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Minnesota Unique Well Number <br />506539 <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 />DAHLHIEMER, 120 22 W 8 ADDCAC 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 14747 VICKSBURG LA DAYTON MN 55327 Well Hydrofractured? Yes ❑ No <br />Stratigraphy Information <br />Geological Material From To (ft.) Color Hardness <br />CLAY 0 25 YELLOW SOFT <br />SAND & CLAY 25 35 YELLOW SOFT <br />CLAY 35 54 YELLOW SOFT <br />SAND & GRAVEL 54 68 YELLOW SOFT <br />CLAY 68 125 RED/BRN MEDIUM <br />CLAY & ROCKS 125 135 BROWN HARD <br />SHALE & SANDROCK 135 211 YEL/WHT MEDIUM <br />SHALE & SANDROCK 211 260 VARIED HARD <br />Remarks <br />Casing Type Single casing <br />Drive Shoe? Yes ® No ❑ <br />Casing Diameter Weight <br />4 in. To 214 ft. 11 lbs./ft. <br />Open Hole <br />Screen? <br />From 214 ft. <br />Type <br />Entry Date 12/04/1991 <br />Update Date 04/01/2016 <br />Received Date 09/21/1989 <br />Date Well Completed <br />08/28/1989 <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 />6 in. To 214 ft. <br />4 in. To 260 ft. <br />To 260 ft. <br />Make <br />Static Water Level <br />68 ft. land surface Measure 08/28/1989 <br />Pumping Level (below land surface) <br />78 ft. 3 hrs. Pumping at 50 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. 214 ft. <br />neat cement ft. ft. <br />Nearest Known Source of Contamination <br />75 feet Southwes Direction Septic tank/drain field Type <br />Well disinfected upon completion? X❑ Yes ❑ No <br />Pump ❑ <br />Manufacturer's name <br />Not Installed Date Installed 08/29/1989 <br />AERMOTOR <br />Model Number SD1275 HP 0.75 <br />Length of drop pipe 100 ft Capacity 12 <br />Abandoned <br />Does property have any not in use and not sealed well(s)? <br />Variance <br />Was a variance granted from the MDH for this well? <br />Miscellaneous <br />First Bedrock Jordan Sandstone <br />Volt 230 <br />g.p. Typ Submersible <br />❑ Yes ❑X No <br />❑ Yes ❑ No <br />Aquifer St.Lawrence- <br />Last Strat St.Lawrence-Tunnel City Depth to Bedrock 135 ft <br />Located by Minnesota Geological Survey <br />Locate Method Digitization (Screen) - Map (1:24,000) <br />System UTM - NAD83, Zone 15, Meters X 461965 Y 5007231 <br />Unique Number Verification Address verification Input Date 07/18/2008 <br />Angled Drill Hole <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 />506539 <br />Printed on 09/20/2017 <br />HE-01205-15 <br />