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3870 Pilot Knob Rd - Vertical Heat Exchanger RecordDEPARTMENT OF HEALTH Minnesota Department of Health Well Management Section 625 North Robert Street, P.O. Box 64975 St. Paul, Minnesota 55164 -0975 651404-4600 or 800/383 -9808 Deaf and hard -of- hearing: TTY 651/201 -5797 Vertical Heat Exchanger Location County Name Township No. Township Name Range No. 4k Z 3 House N 4 ber, Street Name, City, and ZIP Code of Vertical Heat Exchanger Location 3 870 Pi 166 icy a6 d Ec 5Q \t m N 55/ 2 - 2 - Show exact location of vertical heat exchanger in section grid with "X." Sketch map of N installation. Show W . eSC, ate property lines, roads, and buildings. 1 Mile PROPERTY OWNER'S '1 W NER' S NAME C loom Elevation Source of Data, etc. 0.341.1n Property owner's mailing address if different than vertical heat exchanger location indicated above. Hardness of Formation Copy for Owne Section No. " 22. From S (ky f Contr This vertical hcu this report is true ded k7 be lief " . Fraction . ' /IJk) Vtetild ti " Number of Bore Doles Th Type of Grout U ▪ Cement Sand from o Neat CettrIvt from ❑ Bentonite from © Other to to xc Capacity (Tons) 50 tH.do 7/17/2009R J