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Minnesota Unique Well Number <br />CountyWashington MINNESOTA DEPARTMENT OF HEALTH <br />WELL AND BORING REPORT Entry Date 111/18/2002 <br />674743 Quad Hugo Update Date 0/14/201111 <br />Quad ID 118B Minnesota Statutes Chapter 1031 <br />Received Date <br />Well Name Township Range <br />Dir Section Subsection <br />Well Depth Depth Completed Date Well Completed <br />ARCAND, 31 21 <br />W 29 DCCDAC <br />85 ft. 85 ft. 08/08/2002 <br />Elevation 933 ft. Elev. Method 7.5 minute topographic map (+/- 5 feet) <br />Drill Method Non -specified Rotary Drill Fluid Bentonite <br />Address <br />Use domestic Status Active <br />Well 5754 130TH ST HUGO MN 55038 <br />Well Hydrofractured? Yes ❑ No ❑ From To <br />Casing Type Single casing Joint <br />Drive Shoe? Yes ❑ No ❑ Above/Below <br />Stratigraphy Information <br />Casing Diameter Weight Hole Diameter <br />Geological Material From To (ft.) Color Hardness <br />SAND/CLAY 0 <br />25 BROWN MEDIUM <br />4 in. To 75 ft. lbs./ft. 8 in. To 35 ft. <br />SAND 25 <br />45 BROWN MEDIUM <br />6.2 in. To 85 ft. <br />CLAY 45 <br />70 GRAY MEDIUM <br />SAND 70 <br />85 BROWN SOFT <br />Open Hole From ft. To ft. <br />Screen? X❑ Type slotted pipe Make BIG FOOT (PVC) <br />Diameter Slot/Gauze Length Set <br />4 in. 10 10 ft. 75 ft. 85 ft. <br />Static Water Level <br />20 ft. land surface Measure 08/08/2002 <br />Pumping Level (below land surface) <br />35 ft. 1 hrs. Pumping at 25 9-p.m. <br />Wellhead Completion <br />Pitless adapter manufacturer SNAPPY Model <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 />high solids bentonite 1.5 Sacks 5 ft. 35 ft. <br />Nearest Known Source of Contamination <br />55 feet South Direction Other Type <br />Well disinfected upon completion? Yes ❑ No <br />Pump ❑ Not Installed Date Installed 08/08/2002 <br />Manufacturer's name AERMOTOR <br />Model Number T12-50 HP 0_5 Volt 230 <br />Length of drop pipe 46 ft Capacity 12 g-p. TYP Submersible <br />Abandoned <br />Does property have any not in use and not sealed well(s)? ❑ Yes ❑X No <br />Variance <br />Was a variance granted from the MDH for this well? ❑ Yes X❑ No <br />Miscellaneous <br />First Bedrock Aquifer Quart. buried <br />Last Strat sand -brown Depth to Bedrock ft <br />Located by Minnesota Geological Survey <br />Locate Method Digitization (Screen) -Map (1:24,000) <br />System UTM - Mad83, Zone 15, Meters X 501023 1' 4998363 <br />Remarks <br />SOURCE OF CONTAMINATION: TYPE - VENT PIPE. <br />Unique Number Verification Info/GPS from data Inpute Date 06/27/2007 <br />Angled Drill Hole <br />Well Contractor <br />Schroepfer Well Drilling, Inc. 13119 SCHROEPFER, L <br />Licensee Business Lic. or Reg. No. Name of Driller <br />Minnesota Well Index Report <br />674743 <br />Printed on 08/31/2016 <br />HE-01205-15 <br />