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Minnesota Unique Well Number <br />690420 <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 <br />LAUREL TREE 120 22 W 5 DDCCCD <br />Elevation 883 ft. Elev. Method <br />Address <br />Well <br />7.5 minute topographic map (+/- 5 feet) <br />16301 DAYTON RIVER RD DAYTON MN 55327 <br />Stratigraphy Information <br />Geological Material <br />CLAY <br />SAND <br />COARSE GRAVEL <br />CLAY & GRAVEL <br />CLAY & GRAVEL <br />CLAY <br />CLAY, GRAVEL & ROCK <br />SAND BRN, YEL, & <br />Remarks <br />From To (ft.) Color Hardness <br />0 18 YELLOW MED-HRD <br />18 42 BROWN SOFT <br />42 50 BRN/BLK SFT-MED <br />50 65 GRY/BLK SOFT <br />65 74 GRY/BLK SOFT <br />74 80 RED/BRN MEDIUM <br />80 137 BRN/BLK SFT-HRD <br />137 156 VARIED M.HARD <br />Well Depth <br />156 ft. <br />Entry Date <br />Update Date <br />Received Date <br />08/12/2008 <br />04/11/2003 <br />Depth Completed Date Well Completed <br />156 ft. 03/14/2003 <br />Drill Method Non -specified Rotary <br />Use domestic <br />Well Hydrofractured? <br />Yes ❑ <br />No <br />Casing Type Single casing <br />Drive Shoe? Yes ❑ No ❑ <br />Casing Diameter Weight <br />4 in. To 137 ft. lbs./ft. <br />Open Hole <br />Screen? <br />Diameter <br />2 in. <br />Drill Fluid Qwik gel <br />U From <br />Joint <br />Above/Below <br />Status Active <br />To <br />Welded <br />Hole Diameter <br />6.5 in. To 148 ft. <br />From ft. To ft. <br />Type stainless Make JOHNSON <br />Slot/Gauze Length Set <br />10 8 ft. 148 ft. 156 ft. <br />Static Water Level <br />40 ft. land surface <br />Pumping Level (below land surface) <br />80 ft. 2 hrs. Pumping at <br />Wellhead Completion <br />Pitless adapter manufacturer MERRILL <br />X❑ Casing Protection ❑X 12 in. above grade <br />❑ At -grade (Environmental Wells and Borings ONLY) <br />Grouting Information <br />Material <br />high solids bentonite <br />cuttings <br />Measure <br />03/14/2003 <br />50 g.p.m. <br />Model MCK6.5 <br />Well Grouted? X❑ Yes ❑ No ❑ Not Specified <br />Amount From To <br />2 Sacks 0 ft. 30 ft. <br />30 ft. 148 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 ❑ Not Installed Date Installed 03/17/2003 <br />Manufacturer's name AERMOTOR <br />Model Number 12T75 HP 0.75 Volt 230 <br />80 ft Capacity 12 g.p. Typ Submersible <br />Length of drop pipe <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 <br />Last Strat <br />Located by <br />Locate Method <br />System <br />❑ Yes ❑X No <br />❑ Yes X❑ <br />Aquifer Quat. buried <br />sand Depth to Bedrock ft <br />Minnesota Geological Survey <br />Digitization (Screen) - Map (1:24,000) <br />UTM - NAD83, Zone 15, Meters X 461745 Y 5007979 <br />Unique Number Verification <br />Angled Drill Hole <br />No <br />Address verification Input Date 07/10/2008 <br />Well Contractor <br />McAlpine Well Drilling 27695 MCALPINE, T. <br />Licensee Business Lic. or Reg. No. Name of Driller <br />Minnesota Well Index Report <br />690420 <br />Printed on 09/22/2017 <br />HE-01205-15 <br />