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Minnesota Unique Well Number <br />488761 <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 />Well Name Township Range Dir Section Subsection Well Depth Depth Completed <br />DAHLHEINER, 120 22 W 9 CBBBBB 260 ft. 260 ft. <br />Elevation 923 ft. Elev. Method 7.5 minute topographic map (+/- 5 feet) Drill Method Non -specified Rotary <br />Address Use domestic <br />Well 14700 VICKSBERG LA DAYTON MN 55327 Well Hydrofractured? Yes ❑ No <br />Stratigraphy Information <br />Geological Material From To (ft.) Color Hardness <br />CLAY 0 30 YELLOW MEDIUM <br />SAND 30 40 YELLOW SOFT <br />CLAY & SAND 40 103 YEL/BRN MEDIUM <br />CLAY 103 122 RED/BRN MEDIUM <br />SAND 122 126 BROWN SOFT <br />CLAY 126 165 BROWN MEDIUM <br />SHALE & SAND YEL 165 219 VARIED SFT-HRD <br />SHALE & SANDROCK 219 260 VARIED HARD <br />Remarks <br />Casing Type Single casing <br />Drive Shoe? Yes ® No ❑ <br />Casing Diameter Weight <br />4 in. To 222 ft. 11 lbs./ft. <br />Open Hole <br />Screen? <br />From 222 ft. <br />Type <br />Entry Date 12/30/1993 <br />Update Date 03/21/2017 <br />Received Date 04/01/1992 <br />Date Well Completed <br />02/18/1992 <br />Drill Fluid Qwik gel <br />U From <br />Joint <br />Above/Below <br />Status Active <br />To <br />1 ft. <br />Hole Diameter <br />8 in. To 30 ft. <br />6.5 in. To 222 ft. <br />4 in. To 260 ft. <br />To 260 ft. <br />Make <br />Static Water Level <br />77 ft. land surface Measure 02/18/1992 <br />Pumping Level (below land surface) <br />100 ft. 3 hrs. Pumping at 40 g.p.m. <br />Wellhead Completion <br />Pitless adapter manufacturer WHITEWATER Model SU5.5 <br />❑ Casing Protection ❑X 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 ft. 222 ft. <br />Nearest Known Source of Contamination <br />60 feet South Direction Septic tank/drain field Type <br />Well disinfected upon completion? X❑ Yes ❑ No <br />Pump ❑ Not Installed Date Installed 02/22/1992 <br />Manufacturer's name TEEL 9 (OWNERS) <br />Model Number HP 0.5 Volt 230 <br />Length of drop pipe 100 ft Capacity 12 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 Jordan-St.Lawrence Aquifer St.Lawrence- <br />Last Strat St.Lawrence-Tunnel City Depth to Bedrock 165 ft <br />Located by Minnesota Geological Survey <br />Locate Method Digitization (Screen) - Map (1:24,000) <br />System UTM - NAD83, Zone 15, Meters X 462108 Y 5007150 <br />Unique Number Verification <br />Angled Drill Hole <br />Address verification Input Date 07/15/2008 <br />Well Contractor <br />Mc Alpine's Well Co. 27186 MCALPINE, T. <br />Licensee Business Lic. or Reg. No. Name of Driller <br />Minnesota Well Index Report <br />488761 <br />Printed on 09/20/2017 <br />HE-01205-15 <br />