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Authentisign ID:16706484-ACCB-47DF-8A07-E7DEFF933E7F <br /> Coldwell Banker Burnet WELL DISCLOSURE STATEMENT <br /> 67. Page 3 • <br /> 68. INSTRUCTIONS FOR COMPLETING THE WELL DISCLOSURE STATEMENT <br /> 69. DEFINITION:A'well'means on excavation that is drilled,cored, bored, washed, driven, dug,Jetted or otherwise <br /> 70. constructed If the excavation Is intended for the location,diversion,artificial recharge or acquisition of groundwater. <br /> 71. MINNESOTA UNIQUE WELL NUMBER: All new wells constructed AFTER January 1, 1875, should have been <br /> 72. assigned a Minnesota unique well number by the person constructing the well.I1 the well was constructed alter this <br /> 73. dale,you should have the unique well number in your properly records.It you aro unable to locale your unique well <br /> 74. number and the well was constructed AFTER January 1,1975,contact your well contractor.If no unique well number <br /> 75. is available,please indicate the depth and year of construction for each well. <br /> 76. WELL TYPE:Use one of the following terms to describe the well type. <br /> 77. WATER WELL:A water Wali is any typo of well used to extract groundwater for private or public use.Examples <br /> 78. of=ter wells are:domestic welts,drive-point wells,dug wells,remedial wells and municipal walls. <br /> 79. IRRIGATION WELL:An Irrigation well is a well used to Irrigate agricultural lands.These are typically <br /> 80. large-diameter wells connected to a large pressure distribution system. <br /> Si. MONITORING WELL:A monitoring well Is a well used to monitor groundwater contamination.The well Is <br /> 82. typically used to access groundwater for the extraction of samples. <br /> 83. DEWATERING WELL:A dewatering well is a well used to lower groundwater levels to allow for construction <br /> 84. or use of underground spaces. <br /> 85. INDUSTRIAL/COMMERCIAL WELL: An industriaUcommerctal well Is a nonpotable well used to extract <br /> 86. groundwater for any nonpotable use,Including groundwater thermal exchange wells(heat pumps and heal <br /> 87. loops). <br /> 88, WELL USE STATUS:Indicate the use status of each well.CHECK ONLY ONE(1)BOX PER WELL. <br /> 89, IN USE:A well Is'In use"it the well Is operated on a daily,regular or seasonal basis.A well In use Includes <br /> 80. a well that operates for the purpose of irrigation,fire protection or emergency pumping. <br /> 91. NOT IN USE:A well is°not in use"if the well does no!meet the definition of"in use above and has not been <br /> 92. sealed by a licensed well contractor. <br /> 83. SEALED:A well is"seated"If a licensed contractor has completely tilled a well by pumping grout material <br /> 94. throughout the entire bore tole after removal of any obstructions from the well.A wall is"capped"it It has <br /> 95. a metal or plastic cap or cover which Is threaded,bolted or welded into the top of the well to prevent entry <br /> 06. Into the well.A"capped'watt Is not a"seated'well, <br /> 97. If the well has been sealed by someone other than a licensed well contractor or a licensed well sealing <br /> 98, contractor,check the well status as"not in user <br /> 99. if you have any questions,please contact the Minnesota Department of Health,Well Management Section, <br /> 100. at(651)201-4587(metropolitan Minneapolis-St.Paul)or 1.800-383-9808(greater Minnesota). <br /> 101. ORIGINAL COPY TO LISTING BROKER;COPIES TO SELLER,BUYER,SELLING BROKER. <br /> Mr.WDS-3(8107) <br /> v.teram,",No-n:00 <br />