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Minnesota Unique Well Number <br />C <br />563482 <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 />KLOSTERMAN, 120 22 W 8 ADABCB 254 ft. 254 ft. <br />Entry Date 12/12/1996 <br />Update Date 04/01/2016 <br />Received Date 08/14/1995 <br />Date Well Completed <br />08/03/1995 <br />Elevation 929 ft. Elev. Method 7.5 minute topographic map (+/- 5 feet) Drill Method Non -specified Rotary Drill Fluid Qwik gel <br />Address Use domestic Status Active <br />Well 14847 VICKSBURG LA DAYTON MN 55327 Well Hydrofractured? Yes ❑ No ❑ From To <br />Casing Type Single casing Joint Threaded <br />Stratigraphy Information Drive Shoe? Yes ® No ❑ Above/Below <br />Geological Material From To (ft.) Color Hardness Casing Diameter Weight Hole Diameter <br />CLAY 0 27 YELLOW SOFT 4 in. To 202 ft. 11 lbs./ft. 6.2 in. To 202 ft. <br />CLAY & SAND 27 106 BROWN SOFT 4 in. To 254 ft. <br />CLAY & SAND 106 119 DK. BRN M.HARD <br />CLAY & GRAVEL RED 119 135 VARIED HARD <br />ROCKS, GRAVEL & 135 195 VARIED HARD <br />SHALE & SANDROCK 195 254 VARIED HARD Open Hole From 202 ft. To 254 ft. <br />Screen? n Type Make <br />Remarks <br />Static Water Level <br />65 ft. land surface Measure 08/03/1995 <br />Pumping Level (below land surface) <br />100 ft. 5 hrs. Pumping at 50 g.p.m. <br />Wellhead Completion <br />Pitless adapter manufacturer MERRILL Model SPK5.5 <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 />cuttings 30 ft. 254 ft. <br />bentonite 2 Sacks ft. 30 ft. <br />Nearest Known Source of Contamination <br />50 feet Northwes 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 08/08/1995 <br />AERMOTOR <br />Model Number 12T75 HP 0.75 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)? ❑ Yes No <br />Variance <br />Was a variance granted from the MDH for this well? ❑ Yes ❑ <br />No <br />Miscellaneous <br />First Bedrock Jordan -Tunnel City Aquifer Jordan -Tunnel <br />Last Strat Jordan -Tunnel City Depth to Bedrock 195 ft <br />Located by Minnesota Geological Survey <br />Locate Method Digitization (Screen) - Map (1:24,000) <br />System UTM - NAD83, Zone 15, Meters X 461916 Y 5007505 <br />Unique Number Verification Address verification Input Date 07/15/2008 <br />Angled Drill Hole <br />Well Contractor <br />Mc Alpine's Well Co. 27186 MCALPINE, S. <br />Licensee Business Lic. or Reg. No. Name of Driller <br />Minnesota Well Index Report <br />563482 <br />Printed on 09/20/2017 <br />HE-01205-15 <br />