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1405 Vince Tr - Vertical Heat Exchanger RecordDakota Township Name Towexhip No. Range No. ' Section No. Fraction Ea an 2711 23W 4 SE IA SE y SE y Howe Number, Street Name, City. and ZIP Code of Vortical Beat Exchanger Location Hole Diameter 51/4 ie.. to 335 1405 Vince Trail, Eagan 55121 Show meet location averted heat exchanger in section grid with" X." Sketch ow of insmiletivn. $how Ihyes, reeds. Brown Tan H buil Minnesota Department of Health Copy CC - 30 VERTICAL HEAT EXCHANGER RECORD E.H Renner & Sons. t Convector Business Nano Ed Renner Nento of Driller Depth (completed) 335 a. in. to (t. Number of Bore Holes 3 Pipe Material Xr High Density Polyethylene ❑ Other Type of Joint 0 Butt Fusion Er Socket Fusion ❑ other Date Wark Comptctcd 9/21/10 Pipe Ohnmtcr _ inches Capacity (Tone) 1431 t License No. Roger E. Re>ner 467 10/19[10 T CcnificdRepresentativc Signature f Certification No. fi Date 10 0 T Date Air Mechanical Name of Hoar Pomp installer (HVAC Contractor). if different (Options ) origalvctl heat exchan$er MDH.doc 7/17/20098 Vertical Heat Exchanger Location County Neato Geological Materials 5 PROPERTY OWNER'S NAM Thorson Homes Property& owner's mailing address if different than voted beet exchanger loaatios indicated above. Brian Thorson 4466 Wedgewood Drive Eagan, MN 55123 (763) 746 -3795 ill dirt Sand /Gravel Clay C),av /Rocks Sandy Clay _ San4/Rock Sandstone Color Black_ Brown Brown Remark, Elevation Source of Data, ere. Minnesota Department of Health Well Management Section 625 North Robert Street, P.O. Box 64975 St. Paul, Ivlinnesota 55164 -0975 651/201 -4600 or 800/383 -9808 Deaf and hard-of-hearing: Tr( 651/201 -5797 Hardness of Formation Elevation: 920' MSCS Quad: C103 Gas line suns through loop field To 0 8 8 28 28 52 336 E H RENNER & SIN Typo of Grout Used (Indicate Product Nome) 0 Cement Sand from to R ❑ Neat Cement from to R. ,KT Bentonite from 0 to 335 L}. O Thermally Enhanced Bentonite from to ft. In Other from to #t Type of Coolant Used (Indicate Product Name) ❑ Water S PropytencGlycol Cryo _Tek 35284 ❑ Other Premiere Teat ofIn tolled Piping Tait Pressure 0be.) rev M 52 89 , Teat Duration * nutaa) 60 mina . Grey M 89 104 Contractor's Certification This vertical heat exchangcrwas constructed under my jurisdiction and S -M 104 335 this report is true to the best of my knowledge and belief. Inc . PAGE 01/02