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Home My WebLink AboutRe: well record MINNESOTA UNIQUE WELL WELL OR`BORING LOCATION , MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. County Name - WELL AND BORING CONSTRUCTION RECORD 826639 ...,..r�i.. Minnesota Statutes,Chapter 1031 Township Name Township No. Range No. Section No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED Orono .117 23 07 NW St SE ,/. 96 n. 8. 30-17 GPS LOCATION=decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool n_Dnven ❑Auger Rotary House Number,Street Name,City,and ZIP Code of Well Location ❑Other 4005 North Shore Dr, orono 55364 DRILLING FLUID WELL HYDROFRACTURED? LI Yes I'f�No Show exact location of well/boring in section grid with"X:' Sketch map of well/bori location. bentonite From ft.To J ft. Showing prorty1ines; N loads,buildings,an direction. USE Domestic ❑Monitoring ❑Heating/Cooling --- , ❑Noncommunity PWS ❑Environ.Bore Hole ❑Industry/Commercial ❑Community PWS ❑Irrigation ❑Remedial --- •--'---' --- ❑Elevator ❑Dewatering ❑ w E CASING MATERIAL Drive Shoe? ❑Yes Slo HOLE DIAM. t T ❑Steel ❑Threaded ❑Welded mite Plastic ❑ CASING T s Diameter . Weight Specifications I---tMile 4 in.To ft. lbs./ft. 8 in.To _ft. PROPERTY OWNER'S NAME//CO PANY NAME in.To ft. lbs./ft. in.T _k. Jim & Vicki Splinter in.To ft. lbs./ft. in.To ft. SCREEN OPEN HOLE Properlown�e'smatilian�gaaddreess�iffdli(f+efreM than well location address indicated above. Make athroon �a�� 'yam Austin, Mg 55912 Tyle standees steel From ft. To ft. SIoUGauze 86.010 Length 41 + 41 RECEIVED Set between ft.and 96 ft. FITTINGsnrlf leador STATIC WATER LEVEL Measured from MAR0 2 2Q18 40 fteBelow ❑Above land surface Date measured 8.1047 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) an ft.after 2 hrs.pumping 40 q.p.m.WelUbonngowner's mailing address if different thanprfitjI. /n a p`nAr above. WELLHEAD COMPLETION � - XPitless/adapter manufacturer 7 +tf ter Model ❑Casing protection Ar12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material b! 'ltOflite From 0 To ft. 3 0 Yds. 'Bags Material' ti� From 7 To ft. yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL Driven seal From To Bags C lay brown medium 0 * NEAREST KNOWN SOURCE OF CONTAMINATION .5 feet *...++. `direction f` 'ZI...2.8.-k—t-lype- sandyclay *9 37 Well disinfected upon completion? Yes ❑No �rssJ i9 PUMP - sand mix soft 37 96 ❑Not installed Date installed 811481116 �i/ �.a.:;18 Manufacturer's name Schaefer Model Number Hf Of Volts Length of drop pipe ft Capacity g.p.m, Type Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yesf No VARIANCE Was a variance granted from the MDH for this well? ❑Yes le 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. Don St la * Drilling Cosi Inc. 1691 Licensee Business Name i Lic.or Reg.No. .e z 1-•15-18 `ifi- • .resents iv=, ,,, -rre Certified Rep.No. Date 826639, ^{ Q Rob Shia LOCAL COPY V 2 6 6 3 9 Name of Driller ID#52603 HE-01205-15(Rev.8/13) Minnesota State Laboratory ID#027-053-119 Twin City Water Clinic Laboratory Test Report Wisconsin State Laboratory ID#105-10117 Wisconsin DNR Lab ID#399073400 Client: Don Stodola Well Drilling Report Number: 17-10336 Twin City Water Clinic Inc. Sample Collection Date: 08/30/17 617 13th Avenue South Address: 3841 N Main Street Sample Collection Time: 13:30 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 08/31/17 Phone:(952)935-3556 Report Issue Date: 09/01/17 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 17-10336 Coliform Drinking Water 08/31/17 13:36 Absent 17-10336 Nitrate/N Drinking Water 08/31/17 12:05 <1.0 mg/L 17-10336 Arsenic Drinking Water 08/31/17 8:30 09/01/17 10:34 4.35 p.g/L Lead Drinking Water µg/L mg/L Well No.: 826639 X No samples were subcontracted;or the above test result(s) with'*"designation were produced by a subcontracted Sample pt: well laboratory. [Laboratory name;address;MDH Lab ID#]. The Well Adr: 4005 North Shore Drive;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Jim&Vicki Splinter field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 16°C Discussion: Notes: Approved methods used in analyzing the samples listed above have. the following reporting levels: Maximum contaminant levels: SM9222B-Coliform;1 cfu/100 ml Coliform-<1 cfu/100 ml Nitrate EPA 353.2-Nitrate Nitrogen expressed as NO3+NO2,1.0 mg/L Nitrogen 10.0 mg/L Arsenic,10.0 5M31138-Arsenic,2.0µg/I,Lead,2.0 µg/L µg/L Lead,15.0 Lig/L EPA 353.2-Nitrite Nitrogen,1.0 mg/L Nitrite,1 mg/L Sample Collected by: X Client TCWC Approved By: / Bill Van Arsdale Laboratory Manager 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 4.0 Page 1 of 1