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<br />JUL 22 '98 03:16PM PET, 8ELL,CONV,JENSE
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<br />P.5/8
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<br />INSTRUCTION~ FOR COMPLETING THE Wf:;ll DISCLOSURE Sl'A TEMENT
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<br />DEFINIlION
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<br />A "we'r mcnns en excav.,liuII Ih;:\11!; rJrfll9d, corG<l. bOfCd. washed. \1fiVHI1,l;1I.lg. Jened. or o'hcrwi,e canslru(.1ed
<br />if !he eJr.\';!:IV"dUon I~ 'n,qr1dec;l 'or Ihe 10091ion. diverAi,)rl, ""Iiflclal rec:hargo, or noquisition 01 U1uur,IJw.'IIPr
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<br />MINNESOTA UNIQUE WELL NUMBER
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<br />^" IIHW w~,~ oonr.lrllc1c:cI ArTtn JAI1VIflY f, BI75 st1oll't' h:<!vo 1)110" nS$iClned ~ Mi"np,~01a unique woll
<br />nu/nbcr by I1le pers,), I I,;UI1!('rur.t'ng 1I>e wolf. " Ihe IIW,:II W&~ con5;l. "' :I... I ~I1EI Ihls dill" you :sholllrl have (I II:!
<br />unique w~\ll1lJlTlher in your properly record~, "y,)I, KIf-! r.lnable 10 1001110 your Urtiqve well Ilurntw rhp. w('1/ wag
<br />r:nn~lruCled AFTER Januarv " 197!i, I:ontact YOllr well can(rao!or, If no Ul1ilJue wp.II nlJmb~r ,t avail3blo. "lease
<br />indicate Ihe dePth ,UId year ot com:tructiOT1 lor f!l'Ich well.
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<br />WELL TYPE
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<br />1I5€ Ont:! 01 Ihp. fOllowing termF) 10 describe 'he wP.l! 'Vile,
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<br />WATER WELL ^ waler we/lis any IYJJ9 nl well uged 10 Elxlrac:t Qroundwaler 11'11 private or pubfic
<br />use, 1:><3mplea 01 waler wtllIs arR~ rtnmqglic "'9119, drive DQinl wells, dUll wI?III:. remedial wello, !lnd municipal
<br />wells.
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<br />IRRIGA TION WELL An irrrgoliol'l well is a welllNt!lJ In Imgale agricullUlollands. lhese are fvpin'llly
<br />",'!)../1ml"n4ller wollo con_cleO 10 a 1cI11,I~ pr~~-,r,.. diglribulioF1 oyOlem,
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<br />MONITORING WELL ^ ,"Ol'litorlno "...11 i~ III well V~A(j 10 monitor grOllndwCtter mnl:!J'"il1;!'ion I he
<br />_II is lypicaDy used 10 BC\ :fo!S,.~ groundwaler lor 'he exlraclion QI !:>/lrnf)1p_Q
<br />
<br />DEWATERING WELL A treW::IIp.rlng well il: a well u3ed 10 lowe.r """Indwarer 'ev91~ fo anow for
<br />(:Ol1s!lIIc;(iol1 Or U~ nr IlndergrOllnd sp.,o~,
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<br />INDUSTRIAUCOMMEFlCIAl WELL ^n inclu.slrialft:;Olmrl(~rd"'l well i9 a nonpclab1c wel1l1sl!d 10
<br />e>:lrad U".lIJndw~l1l3r (Of any nOF1pol8b1e UE;\J I"elunlno groundwater Ih~rnal oxcnange Wfill>l ~tfi'at pumps
<br />and heat loop!!).
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<br />WELL USE STATUS
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<br />IndiCi'J11!'! II If-! ~slalusol each well. CI rr:clc ONLY I ROX'PEA wHL.
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<br />IN USE A weill!: "in U~~" if the well is pllII 11Idl1g 9l1U1ci9nt 10'.'1110110 meet ils il1tt:!lldp.rf IJ~I'! and ig being
<br />C'per('llcd on 8 f!'!oular bi'lsi",
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<br />NOT IN USE A weR i~ "nolln 1)$9- if HIe well i:: ino"erabls ami ''',' In m:e or !he woll iD di30cnnecled
<br />Irom ~I IJt1WP.r ~11f'1rly ana is no! Gooled,
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<br />SEALED A w..1I is -sealed" il Iho WI!IH "'AS beer1 &e(JlecJ hy '" 1IC'.Qns:ed contr:Jctor Md there is 11 ~"'at1
<br />WHU neporl on hlO OJI the Mlnnesola Df!,'mlmel1l 01 Health, ^ properly sealf!d _II IIi'\; be!!n sallied by"
<br />"ccnsed cOI'1trar:lu' by nllmping grolJl th'o~hout the enlir~ bnr~htlle rrOlll the bollom of the weir.
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<br />NOTE If a well is irlODer1l1llH I:!ncl nOlln USA or diooonnP-Cled IrOl11 i:lll!Jwp.r !;:t'UICII. II mus' be ::ce\led by ~
<br />licensed WHfI conlfOClor or 3 well owner ",ust obl..i" " m::llnlen:;tl1ca perfnillrom the Mlnnes...'... nr~par'me'"
<br />or Heallh and paV an annual IIIsinlllnence fee. " a well i3 operable ancf pmpt'rly m9lncained 0 mointenance
<br />pt'!rmil is IJUI rp.!111lrP.d,
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