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Minnesota Unique Well Number <br /> County Sherburne MINNESOTA DEPARTMENT OF HEALTH <br /> WELL AND BORING REPORT Entry Date 02/11/2003 <br /> 6$3321 Quad Lake Update Date 12/19/2011 <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 /> SB-6 34 26 W 34 CDBDAA 64 ft. 64 ft. 10/15/2002 <br /> Elevation 1001 Elev.Method 7.5 minute topographic map(+/-5 feet) Drill Method Auger(non-specified) Drill Fluid <br /> Address Use monitor well Status Active <br /> C/W 22640 169 HY NW ELK RIVER MN 55330 Well Hydrofractured? Yes <br /> No X From To <br /> Casing Type Single casing Joint Threaded <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 0 64 BROWN MEDIUM 2 in.To 54 ft. lbs./ft. 8 in.To 64 ft. <br /> Open Hole From ft. To ft. <br /> Screen? X❑ Type stainless Make JOHNSON <br /> Diameter Slot/Gauze Length Set <br /> 2 in. 10 10 ft. 54 ft. 64 ft. <br /> Static Water Level <br /> 54 ft. land surface Measure 10/15/2002 <br /> Pumping Level(below land surface) <br /> ft. hrs. Pumping at 9- <br /> p.m-Wellhead Completion <br /> Pitless adapter manufacturer Model <br /> X❑ Casing Protection FX12 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 /> high solids bentonite 4 Sacks 0 ft. 48 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 ❑X No <br /> Variance <br /> Was a variance granted from the MDH for this well? ❑ Yes X❑ No <br /> Miscellaneous <br /> First Bedrock Aquifer Quat.Water <br /> Last Strat sand-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 455919 Y 5026236 <br /> Unique Number Verification Name on mailbox Inpute Date 11/12/2010 <br /> Angled Drill Hole <br /> Well Contractor <br /> Boart Longyear 49653 WILBER,E. <br /> Licensee Business Lie.or Reg.No. Name of Driller <br /> Minnesota Well Index Report 68 321 Printed on 08/16/2016 <br /> HE-01205-15 <br />