 /. feet A-1 direction / �.,.L broom/ Well disinfected upon completion? Yes [I No clay/rocks varied medim q4 21 PUMP c ay yellow soft X21 34 ❑Not installed Date installed 10-2-13 clay/sand a medium -+4 57 Manufacturer's name granite boulder white/ � 57 �$ Model Number '` HP_1 Volts 730 gray c ay F1raymed58 112 Length of drop pipe 126 ft. Capacity 9-p.m sand/silt varied medium 112 171 Type: Submersible ❑L.S.Turbine E]Reciprocating F]Jet ❑ yells ABANDONED WELLS city/sand gray soft 171 316 Does property have any not in use and not sealed well(s)? ❑Yes No gravel white soft VARIANCE 1. tom_ eal low/varied 316 33, Was a variance granted from the MDH for this well? ❑Yes No TN# sandrock/shale tail/o WELL CONTRACTOR der my upTION p This well was drilled under m supervision and in accordance with Minnesota Rules,Chapter 4725. medium 331 13" The information contained in this report is true to the best of my knowledge. Use a seconcbim needed. REMARKS,ELEVATION.SOURCE OF DATA,etc. Dion Stodol a 1*t t Dr lli ft 0L'• Im. 1691 Licensee Business ame /.l a/lGiil'a'sa6y{7Lic.or Reg.No. Orr 10.31-13 f d Fl6i5resentative Sig ure Certified Rep.No. Date 792017 �" e LOCAL COPY 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: 13-12170 Twin City Water Clinic Inc. Sample Collection Date: 10/01/13 61713th Avenue South Address: 3841 North Main Street Sample Collection Time: 16:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 10/02/13 Phone: (952)935-3556 Report Issue Date: 10/03/13 Fax:(952)935-5077 Laborato Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 13-12170 Coliform Drinking Water 10/02/13 15:01 Absent 13-12170 Nitrate/N Drinking Water 10/02/13 14:16 <1.0 mg/I 13-12170 1 Arsenic Drinking Water 10/02/13 9:00 10/03/13 12:23 1 <2.0 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water Well No.: 792017 X No samples were subcontracted;or the above test result(s) with""designation were produced by a subcontracted Sample pt: laboratory. [Laboratory name;address;MDH Lab[D#].The Well Adr: 4731 North Shore Drive;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Colson Custom Homes field(s)of testing performed. , Owner Adr: Sample Conditions: Sample Temperature: 17 `C Discussion: Notes: Approved methods used in analyzing the samples listed above have the following reporting levels: Maximum contaminant levels: SM92226-Coliform,1 cfu/100 ml Coliform-<1 cfu/100 ml Nitrate Nitrogen 10.0 mg/1 SM4500D-Nitrate Nitrogen,1.0 mg/I Arsenic,10.0 gg/I SM3113B-Arsenic,2.0µg/I Lead,15.0µg/I SM3113B-Lead,2.0µg/I 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 WELL OR BORING LOCATION r MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring " { �)(1 `� County Name WELL AND BORING SEALING RECORD Sealies°a°unique well No. L G�J Minnesota Statutes,Chapter 1031 or W-series No. (Leave dank if not known) Township Name Township No. Range No. Section No. Frig (sm.-Ig J Date Sealed Date Well or Boring Constructed Orono 117 211 07 '1�[I I / /4MrA l GPS Latitude degrees_ minutes seconds Depth Before Sealing ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds A�OUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location 79 Single Aquifer ❑Multiaquifer A W LL/BORING Measured ❑Estimated Date Measured °xPYi`-' r-V-�/6j 4731 North Shore DC Orono 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 Ak4AL tt. Vbelow ❑above land surface I' es,ro sand buildings. N f, CASING TYPE(S) Steel ❑Plastic ❑Tile ❑Other --'I----- '--`-----`-- WELLHEAD COMPLETION W E T r Outside: L1 Well Nouse XAt Grade Inside: Ll Basement Offset h Mile •, ❑P'Itless Adapter/Unit ElBuried El Well Pit LVID Buried s ❑Well Pit El Other �1 Mile -I -.+'.4-�..r.. /t,:t- yl-`^a-•. rx F-1Other -- --- PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Col son nigmirl Timpn Diameter Depth G; , Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above Z'of in.from Q t0 56 ft. ❑Yes XNo ❑Yes ❑No ❑Unknown 216 Water St in.from ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown Excelsior, MN 55331 n.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � 1 Well owner's mailing address if different than property owner's address indicated above Screen from r� to 4.� ft. Open Hole from to ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill X No Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL I COLOR HARDNESS oOR FROM TO Obstructions removed? El Yes El No Describe FORM If not known,indicate estimated formation log from nearby well or boring. PUMP Type ❑Removed XNot Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: XNo 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=501bs.) Grouting Material&Q7 Cee^5,4.T from U to &0 ft. yards Z 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 %. How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION I 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. Dw Stodola Well drilling Co. Inc. 1691 Licensee Business Name License or Registration No. 4-19-13 erh d Frepresentatilve Sighatt re Certified Rep.No. Date " 312 017 Jim Monson LOCAL COPY Name of Person Sealing Well or Boring HE-01434-13 IC#140-0423 5/128 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring 312 0 1 Sealing No. H I County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Hennepin Minnesota Statutes,Chapter 1031 or W-series No. (Leave blank if not known) Township Name Township No. Range No. Section No. Fraction(sm.—Ig.) Date Sealed Date Well or Boring Constructed Orono 117 23 07 NR W SR A 13 GPS Latitude degrees minutes seconds Depth Before Sealing4• ft. Original Depth ft. LOCATION: Longitude degrees minutes seconds AgUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Locatioon)' 9 Single Aquifer ElMultiaquifer 4731 North Shoe fir, Orono 55364 WELLBORING Measured [j Estimated Date Measured f'RMk DAY 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 ' ft. below ❑above land surface Ii s, oads;an buildings. N %J' CASING TYPE(S) Steel ❑Plastic ❑Tile ❑Other -'-----i------------------ mile '�'�""��- WELLHEAD COMPLETION W - ET �VVIJ Outside: ❑Well House )<At Grade Inside: ❑Basement Offset 'h ❑Pitless Adapter/Unit ❑Buried ❑Well Pit ..................... 1 ❑ 9 ❑Well Pit Buried dq El Other -1 Miley r„� >i}� ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Colson Custom l2FJ1iiCs Diameter Depth ' Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above "' in.from U tog&ft. ❑Yes Y4 No ❑Yes ❑No ❑Unknown 216 Water St in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown excelsior, MH 55331 n.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE r � Well owner's mailing address if different than property owner's address indicated above Screen from to ft. Open Hale from to ft. OBSTRUCTIONS ❑Rods/Drop Pipe ❑Check Valve(s) ❑Debris ❑Fill Wo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL F COLOR HARDNESS OR FROM TO Obstructions removed? El Yes EJ No Describe FORMATION If not known,indicate estimated formation log from nearby well or boring. PUMP Type Lie'ft ❑Removed XNot Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: XNo 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 MATERIALS) (One bag of cement=94 lbs.,one bag of bentonite=50 lbs.) Grouting Material",47- from /'to_IRA_ft. yards_j` 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. 1) StMola Nell Drilling rn-. Inc. 1691 Licensee Business N. License or Registration No. } 4-14-13 i ere enWive SignatureCertified Rep.No. Date LOCAL COPY H 312016 Jim Antonson Name of Person Sealing Well or Boring,. HE-01434-13 IC#140-0423 5112R