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Home My WebLink Aboutwell info� STATh:OF�MINNI�:S()TA DFYAMTMF:NTOI�MULTH I. L()(ATI()N()I-W4�LL FI/NNf:50TA UNfQUF WEl.L NO. � � ,�: -� .� � .� CnumyNume �� WATER WEIL RECORD ��,w,«.samor �� „ �,� „� � .p �"y+. �� MinnriotoSlaMfIlISM1A.III�.lIN . � T��wnxhip Name Tnwnship Numher Nan`e Numher y�cti�n N�. I�r�a�lli�n J. YROYk:RTV OWNk:RS NAM! ;� ' Oro� 1ITt�, s� �3�' W 5 s�r '`� y awa' �:�l��ia Pe+tersorxl� ��Lc,s c,�' 1)islan�r anJ I)vecl�un(rum R�uJ In�<nec�inns��r Slrc�i AJJress and C�IY of Wsll Lnc�liun A�d!�. q7g �g�� .�,.Rd� ) i', �' �or�� , � _ 55356 ; � Snnw ea�at liica�ion i�f well in rec�l��n griJ wilh"X." Ske�cn map of well Ir�c�tiun. a.WELL DEPTH(completed) D�te of Completion M ! �.�� ,�;,,��,m� a_6„-�� ; � -� - - ,-- -�- - - «. ; � s. ; ,>s: � , � ipc.nir�ooi a❑Ke�rrse �On.�.�� o0u�� " �. N -' - -`- -�-I� - E ylock Num�er Z❑HnllnwruJ SOAir BOBnrod I I❑ ��_-.V� i _ '_ '` � - - 4.n. �C�,�i�rr e❑ieure aOv��we�n�e�r ��- ' � ' � � Lot Numher 6. USE � .� '_i_ ' _''' _ "_'__ � I�nmestic 4�YuAlic Su00�Y '1�Induslry ?k i i r :e� J F-1�1l.tt� 3❑IrriH+ti��n S❑Municlpal B�C�mmercial H�IlI/Nf:SS OF I. FONMATIONLO(: �('OLON F()HMATIUN fKOM TO lOTect Welt 6OAir(1�ndilinnin� 9❑ 6t ,p� =q 7.CASING HEIGHT: Above�Below NOLE UTAM �r�� Vi�w/i.� V � I�Black. 4❑ThreadeU � �2 3�(:alv. 5❑Welded Surfece /t. " $� �� ,7[�105tFC 6❑sO��Drive Shoe? Yes_ No�� .�_in.Io 1,�]$ !f. Weighl �� '�� Ib�./ft. �in.ro� , CI.��-j§Z�Tttl �TZ.�'�Tta �S '�� _� in.lo fl. Wei`ht Ihs./f!. n.to_fl. in.to R. WeiRht Ibs./ft. _in.to_fl. ' gravel brcr�a 9t� li�S B. SCREEN �4 �� .op�� o�� Make from (1.�o ft. ��ale—grevle rod—i�►rw 1�s5 13t� TY,� P�G o,.. 4" Sbt/Gauu �Fd Len t� �py �{.yy-+� ' y��'��, rQ(j��}� ��y ,;.�� Setbetween � ft.anA �ft. �� T�� I� `! �' t�r�l. ClC v'd1V�: ��.a�a ��. 9. STATIC WATtR LEVF:L � �� f��helnw ❑ahnve Dat<Measured �� - land surface ' 10.PUMYINGLEVEL@elowlandsurface) t('�()� . iVW i� e�.aner n...o�mo�os e.o.m. ft.afler hrs.pumpin6 6�V�m� 11.WELLHEADCOMYLF;TION ��Pitlesx etlepter,manutacturer model �� ]�Baeemenl of(sel 70 At lexst 12"above grede 12.WELL GROUTED? � L�Ye� ❑No 1�`7<al('emenl 7�Benl��nite J❑ � Grout ma[er�ai from to (t..Cu.YAs. � 13.NEAREST SOURCES OF POSSIBLE CONTAMINATION L�<«, a,.e��,o� �Yo� Well disinfttfed upon complelion^. Ves� Na❑ . 14. PUMP Date installed ❑Not insta11e0 � Manufac�ureiS Name ��Q�` ' Model Numbcr HY_�Volts � Length of droD P�D< � ft.capacilY ��e.p.m. . � Material o(droD D�De ��aC��lts �� TyDe: I�Suhmi•rsihle ��L.S.Tutbine 5❑Iteclpnrtaling �' 101el <�C'rnlrifu6�1 60 , Use a semnd Sheet,if needed 16.WATER WELL CONTRACTOR'S CERTIFICATION 15.REMARKS.ELEVA170N,SOURCE OF DATA,etc. This well was drilled under my jurisAic�ion and t�is reDort u Irue lo ' the Desl of my knowledge and beliel. � �. �SCBY@A!d C��3.Z t:O ��I�li ' C..- �� ZO t�- •-� -- .� Liceruee Bu+lnen Name Lieenx No. ' ; �` E� f-� a ; tJ��;L�' i�`. . ; �_r :.i F _ �� ! „�� 624� 2 � �i 1 ` `� S9 .; _ .�`.__. - -- ', � ' ---� _._ s � MAR � 8 rgg�; ° ' r 1� � 5�6 d � - . .:✓� . � ..�� .. Date� 1 Au1ho�xed Repr enutive � � �r � � Cid.�.'li ai��n�� D�te �'^��=" . \ � Name o!Driller ,� ..,.... .,� - ,. ,. 5/7d 30M � � I _'_- r, 7/76 30M _ � �/7B 30M � '' M M/NNESOTA UNIQUE WELL WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BOR/NG NO. �o��,tY Name WELL AND BORING RECORD Minnesota Statutes,Chapter 103I � 1��) �,/�'�� Township Na e Township No. Range No. Section No. Fraction WEWBORING DEPTH(completed) DATE WORK COMPLETED ,� n. GPS • DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds J Cable Tool []Driven �]Auger �Rotary House Number,Street Name,City,and ZIP Code of Well Location ❑Other 475 C)xfacr? ��J� `.7L� 55356 DRILLWG FLUID WELL HYDROFRACTURED? ❑Yes �No � , , Show exact location of well/boring in section grid with"X:' Sketch map of welVboring lo ation. [7CClt VI:LL Ce From ft.To ft. Showing propert lines, N roads,buildings,and dir ct�r} USE qDomestic �;Monitorin x � g [J Heating/Cooling __:___ __1__ ___L____:_ � r �� ❑Noncommunity PWS i�Environ.Bore Hole []Industry/Commercial [ i , 'S�, C Community PWS ❑Irrigation [;Remedial --'--- --'-- ---`-----t-- � ` — �. ; �Elevator ❑Dewatering �� _ _____ �' W , � E T � � - CASING MATERIAL ve Shoe? ;�Ye [�No HOLE DIAM ' --r - , - %--� \ Dr i l I � � �° ; Steel ❑Threaded [ Welded '/Mile ._' � ,��' :� .. � , , ' f .. ' Stif. � �j'Pla ❑ ; .----� -: 1 � ,,� � , ; ; : �'•CASING �. g `•_. _. .- � Diameter Weight Specifications , 1 /� C o C�t �1 Mile� . `�' in.To 1.77 ft. Ibs./ft. __ t3 in.Ta Jt.�tt � PROPERTY OWNER'S NAME/COMPANY NAME _in.To ft. Ibs./ft. �_in.To�ft `�'l�Jffk,.ZS �C@n {s�5 ��.ro ft. IbsJft. in.To n Proper[y owner's mailing address if different than well location address indicated above. � SCREEN OPEN HOLE Z/1�� R� iry�� {� ��n Make vVtui�,YV�l From_ ft To ft. L! �t Lan;; I,�kA, r'�� 5535� TYPe�t�inless steel Diam.— -- SlotlGauze_..___ �� .Length�� {.�,�� .} /k� � Set between ft.and ft. FITTINGS t� STATIC WATER LEVEL �� Measured from Ts_�y ft.�Below [l,Above land surface Date measured ��lrJ�l� WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 1�L� ft after 3 hrs.pumping St.r __g p m. Well/boring owner's mailing address if differeM than property owner's address indicated above. WELLHEAD COMPLETION T7�., �Pitless/adaptermanufactur�l�"��t�r Model _ ___ Li Casing protection f�12 in.above grade ❑At-grade ❑Well House � '��Hand Pump GROUTING INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other) Material }�I1t{)?1lrffrom�_To�r ft. __� j�Yds. �eags Material r�_�_To�_�.�ft. ❑Yds. ❑Bags HARDNESS OF Material From _To_ ft. ❑Yds. ❑Bags GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO Dnvencasingseal From_ To Bags NEAREST KNOWN SOURCE OF CONTAMINATION � C Zc'?j/ �7 EQWT7 SC3 f� (3 � t ._.___ _._._ feet direction type r Well disinfec[ed upon completion? �'Yes [�No . C.`l.�'.Z� vCa.� 3OLL 3 q PUMP � ��2 �_I Not installed Date installed 1��1� clay tatl SOft � 17 Manufacturer'sname ��x��___ �� L f. Model Number HP__ r Volts cl�y �ray r�di� tt=� Lengih of drop pipe 1Q� _ ft. Capaciry _g.p.m ��!�'r��1 vacied �j� fi4 7t� Type:�Submersible ❑LS.Turbine f.i Reciprocating ❑Jet ❑ ABANDONED WELLS �;CB�T s�ru�/�;ravel br(�jj['� Tfj�[ji� 71� '1F{� 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 � o TN# WELL CONTRACTOR CERTIFICATION This well was drilied under my supervision and in accordance with Minnesota Rules,Chapter 4725. The intormation contained in this report is irue to the best of my knowledge. Use a second sheet,if needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Ik�cz SCodol� C�eII 13�'ill�t't; Gos.�t�c. 1£�91 Licensee Business Name Lic.or Reg.No. • l 3�.. 1—�Z-24 ' -: . �..o .- - .- � � �� - ��`�,�"� GQrtifiAd Representative Signature f Certified Rep.No. Date .._ A, ,�� ,, �iy8i2 �"�E.'g8S[C.� LOCAL COPY � '� �"'`_� — — - .y ' f_f - Name of Driller � IC 140-0020 � � � - HE-01205-14(Rev.5'12) � � �r TW111 Clt�/W8tE1' C�II11C L8bOP8t01"�/TeSt R2pOP't Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory ID#105-10117 Client: Don Stodola Well Drilling Co Report Number: 13-13528 Twin City Water Clinic Inc. Sample Collection Date: 10/30/13 61713th Avenue South Address: 3841 North Main Street Sample Collection Time: 15:30 Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 30/31/13 Phone:(952)935-3556 Report Issue Date: 11/Ol/13 Fax:(952)935-5077 Laborato Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 13-13528 Coliform Drinking Water 30/31/13 12:46 Absent 13-13528 Nitrate/N Drinking Water 10/31/13 12:02 <1.0 mg/I 13-13528 Arsenic Drinking Water 10/31/13 10:40 li/Ol/13 1129 2.24 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water Well No.: 799023 X No samples were subcontracted;or the above test result(s) with'**'designation were produced by a subcontreded Sample pt: laboretory. [Laboretory name;address;MDH Lab ID#].The Well Adr: 475 Oxford Rd Orono,MN subcontracted laboratory maintains MDH Certification for the Owner: Thomas Bren Homes field(s)of testing performed. Owner Adr. Sample Conditions: Sample Temperature: 11 '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 SM4500D-Nitrate Nitrogen, 1.0 mg/I Nitrate Nitrogen 10.0 mg/I Arsenic,10.0 µg/I SM3113B-Arsenic,2.0µg/I Lead,15.0µg/t SM31136-Lead,2.Oµg/I � �� ; ��. � Sample Collected by: X Client _TCWC Approved By: ;;` `��f 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 ; WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 316 9 ?6 County Name WELL AND BORING SEALING RECORD Mennle9oNa Unique Well No. � Minnesota Statutes,Chanter 1031 or W-series No. �� .r Y Leave blenk�I nol known) ��-S.,r�.11.� :x':�G Township Name Township No. Range No. Section No. Fraction(sm.-+Ig.) Date Sealed Date Well o�Boring Constructed . 't.�.�,-�,� 1l 7 `l'� ('�� F..'!dff ?`'�: N�'� I � �i X R. ., i GPS Latitude_____ degrees minutes_ _ seconds Depth Before Sealing ��r"�� ___._ft. Original Depth _ ft. LOCATION: Longitude___ degrees minutes seconds qQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location [� �Single Aquifer (]Multiaquifer � .- WELLBORWG �Measured ❑Estimated Date Measured '��--j f �"�'- �-F��? �'�i�C)[�� '�� `i r��on �'jNvater-s�ppiy wen ❑Mona.weii � Show exact locahon of well or boring Sketch map of well or b ring �Env.Bore Hole �� ft. j]below ❑above land surface - ° in section grid with"X" location,showing prope y ❑Other_ ._ __ N lines,roads,and buildin s. CASING TYPE(S) � ' � �1 Steel ��. I Plastic �]Tile U Other � '-- '--- � � /� � ELLHEAD COMPLETION ---- � - ---� � -�------�- --`-- ---`�- / �- , W �� 'N ' ' ' ' E T `a� � G d I Off , 1 r r i Mile � �A1 ra e nside: �Basement set - _ ___ __ __ __ __ __ __ � Outside: j �Well House � � � � � I A U uned Well Pit � ; ; ; ; !�Pit ess dapter/ nit n B ' --�--- --�-----�-- ---�-- I � �_�. . � ❑Buried L �, ��.Well Pit , . S , , � ❑Other ''�� . �i Mile—� �ll Other_ �� PTRO�PERTY OWNER'S NAME/COMPANY NAME CASING(S) `� t.�;f)`,"1$$ ��t�.'�. �?�?"T!�q Diameter Depth Set in oversize hole? Annular space initially grouted? ;� � Property owner's mailing address if ditterent ihan well location address indicated above __�in.from_ J to i�W ft. [_�Yes �"No ❑Yes Lj No ❑Unknown � , �n73 �? 4•layzat�. Flvd, �10 x,R, _in.from to ft. �a Yes_,, ❑No ❑Yes ❑No �J Unknown I:�nU Lake, , 5535f, _ . i�.� __.._in.from to__ ft. �__'�.Yes ❑No ❑Yes f�No '�, �Unknown �� WELL OWNEA'S NAME/COMPANY NAME SCREEWOPEN HOLE Well owner's mailing address it diHe�ent than property owner's address indicated above Screen from /...:�to �`-�� ft. Open Hole from to __ ft �� , OBSTRUCTIONS �Rods/Drop Pipe ❑Check Valve(s) [_.�Debris ❑Fill ',�No Obstruction �, 5 Type of Obs[ructions(Describe),_ �� ' *�______,______ � �- --_ _ . GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? es r;No Describe FORMATION PUMP If not known,indicate estimated formation log from nearby well or boring. � � n C� _ : �.;�.��:�� . TYPe ._...��___�..r-w�-��.��..�..1�.A>,a.�--�^'�- . . �� '� �Removed '�'Not Present ❑Other__._ _ •r:: METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: -,...�,�:-.� f,�No Annular Space Exists [;Annular Space Grouted with Tremie Pipe �Casing Perforation/Removal in.from ___to .__. ft r;Perforated ❑Removed . � in.from_ to ft. ❑Perforated ❑Removed . -- ^R Type of Perforalor_ ___,__ __ _ L;Other__ GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material J" from l� to�__.� tt. yards ��"- bags i from__ to___ ft. ____ yards _ bags " ______ from_ to____ ft.____ yards ____ bags " OTHER WELLS AND 80RINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on properry? ❑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 hue to the best of my knowledge. s '�;.Inc. IF�a1 Licensee Business Narpe License or Registration No. !�+ /r��F� � • . / 1 ,� �,.�� ,j� . . • ; .,°`'`,�' ,s�=�:� = �;�_�- = ___ � -�`-�__�---- eL�rtilie�R2presentative Signature Certilied Rep.No. Date i .__. ' LOCAL COPV " � 1 E�2 6 ��y4''� —--. ._-- --- --- Name of Person Sealing Well o�Boring HE-01434-13 IC#140-0423 � snzR