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<br />JUL 22 '98 03:16PM PET, BELL,CONV,JENSE
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<br />P.5/8
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<br />INSTAUCTION~ FOR COMPLETING THE W~LL DISCLOSURE S T'A TEMENT
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<br />DEFrNIl ION
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<br />A '~fI" ,,"pnns an eIlC/lv",liUJllhall!:l drlllM, oorod, bored. wa:'lhed, d,i"...., dl,lg. jened, (V o!hmwi~e C:On,,>lflJL:.1~1.1
<br />if the e).~i:1V'<'Ihnn ~ 'nleF'tded lor !he Ioeo!;on. divelf;i..,,,. ~rlillr.:1;1 rOChElrgo, or ncquisition 01 u,uurldw.:llp.r
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<br />M'NNE~OTA UNIQUE WELL NUMBER
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<br />^"'IHW w~r!: conr.II\.lcI~d Arrr;n JI'II1~I<I'Y r, 1!'I75 !:I1nU'tl h::avc "(1(:11 ns$ioneci ~ Mill,,~~o'A uniqlJe well
<br />nu,nbcr by the rrer~o" \;ulI!drll~Hr1g 11>e wgll, 1/ rho well W8.' con...""dHrl <1"12. .his d~1f) YCH.I 3hollkl have !l1~
<br />uniQue ....~IIIIlJtTlhl;>r in your prOf)Crly record~, II y,"tI, Htt< ',Inable (0 loCale your lJnique weT! IlIJlI1hf!f rhl'! WI;III wa~
<br />~nn'!:lruc:1ed AFTE~ Janul!ry 1. 197:'. I :r,mlaCl yOllr well cont,nelor, If no \,Jl1iulJf'! wp.fl nlJrnbe~ It aV3i13blc, plel:lse
<br />indicate ihe deptl) ""d year ot r::one:II1J(:lio" 10' ell~h well,
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<br />WELL TYPr;:
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<br />U$e Ort!:! ollhp. rt:\llow;rog t9.mt.: 10 describe Ihe WI~U fyI'''',
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<br />WATER WELL ^ woler well is any IYVR 01 w~1t m:ed 10 9xtracl groundwaler fnl '!rivall? or public
<br />UW, ~"3mp/es oT waleI' VII!;;fII!! arR: t101'nfi19!ic .....ella, drive ooinl weNs, dill} w~n~. relTlet1ial wc,,~. nnd municipal
<br />well!'>,
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<br />IRRtGA TION WI:;LL An i,rogation ""ell is a wen usad '0 Irr'0319 agricultlJr.:1llands, 1~ese alp. 'Yl'w",llIy
<br />I>HU" (il:!rnoQ'ler wol1~ COf'Inecled loa '<l11,/1:! IH~~,If"di\11ritJulioo !:y~IGm,
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<br />MONITORING WELL ^ rnonitorlno ""..II i-!' a welt U!;A(j to monitor o'Ollndwafer r:nnl:lrnil1::1ti"n 'he
<br />IN9I1 ;r, lypicOfly u:\ed 10 t1r~ ;~.. g'oundw~ler lor lt1e extr~1ion ,-A ~amplp_o:
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<br />Dr:WATERING WELL A tJP.wi'llp.rll"l9 wt!1I i; a wdlu3ed 10 'ow~r 1"""l1dwar!:!'r reva'~ 10 olio'" '(Jr
<br />(,:Ol1slwC'./iOI) 01 uSt! of undetgrallnd $P."lC~,
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<br />INDUSTRIAUCOMMERCIAL WELL ^n fndIJ31rialt'~Q"'JTlf!rr:I.:I1 well i~ iii nonpol;1bl(: wen US~ 10
<br />ex'rac:l u","..ncl\o\l:iller ror ::IllY nor1potable Ut:13' itldudlna O'l)undwater Ih~rnCl' oxchange _II" (h-":ll pumps
<br />and heol loop~),
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<br />WELL USE STATUS
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<br />Indical!'! II".., I,,*, !;1::JIU!; 01 each well. cr IECI< ONLY 1 ROX' PHI WHt..
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<br />IN USE A well.I; "in li!m" if Ihe ~/e!l is pUIIll.lcing SlJlflcj9nt waler to me!!1 irs il1lt~ndf!111'<;"" and jg t:l9ing
<br />opgrl'l!cd 011 a regulClr b.."i~
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<br />NOT IN USE ^ ~n is "nollr1l,1$Q- if Ihe wen i:; ino"erl!lble ann '" ,I in U!:Q or Ih9 well ;:; di3oon~lecI
<br />hom ". I)OWQr !';111"'r"Y 911(/ is nol cC::Ilcd.
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<br />SEALED A .\,,~JI i", -'>&i!led" il Iho wlln I,!'I!I been 6o)'tJIH!I hy ::J II~Il~et,! C:Qnlr~c10' Mrl Ihero;! is it &"""'3r.1
<br />W~b nept:)rl on hie Dllhe Minnesota Dejmrlrnent 0' H~llh, ^ p'Of)P.rly $eal~d Wl'!1I h~<; bp.en sealed by [1
<br />"ccosed cOIltrar.tUf by numrJng gr()l,I! IhtO~houl ,he el'1!ir~ hnrt<hr.'h.' IrOllllhe bOllom of the weJJ.
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<br />NOTE II c well i~ ;rloDerit"lp. ;,Iud 1'101 In UiA Ot c:li3Connm:led In:ul1 i:I Jlnwpr "IfJUrCP.,1t musI be !!co'ed by ~
<br />licensed wp.1I COf'1I'9CIOf 01 ::I well o'lllller musl Oblair!::! m::Jlnlen;iI1C8 rsrrnit Irom Ihe Mlnne~'''it nf;'r~r'mE'''t
<br />0' Heallh :md pay !!In annual ,l1airllP.nance roo, .r a well P.:I operlJble anrf prnflP.rty ma'I1tained a m!linlemmce
<br />p<'!tmil is IIUI fertl,'rP.r:1.
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