The URL can be used to link to this page

Home My WebLink AboutWell Record - 3-22-2017 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH ,. MINNESOTA UNIQUE WELL AND BORING NO. County Name WELL AND BORING CONSTRUCTION RECORD Q Q Hennepin Minnesota Statutes,Chapter 1031 V? 3 4 6 V Township Name Township No. Range No. Section No. Fraction WELL/BORING DEPTH(completed) DATE WORK COMPLETED Orono 117 23 06 ,,M SST 155 h. 3-22-17 GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD Latitude Longitude ❑Cable Tool ❑Driven ❑Auger Rotary House Number,Street Name,City,and ZIP Code of Well Location` El]Other 4705 Augusta St, Orono 55364 DRILLING FLUID • WELL HYDROFRACTURED? ❑Yes I]tNo Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. From ft.To ft. Showing pro erty lines, water roads,buildings, rection. USE N Domestic ❑Monitoring ❑Heating/Cooling __,_____ __, __L -_ / . ❑Noncommunity PWS 111 Environ.Bore Hole IDIndustry/Commercial ,, ❑Community PWS ❑Irrigation 111Remedial ---1-------1.--- __1 : -_ ❑Elevator ❑Dewatering ❑ w ; E CASING MATERIAL Drive Shoe? ❑Yes �No HOLE DIAM. T \ _, ❑Steel ❑Threaded ❑Welded 'h Mie lastic ❑ - - CASING S Diameter L Weight Specifications p n —1 Mile (sr _) 4 in.To 147 ft. lbs./ft. Qp:�—in.To 5°ft. PROPERTY OWNER'S NAME/COMPANY NAME n.To ft. lbs.ft. - in.To 16 Norton Ibmes in.To ft. lbs./ft. in.To ft. OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN 18215 45th Ave N, Ste D Make _ Type stainless steel From fief ft. To ft. Plymouth, M 3 55446 Slot/Gauze .010 Length 4' + 4' ,�,. Set between 147 ft.and 155 ft. FITTINGS 2"a3-' leader STATIC WATER LEVEL Measured from 75 ft. elow ❑Above land surface Date measured 3-22-17 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 1402 r� ft.after hrs.pumping 40 q.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION tom-=tester Pitless/adapter manufacturer Wii2 Model ❑Casing protection j:ir12 in.above grade ❑At-grade ❑Well House ❑Hand Pump GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material bORntoniterom 500 To 50 ft. 3 ❑Yds. Bags Material cuttings From To 147 ft. ❑Yds. ❑Bags HARDNESS OF Material From To ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR FROM TO MATERIAL Driven casing seal From To Bags NEAREST KNOWN SOURCE OF CONTAMINATION clay brown medium 0 21 %'- (9 . feet t j ) direction . 1 +� , �"- type `�'— Well disinfected upon completion? ,Wes E]No \ clay gray medium 21 86 PUMP q LI Not installed Date installed 12- 6-17 silty clay/sand gray soft 86 95 Manufacturer's name .Ci(`hP fPY__ fine sand brown ?!tedium 95 143 Model Number { HP 1.5 Volts 230 1 t C 16Length of drop pipe 105 ft. Capacity g.p.m. water sand brown medium 143 2 Type:,Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ ABANDONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes , lo VARIANCE Was a variance granted from the MDH for this well? ❑Yes Alo TN# - WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. Use a second sheet,if needpe The information contained in this report is true to the best of my knowledge. REMARKS,ELEVATION,SOURCE OF DATA.etc. RECEIVED 0 `, Don Stodola Well Drilling Co,. Inc. 1691 APR1 Z018 Licensee Busines Name Lic.or Reg.No. � 1-17-18 CITY OF ORONO �C , e e pr nudge agna ure Certified Rep.No. Date LOCAL COPY 82 3-4 6 H Name of Driller Rob Stodola 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: 17-03436 Twin City Water Clinic Inc. Sample Collection Date: 03/22/17 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: 16:00 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 03/23/17 Phone: (952)935-3556 Report Issue Date: 03/24/17 Fax: (952)935-5077 Laboratory Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 17-03436 Coliform Drinking Water 03/23/17 12:17 Absent 17-03436 Nitrate/N Drinking Water 03/23/17 12:06 <1.0 mg/L 17-03436 Arsenic Drinking Water 03/23/17 9:00 03/24/17 11:31 <2.0 pg/L Lead Drinking Water µg/L Nitrite/N Drinking Water mg/L E.coil Drinking Water Well No.: 823468 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: 4705 Augusta Street;Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Norton Homes field(s)of testing performed. Owner Adr: Sample Conditions: Sample Temp: 10 '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 EPA 353.2-Nitrate Nitrogen expressed as NO3+NO2,1.0 mg/L Nitrate Nitrogen 10.0 mg/L SM3113B-Arsenic,2.0µg/I,Lead,2.0 µg/L Arsenic,10.0 µg/L Lead,15.0µg/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