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Minnesota Unique Well Number <br /> County Sherburne MINNESOTA DEPARTMENT OF HEALTH <br /> WELL AND BORING REPORT Entry Date 09/16/1994 <br /> 545375 Quad Lake Update Date 02/14/2014 <br /> Quad 1D 137A Minnesota Statutes Chapter 1031 <br /> Received Date <br /> Well Name Township Range Dir Section Subsection Well Depth Depth Completed Date Well Completed <br /> TOTH,JOHN 34 26 W 34 CDDCBA 156 ft. 156 ft. 05/13/1994 <br /> Elevation 1009 Elev.Method 7.5 minute topographic map(+/-5 feet) Drill Method Non-specified Rotary Drill Fluid Bentonite <br /> Address Use domestic Status Active <br /> C/W 22915 169 HY ELK RIVER MN Well Hydrofractured? Yes <br /> No From To <br /> Casing Type Single casing Joint Glued <br /> Stratigraphy Information Drive Shoe? Yes ❑ No ❑X Above/Below <br /> Geological Material From To(ft.) Color Hardness Casing Diameter Weight Hole Diameter <br /> SAND&GRAVEL 0 13 BROWN SOFT 4 in.To 147 ft. lbs./ft. 8 in.To 156 ft. <br /> GRAVEL&CLAY 13 19 BROWN SOFT <br /> GRAVEL 19 73 VARIED SOFT <br /> CLAY 73 75 BROWN SOFT <br /> CLAY 75 81 GRAY SOFT <br /> CLAY 81 90 RED SOFT Pen Hole From ft. To ft. <br /> CLAY&GRAVEL 90 125 BROWN SOFT Screen? Type stainless Make JOHNSON <br /> Diameter Slot/Gauze Length Set <br /> CLAY 125 145 RED SOFT 2 in 10 8 ft. 147 ft. 156 ft. <br /> SAND 145 156 YELLOW SOFT <br /> Static Water Level <br /> 56 ft. land surface Measure 05/13/1994 <br /> Pumping Level(below land surface) <br /> ft. 1 hrs. Pumping at 60 g.p.m. <br /> Wellhead Completion <br /> Pitless adapter manufacturer MONITOR Model SPL41UCL <br /> ❑ Casing Protection ❑ 12 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 /> bentonite 0 ft. 30 ft. <br /> cuttings 30 ft. 147 ft. <br /> Nearest Known Source of Contamination <br /> 55 feet Northwes Direction Septic tank/drain field Type <br /> Well disinfected upon completion? Yes ❑ No <br /> Pump ❑ Not Installed Date Installed 05/19/1994 <br /> Manufacturer's name STA-RITE <br /> Model Number IOPD4CO4J- HP 0.75 Volt 230 <br /> Length of drop pipe 80 ft Capacity 15 g-p- Typ Submersible <br /> Abandoned <br /> Does property have any not in use and not sealed well(s)? X❑ Yes ❑ No <br /> Variance <br /> Was a variance granted from the MDH for this well? ❑ Yes ❑ No <br /> Miscellaneous <br /> First Bedrock Aquifer Quat.buried <br /> Last Strat sand-yellow 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 455976 Y 5026061 <br /> Unique Number Verification Address verification InputeDate 11/12/2010 <br /> Angled Drill Hole <br /> Well Contractor <br /> Mork Well Co. 02133 THOMPSON,S. <br /> Licensee Business Lie.or Reg.No. Name of Driller <br /> Minnesota Well Index Report 545375 Printed on 08/16/2016 <br /> HE-01205-15 <br />