08-22-2001 Council Agenda - Laserfiche WebLink

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INSTRUCTIONS FOR COMPLETING THE WELL DISCLOSURE STATEMENT DEFINITION A "well" means an excavation that is drilled, cored, bored, washed, driven, dug, jetted, or otherwise constructed if the excavation is intended for the location, diversion, artificial recharge, or acquisition of groundwater. MINNESOTA UNIQUE WELL NUMBER All new wells constructed AFTER January 1, 1975 should have been assigned a Minnesota unique well number by the person constructing the well. If the well was constructed after this date you should have the unique well number in your property records. If you are unable to locate your unique well number and the well was constructed AFTER January 1, 1975, contact your well contractor. If no unique well number is available, please indicate the depth and year of construction for each well. WELL TYPE Use one of the following terms to describe the well type. WATER WELL A water well is any type of well used to extract groundwater for private or public use. Examples of water wells are: domestic wells, drive -point wells, dug wells, remedial wells, and municipal wells. IRRIGATION WELL An irrigation well is a well used to irrigate agricultural lands. These are typically large diameter wells connected to a large pressure distribution system. MONITORING WELL A monitoring well is a well used to monitor groundwater contamination. The well is typically used to access groundwater for the extraction of samples. DEWATERING WELL A dewatering well is a well used to lower groundwater levels to allow for construction or use of underground spaces. INDUSTRIAL /COMMERCIAL WELL An industrial /commercial well is a nonpotable well used to extract groundwater for any nonpotable use including groundwater thermal exchange wells (heat pumps and heat loops). WELL USE STATUS Indicate the use status of each well. CHECK ONLY 1 BOX PER WELL. IN USE A well is "in use" if the well is producing sufficient water to meet its intended use and is being operated on a regular basis. NOT IN USE A well is "not in use" if the well is inoperable and not in use or the well is disconnected from a power supply and is not sealed. SEALED A well is "sealed" if the well has been sealed by a licensed contractor and there is a Sealed Well Report on file at the Minnesota Department of Health. A properly sealed well has been sealed by a licensed contractor by pumping grout throughout the entire borehole from the bottom of the well. NOTE: If a well is inoperable and not in use or disconnected from a power source, it must be sealed by a licensed well contractor or a well owner must obtain a maintenance permit from the Minnesota Department of Health and pay an annual maintenance feel. If a well is operable and properly maintained, a maintenance permit is not required. 1316963v1 Page 98