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Minnesota Unique Well Number <br />1 570113 <br />A County Anoka <br />Quad Nowthen <br />Quad ID 136C <br />MINNESOTA DEPARTMENT OF HEALTH <br />WELL AND BORING REPORT <br />Minnesota Statutes Chapter 1031 <br />Entry Date 08/01/1997 <br />Update Date 02/14/2014 <br />Received Date 01/15/1996 <br />Well Name Township Range Dir Section Subsection <br />32 25 W 9 ABDCCB <br />Elevation 895 ft. Elev. Method 7.5 minute topographic map (+/- 5 feet) <br />Well Depth Depth Completed Date Well Completed <br />85 ft. 85 ft. 10/04/1995 <br />Drill Method Non -specified Rotary Drill Fluid Bentonite <br />Use domestic Status Active <br />Address <br />Well 17121 VAROLITE ST NW RAMSEY MN <br />Well Hydrofractured? Yes ❑ No ❑ From To <br />Casing Type <br />Drive Shoe? <br />Single casing Joint Glued <br />Stratigraphy Information <br />Geological Material <br />SAND <br />CLAY & GRAVEL <br />GRAVEL <br />CLAY & GRAVEL <br />SAND <br />From <br />0 <br />14 <br />30 <br />35 <br />73 <br />To (ft.) <br />14 <br />30 <br />35 <br />73 <br />85 <br />Color <br />BROWN <br />RED <br />VARIED <br />BROWN <br />GRAY <br />Hardness <br />SOFT <br />SOFT <br />SOFT <br />SOFT <br />SOFT <br />Yes ❑ No X Above/Below <br />Casing Diameter Weight Hole Diameter <br />4 in. To 76 ft. lbs./ft. 8.5 in. To 30 ft. <br />6.5 in. To 85 ft. <br />Open Hole From ft. To ft. <br />Screen? <br />x Type stainless Make WESCO <br />Diameter Slot/Gauze Length Set <br />4 in. 7 8 ft. 76 ft. 85 ft. <br />Static Water Level <br />22 ft. land surface Measure 10/04/1995 <br />Pumping Level (below land surface) <br />ft. 1 hrs. Pumping at 20 g.p.m. <br />Wellhead Completion <br />Pitless adapter manufacturer MONITOR Model <br />❑ Casing Protection ❑ 12 in. above grade <br />❑ At -grade (Environmental Wells and Borings ONLY) <br />Grouting Information <br />Material <br />cuttings <br />bentonite <br />Well Grouted? X Yes ❑ No ❑ Not Specified <br />Amount From To <br />30 ft. 76 ft. <br />ft. 30 ft. <br />Nearest Known <br />40 feet <br />Well disinfected <br />Source of Contamination <br />Northeas Direction Septic tank/drain field Type <br />upon completion? X Yes ❑ No <br />Pump <br />Manufacturer's <br />Model Number <br />Length of drop <br />❑ Not Installed Date Installed 10/06/1995 <br />name STA-RITE <br />HP 0.5 Volt 230 <br />pipe 40 ft Capacity 10 g.p. Typ Submersible <br />Abandoned <br />Does property <br />have any not in use and not sealed well(s)? ❑ Yes X No <br />Variance <br />Was a variance <br />granted from the MDH for this well? ❑ Yes X No <br />Miscellaneous <br />First Bedrock Aquifer Quat. buried <br />Last Strat sand -gray Depth to Bedrock ft <br />Located by Minnesota Geological Survey <br />Locate Method GPS SA Off (averaged) (15 meters) <br />System UTM - NAD83, Zone 15, Meters X 464137 Y 5014311 <br />Unique Number Verification Address verification Input Date 01/04/2010 <br />Remarks <br />Angled Drill Hole <br />Well Contractor <br />Mork Well Co. 02133 THOMPSON, S <br />Licensee Business Lic. or Reg. No. Name of Driller <br />Minnesota Well Index Report <br />570113 <br />Printed on 07/13/2021 <br />HE-01205-15 <br />