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Home My WebLink Aboutwell info : • �� WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH M/N AEND BOR/N��G NO. ELL ' co��tiName WELL AND BORING RECORD �-7�$ �� pia Minnesota Statutes,Chapter 103/ A Township Name Township No. Range No. Section No. Fraction WEWBORING DEPTH(compleled) DATE WORK COMPLETED t�rono I17 23 08 � N�, N�1 ,, n. GPS � DRILLING METHOD LOCATION: La[itude degrees minutes seconds . i _ . Longitude degrees minutes seconds � .Cable Tool �Driven i Dug �_j Auger �otary ,�:Jetted House Number,Street Name,City,and Zip Code of Well Location or Fire Number �-�. 91S Farr�ood Rd, SrCOCK� 5535b DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well/boring in section grid with"X" Sketch map of well/boring locati�. ��C From,___ ft.To_ ft. Showing property�es, - --- — N roads,buildings,and dir tion. USE �Domestic ,.�Moniroring �'_�,Heating/Cooling ' ___ __ _ __ ' �I Noncommunity PWS ',-_Environ.Bore Hole �_�.Industry/Commercial < < � �� - S;-. �;Community PWS I�Irrigation ,_ 'Remedial --�---- ---- -�- -- >-- � � � L.Elevator � ]Dewatering `�_-] � � `/'/ E � �� -� CASING MATERIAL HOLE DIAM. ; � ; '�, � � ��. Drroe Shoe� _ Y s I No -�-- -- -- � --%-- T "i� � e � � I �"`-- ry- I�Steel ��Threaded �_�I Welded , , 'h Mile �,.s 4° � �': .. ; ; , � , 7 ��Plastic [] �-- - 5 � -�-- :. _ ! CASING � � "'�� Diameter Weight Specifications ----�'. i i nn�ie� "T in.to 471 }t. �1 Ibs./ft. _ �in.to_ 2 PROPERTY OWNER'S NAME/COMPANY NAME in.to_ ft. Ibs./ft. �''�in.to ,S 5��iC' & �At�;�Yf�� I�+� " _ in.to ft. Ibs./ft. in.to ft. ,.i.r,. PropQerty owner's mailing address if different than well location address indicated above. SCREEN OPEN HOLE ��' �47.)�t�l ��tC7[iCS22 .i3�� Make �� _ From —__ft. To_.. _—_---ft. : .. � Yti$�T$$�� r��Rv 55391 TYPe stainles$ '$�,y -- Diam.-- --.—.-- Slot/Gauze _n�n . Length /��j_ Set between ft.and it: FITTINGS STATIC WATER LEVEL � n� Measured from '!C'♦ � ft.'J�Below '� �Above land sur(ace Date measured .T'X"1� WELL OWNER'S NAME/COMPANY NAME P6hpP}[VG LEVEL(below land suAace) � L^ �i G�t3 c�tie ft.after hrs.pumping g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION � �Pitless/adapter manufacturer �, ' J�.._�,�.�._r�.�� • Model ❑Casing Protection _________ �12 in.above grade `�At-grade(Environmental Well and Boring ONLY) GROUTING INFORMATION Well } � � �No j� / x Grout�'�I��cement Lf�entonite�oncrete �Othe1'► From To _ft. '"Yds. L i Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From To __ft r�'Yds. "Bags MATERIAL From To____ft ❑Yda ��Bags NEAREST KNOWN SOURCE OF CONTAMINATION � cl�y ye�Ic� soft 0 28 � >, f- , -� feet 4� direction �-� �� . - - �� type - .}p p� Well disinfected upon completion? ['�Yes []No �""� � � � �;�- -' �._�....... . . C�A�I.Sa� �L�S� .�OfC L(7 �C7t3 PUMP i�. �vl�� r� ��t �� ]Not installed Date installed ` � ��, � �� . Manufacturer'sname '�� " -= .,-��->- .��= -' j Model Number r�� HP � ��--'+ Volts -F `�J coacse sandstor� �ahite saft 297 3Q8 " Length of drop pipe l...T��D ft. Capacity g.p.m. Type:I, �.Submersible �]LS.Turbine �;Reciprocating �. I Jet �-l'�_ ABANDONED WELLS Does property have any not in use and not sealed well(s)? L;Yes �No VARIANCE Was a variance gran[ed from the MDH for this well? �-l�Yes �T�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,il needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. caV[i JtQ(lOiaWeI2 �til.lin� Cc>,. 1jZC s ��1 Licensee Business Name Lic.or Reg.No. � ,� _:�l�-, f 7 C 'ie e resentative Signature ` Certified Rep.No. Date G�?L�C�CC ?�t@ LGCRL COPY � 7� � �> � Name of Driller IC 140-0020 � HE01205-12(Rev.12/OB) - . . � 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: io-oza�a Twin City Water Clinic Inc. Sample Collection Date: i2/zi/io 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: is:oo Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: i2/zz/io Phone: (952)935-3556 Report Issue Date: iz/z3/io Fax: (952)935-5077 Laborato Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 10-11750 Coliform Drinking Water 12/22/10 14:13 Absent Nitrate/N Drinking Water mg/I Arsenic Drinking Water µg/� Lead Drinking Water µg/� Drinking Water Drinking Water Drinking Water X No samples were subcontracted;or the above test result(s) Sample Conditions/Discussion/Notes: with'**'designation were produced by a subcontracted laboratory. Sample Location-well#776855 915 Partenwood Rd.Orono,MN [Laboratory name;address;MDH Lab ID#]. The subcontracted laboratory maintains MDH Certification for the field(s)of testing performed. Sdmple Temperature: 15 °C Sample Conditions: 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, SM92226-Coliform, 1 cfu/100 ml Coliform-<1 cfu/100 ml N►isconsin and EPA Nitrate Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen, 1.0 mg/I Arsenic,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. ,� , � �; �,,,�/ !� , � 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 . � Twin City Water Clinic Laboratory Test Report Minnesota State Laboratory ID#027-053-119 Wisconsin State Laboratory IDq 105-10117 Client: Don Stodola Well Drilling Co Report Number: io-ois�s Twin City Water Clinic Inc. Sample Collection Date: o9/ze/io 617 13th Avenue South Address: 3841 North Main Street Sample Collection Time: is:so Hopkins, MN 55343 St.Bonifacius,MN 55375 Sample Receipt Date: 09/3o/io Phone: (952)935-3556 Report Issue Date: io/oa/io Fax: (952)935-5077 Laborator Analyte Client ID Parameter Sample Prep Sample Analysis Test Sample ID Date Time Date Time Results Units 10-09246 Coliform Drinking Water 09/30/10 11:15 Present-Total 10-09246 Nitrate/N Drinking Water 09/30/10 1139 <1.0 mg/I 10-09246 Arsenic Drinking Water 09/30/10 8:50 10/O1/10 10:18 26.90 µg/I Lead Drinking Water µg/I Drinking Water Drinking Water Drinking Water X No samples were subcontrected;or the above test result(s) Sample Conditions/Discussion/Notes: with'*"'designation were produced by a subcontracted laboratory. Sample Location-Well#776855 Steiner&Koappleman [Laboratory name;address;MDH Lab ID#]. 915 Partenwood Rd. Orono,MN The subcontracted laboratory maintains MDH Certification for the field(s)of testing performed. Sample Temperature: 8 °C Sample Conditions: Coliform Total-Present. Coliform Fecal-Absent. Discussion: Notes: Approved methods used in analyzing the samples This Sample does not listed above have the following reporting levels: Maximum contaminant levels: meet the State of Coliform-<1 cfu/100 ml SM92226-Coliform, 1 cfu/100 ml Minnesota,Wisconsin Nitrate Nitrogen 10.0 mg/I SM4500D-Nitrate Nitrogen, 1.0 mg/I Arsenic,10.0 µg/I and EPA guidelines for SM 3003-Arsenic,2.0µg/I Lead,15.0µg/I safe drinking water for SM3113-Lead,2.0µg/I the analytes tested. , � j ��. �� 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 list�d sam�iles. 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