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Minnesota Unique Well Number <br /> County Sherburne MINNESOTA DEPARTMENT OF HEALTH <br /> WELL AND BORING REPORT Entry Date 06/24/1994 <br /> 49$324 Quad Lake Update Date 02/14/2014 <br /> Quad ID 137A Minnesota Statutes Chapter 1031 <br /> Received Date <br /> Well Name Township Range Dir Section Subsection Well Depth Depth Completed Date Well Completed <br /> 36 OWA 33 26 W 3 ABBBBB 74 ft. 71 ft. 12/13/1991 <br /> Elevation 1017 Elev.Method 7.5 minute topographic map(+/-5 feet) Drill Method Non-specified Rotary Drill Fluid Bentonite <br /> Address Use monitor well Status Active <br /> Well 22822 BALDWIN ST ELK RIVER MN 55330 Well Hydrofractured? Yes ❑ No ❑ From To <br /> Contact 7200 HEMLOCK LA N MAPLE GROVE MN 55639 Casing Type Single casing Joint <br /> Stratigraphy Information Drive Shoe? Yes ❑ No ❑X Above/Below 2.5 ft. <br /> Geological Material From To(ft.) Color Hardness Casing Diameter Weight Hole Diameter <br /> SAND 0 29 BROWN MEDIUM 2 in.To 61 ft. lbs./ft. 7 in.To 74 ft. <br /> SAND/GRAVEL 29 74 BROWN MEDIUM 2 in.To 51 ft. 3.65 lbs./ft. <br /> Open Hole From ft. To ft. <br /> Screen? X❑ Type stainless Make WIREWOUND <br /> Diameter Slot/Gauze Length Set <br /> 2 in. 10 10 ft. 61 ft. 71 ft. <br /> Static Water Level <br /> 61.3 ft. land surface Measure 12/13/1991 <br /> Pumping Level(below land surface) <br /> Wellhead Completion <br /> Pitless adapter manufacturer Model <br /> ❑ Casing Protection <br /> FX <br /> in.above grade <br /> ❑ At-grade(Environmental Wells and Borings ONLY) <br /> Grouting Information Well Grouted? X❑ Yes ❑ No ❑ Not Specified <br /> Material Amount From To <br /> neat cement 0.07 Cubic yards ft. 58 ft. <br /> Nearest Known Source of Contamination <br /> feet Direction Type <br /> Well disinfected upon completion? ❑ Yes No <br /> Pump ® Not Installed Date Installed <br /> Manufacturer's name <br /> Model Number HP Volt <br /> Length of drop pipe ft Capacity g.p, Typ <br /> Abandoned <br /> Does property have any not in use and not sealed well(s)? ❑ Yes No <br /> Variance <br /> Was a variance granted from the MDH for this well? ❑ Yes ❑ No <br /> Miscellaneous <br /> First Bedrock Aquifer Quat.Water <br /> Last Strat sand+larger-brown Depth to Bedrock ft <br /> Located by Minnesota Geological Survey <br /> Remarks Locate Method GPS SA Off(averaged) <br /> System UTM-Mad83,Zone 15,Meters X 456174 Y 5025955 <br /> Unique Number Verification InputeDate 11/12/2010 <br /> Angled Drill Hole <br /> Well Contractor <br /> Bergerson-Caswell 27058 HOLMEN,G. <br /> Licensee Business Lie.or Reg.No. Name of Driller <br /> Minnesota Well Index Report 498324 Printed on 08/16/2016 <br /> HE-01205-15 <br />