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DISCLOSURE STATEMENT:WELL 81, Page 3 82. INSTRUCTIONS FOR COMPLETING THE WELL DISCLOSURE STATEMENT 83. DEFINITION:A"well"means an excavation that is drilled, cored, bored, washed, driven, au or otherwise 84. constructed if the excavation is intended for the location,diversion,artificial recharge,or acquisition oa oundw groundwater. r. 85. MINNESOTA UNIQUE WELL NUMBER: All new wells constructed AFTER January 1. 1975, should have been 86. assigned a Minnesota unique well number by the person constructing the well.If the well was constructed after this 87. date,you should have the unique well number in your property records.If you are unable to locate your unique well 88. number and the well was constructed AFTER January 1,1975,contact your well contractor.If no unique well number 89. is available,please indicate the depth and year of construction for each well. 90. WELL TYPE:Use one of the following terms to describe the well type. 91. WATER WELL:A water well is any type of well used to extract groundwater for private or public use.Exam les 92. of water wells are:domestic wells,drive-point wells,dug wells.remedial wells,and municipal wells. p 93. IRRIGATION WELL: An irrigation well is a well used to irrigate agricultural lands.These are # icali 94. large-diameter wells connected to a large pressure distribution system. yp y 95. MONITORING WELL:A monitoring well is a well used to monitor groundwater contamination.The well i 96. typically used to access groundwater for the extraction of samples. s 97. DEWATERING WELL:A dewatering well is a well used to lower groundwater levels to allow for constructs n 98. or use of underground spaces. ° 99. INDUSTRIALICOMMERCIAL WELL: An industrial/commercial well is a nonpotable well used to extract 100. groundwater for any nonpotable use,including groundwater thermal exchange wells(heat pumps and heat 101. loops). 102. WELL USE STATUS:Indicate the use status of each well.CHECK ONLY ONE(1)BOX PER WELL. 103. IN USE:A well is"in use"if the well is operated on a daily,regular,or seasonal basis.A well in use includes 104. a well that operates for the purpose of irrigation,fire protection,or emergency pumping. 105. ' NOT IN USE:A well is"not in use"if the well does not meet the definition of"in use"above and has not been 106. sealed by a licensed well contractor. 107. SEALED:A well is"sealed"if a licensed contractor has completely filled a well by pumping grout material 103. throughout the entire bore hole after removal of any obstructions from the well.A well is"capped"if it has 109. a metal or plastic cap or cover which is threaded,bolted or welded into the top of the well to prevent entry 110. into the well.A`'capped"well is not a"seated"well. 111. if the well has been sealed by someone other than a licensed well contractor or a licensed well sealing 112. contractor,check the well status as"not in use." 113. if you have any questions,please contact the Minnesota Department of Health,Well Management Section, 114, at(651)201-4587(metropolitan Minneapolis-St.Paul)or 1-800-383-9808(greater Minnesota). Mtn-DS:VV-3(8/171 'i'r,ianet