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Minnesota Unique Well Number <br />242241 <br />County Hennepin <br />Quad Anoka <br />Quad ID 120B <br />MINNESOTA DEPARTMENT OF HEALTH <br />WELL AND BORING REPORT <br />Minnesota Statutes Chapter 1031 <br />Entry Date 12/23/2008 <br />Update Date 02/09/2016 <br />Received Date <br />Well Name Township Range Dir Section Subsection Well Depth Depth Completed Date Well Completed <br />DAYTON - 120 22 W 9 BADCCB 52 ft. 52 ft. 07/28/1987 <br />Elevation 903 ft. Elev. Method 7.5 minute topographic map (+/- 5 feet) Drill Method Drill Fluid <br />Address <br />Stratigraphy Information <br />Geological Material From To (ft.) Color Hardness <br />SILTY CLAY 0 2 DK. BRN MEDIUM <br />SANDY LEAN CLAY 2 4 BROWN MEDIUM <br />SANDY LEAN CLAY 4 13 BROWN <br />SAND W/ SILT SM 13 16 LT. BRN <br />SANDY LEAN CLAY W/ 16 25 BROWN <br />SILTY SAND W/ SM 25 28 BROWN <br />SAND W/ SILT SM 28 30 BROWN <br />SAND W/ SILT LI1"ILE 30 33 BROWN <br />SILT FE W LENSE OF 33 36 BROWN <br />SAND F DRY TO MOIST 36 52 LT. BRN <br />Remarks <br />M.G.S. NO. 3779. SEE DETAILED SOIL BORING. <br />BORING BACKFILLED WITH NEAT CEMENT GROUT TO 3 FT. FROM LAND <br />SURFACE. <br />Use test well <br />Well Hydrofractured? <br />Casing Type <br />Drive Shoe? Yes ❑ <br />Open Hole <br />Screen? <br />From <br />Static Water Level <br />Yes ❑ <br />No <br />No ❑ <br />U From <br />Joint <br />Above/Below <br />ft. To <br />Type Make <br />Pumping Level (below land surface) <br />Status Active <br />ft. <br />To <br />Wellhead Completion <br />Pitless adapter manufacturer Model <br />❑ Casing Protection ❑ 12 in. above grade <br />❑ At -grade (Environmental Wells and Borings ONLY) <br />Grouting Information Well Grouted? 0 Yes ❑ No ❑ Not Specified <br />Material Amount From To <br />neat cement 3 ft. 52 ft. <br />cuttings ft. 3 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 ❑ <br />Miscellaneous <br />First Bedrock Aquifer <br />Last Strat sand+silt-brown Depth to Bedrock <br />Located by Minnesota Geological Survey <br />Locate Method Digitization (Screen) - Map (1:24,000) <br />System UTM - NAD83, Zone 15, Meters X 462697 <br />Unique Number Verification Site Plan Input Date <br />Angled Drill Hole <br />Well Contractor <br />Twin City Testing M0112 <br />Licensee Business Lic. or Reg. No. <br />No <br />ft <br />Y 5007590 <br />12/23/2008 <br />Name of Driller <br />Minnesota Well Index Report <br />242241 <br />Printed on 09/20/2017 <br />HE-01205-15 <br />