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Unique No. 00511091 MINNESOTA DEPARTMENT OF HEALTH Update Date 2014/03/10 WELL AND BORING RECORD County Name Anoka Minnesota Statutes Chapter 1031 Entry Date 1991/04/15 Township Name Township Range Dir Section Subsection Well Depth Depth Completed Date Well Completed 31 22 W 14 DCDDDB 303 ft. 267 ft. 1988/04/21 Well Name CENTERVILLE 1 Drilling Method Non-specified Rotary Drilling Fluid Well Hydrofractured? ❑ Yes ❑ No Bentonite From ft.to ft. Use Community Supply Casing Drive Shoe? [:] Yes ❑ N Hole Diameter 0 in.t 95 ft GEOLOGICAL MATERIAL COLOR HARDNESS FROM TO Casing Diameter Weight(lbs/ft) 0 in.t 267 ft TOPSOIL BLACK 0 2 18 in.t 95 ft 71 12 in.t 200 ft 50 FINE DIRTY SAND WITH CL BROW 2 12 SANDY CLAY BLUE 12 62 SAND&GRAVEL VARIE 62 71 SAND RED 71 93 Screen N Open Hole From 200 ft.to 267 ft. ROCK BROW 93 150 Make Type VOID 150 152 ROCK BROW 152 180 ROCK 180 200 Static Water Level 14 ft.from Land surface Date 1988/04/21 ROCK 200 204 PUMPING LEVEL(below land surface) ROCK 204 208 81.4 ft.after 13 hrs. pumping 605 g.p.m. SANDSTONE 208 253 Well Head Completion SANDSTONE W/LENSES OF 253 265 Pitless adapter mfr Model Casing Protection ❑d 12 in.above grade SHALE 265 267 ❑At-grade(Environmental Wells and Borings ONLY) LENSES OF SANDSTONE& 267 281 Grouting Information Well grouted? d❑ Yes ❑ No Material From To(ft.) Amount(yds/bags) SANDY SHALE GREE 281 293 G 0 95 3.5 Y SHALE GREE 293 303 G 0 200 10 Y Nearest Known Source of Contamination ft. direction type Well disinfected upon completion? 0 Yes ❑ No Pump Not Installed Date Installed N Mfr nam Model HP 0 Volts REMARKS, ELEVATION,SOURCE OF DATA,etc. Drop Pipe Length ft. Capacity 9-p.m GAMMA LOGGED 3-23-1988. M.G.S. NO. Type 2807. Any not in use and not sealed well(s)on property? E:1 Yes d❑No Was a variance granted from the MDH for this Well? ❑ Yes ❑ No USGS Quad Centerville Elevation 912 Aquifer: OPCJ Alt Id: 1020036S01 Well CONTRACTOR CERTIFICATION Lic. Or Reg. No. 91353 License Business Name Report Copy Name of Driller HEJTMANEK, D. 88 HE-01205-06(Rev.9/96)