HomeMy WebLinkAbout1990-650 W 4th Ave well abandonment (2) J
State of Wisconsin WELL/DRILLHOLE ABANDONMENT
Department of Natural Resources Form 3300-5B 11-87
t) GENERAL INFORMATION i C4 FACILITY NAME
Well/Drillhole 5outY OriginalWell wner 11 Known)
Location 1ki k".1 kAJ tS-A G 0
Present Well Owner
_ 1/4 of 1/4 of Sec. ; T. N;R, Elw T A)v ?A tJ L i,,- ,
applicable) Street orrRout !
Gov't Lot GridNumber C, O (-j LIT[q,
Civil Town Name City,State Zip Code
In ,K,9SN
Stgcet Address of Well Well Number and/or Name(If Applicable)
5-0 �J T .q
�n ,V�'Ilage Reason For Abandonment
/-! 1< 0 IVD L nW_,Pcr-Er2 us r-_�:p
ate o anc.o en t '
f y1
WELL/DRILLFIOLE INf+ORMATION
Original Well/Drillhole Construction Completed on (4) Depth to Water(Feet) �!
22ate Pump &Piping Removed? ❑i"Yes ❑ di❑ N of Applicable
Water Well Construction Report Available? Liner(s)Removed? ❑ Yes ❑ No ❑Not Applicable
❑ Drillhole ❑ yes ❑ M Screen Removed? ❑ Yes ❑ No ❑Not Applicable
Casing Left in Place? ❑ Yes ❑ No
Cons cCbn Type: 1f No, Explain
led ❑ Driven(Sandpoint) ❑ Dug
❑ Other(Specify)
Was Casing Cut Off Below Surface? ❑ Yes
Well Type: Did Sealing Material Rise to Surface? ❑ Yes ❑ No
❑ Unconsolidated Forrtiation Well ❑ Bedrock Well Did Material Settle After 24 Hours? ❑Yes❑N o
If Yes,Was Drillhole Retopped? ❑ Yes❑No
Total Well Depth (ft.) �t Casing Diameter(ins.) (5) Required Method of Placing Sealing Material
Casing Depth (ft,) ❑Conductor Pipe-Gravity []Conductor Pipe-Pumped
❑Dump Bailer ❑ Other(Explain)
Was Well Annular Space Grouted?❑ Yes ❑No ❑ Unknown (6) ccepta le Sea g MateTials
If Yes,To What Depth? Feet Neat Cement Grout; Concrete.Grout; Concrete; Clay Slurry;
Sodium Bentonite Slurry
0 Kind of Sealing Material From(Ft.) To (Ft.) No.Yards or Mix Ratio or Mud Weight
Sacks Sealant
G� •-t^'G) �•e,J 1 T � 0C..�J U-- Surface
(i Comments:
ae of Person or Firm Doing Sealing Work
M�Vt
,-- tq,K,/S (10) FOR DNR OR COUNTY USE ONLY Daing Work Date Signed Date Received/lnspected District/County
Street or Route Telephone N tuber Reviewer/Inspector
C eo C1_j 3 k_ t t`7`T4''>��l ` /qo
nty, State, Zip Code Follow-up Necessary