HomeMy WebLinkAbout1997-735 W 4th Ave well abandonment S at, of f W is cons in- "# W E„ LLIDRIL 3R I b L E ABANDONMEN
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I apartment of Natural Re es ( ` p 0 { Form Rev.l 1-9b
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� }ab�dorunent wbrlc s}i' be performed in accordance with the provisions of Chapters NR 811,NR 812 or NR 141,Wis.Adm.Code,whichevs.i is
apphCrible: Also,see instructions on back. i
l''!'GENERAL INFORMATION 2 FACILITY NAME
» ,WeUil7rillhale/Barehole tion County original Well Owner(If Known)
er
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. E Present Well Owner
1!4 of ._._..°1/4of Sec• ; T. N;R. W a
'r (If applicable) Street or Route
Gov't Lot Grid Number '
z rid Locationity,State,Zip a
ft. N. S., ft. E W ,S/7
Civil Town Name , ,TFacility Well No. and/or�Name(If Applicable) WI Unique Well cx
ter
Street Address ce,Well
y.'k-: yyL Reason For Abandonments J _
Alo
'*Ctty,�iilage atc of Abandonment
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` 'WELL/DRILLHOLEIBOREHOL.INFORMATION
(3) Original.Well/Dnlllto leiZorehole Construction Completed On (4) Depth to Water(Feet) _
( Pump &P ipingernoved? ® Y+es []No[]No t App lieable
Liner( s)R emwd? ❑ X es ❑No No t.App IiCahle
s Monitoring Well`" Construction Report Available? Screen Removed? ❑ Yes ❑ No .Not Applicable
W a to r W el l ❑Yes No Casing Left in Place? Yes ❑ Noy.
[ Drillhole If No,Explain
a r Borehole
k Was Casing Cut Ol 1 Belo,N Surface? Yes No
1 'k Did Sealing Materi al Rise to Surface No
tt11Gt101 Ci Type g ® ❑
�rt
DrilledDriven Sandpoint) ❑ Dug Did Material Seale After 24 Hours? Yes No
Other(Specify) , � Z-E-f o IfYc; "HoleRetopped ? [�, Ya❑ No
tftW tvleuibd'3t rtactng �atilig Mawnat' a u r =
„U annatiaa Type.
r ❑Conductor Pipe-Gravity []Conductor Pipe-Pumped
t&7,Unconsolidated.Formation ❑ Bedrock
r []Dump Bailer Other(Explain)
Total Well Depth(W)l�/f Casing Diameter(in.) ~ / ( ) Sealing M at aki Formonitoring wells and
(Fram.g r o un ds ui f';aGe ) C as in g Depth(ft.) Neat CemenrGrout monitoring well boreholes only
9'° l:; ". ❑Sand-Cement.(Concrete)Grout
Lower Drillhole Diameter(in.) �St.�f ❑ Concrete 4 ❑ Bentonite Pellets
❑ Clay-Sand Slurry j ❑ Granular Bentonite
V as Well Annular Space Grouted? ❑ Yes H .No ❑ Unknown ❑ .Bentoni to-Sand Slurry € ❑ Bentonite-Cement Grout
X:f Yes,To What Depth? Feet Bentonite Chips ❑ �Rentonite Chips
Material Used To Ftll Wall/Drillhole From(Ft.) To(Ft.) Sacks Sealant (Circle Mix Ratio
or V0111car, One or Mud Wei ght
surface
44
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(8) Cannments: kzr r.r
(9) Name of Person or Firm Doing Scaling Work (1 FOR DNROR COUNTY USI;,ONLY
�at r '1 ray / ,7, i Rece Elected e icmlCaurity
c _ 1
Signature of Berson Bong Work ate Signed '' .. , }
�""' �,,�,�y-¢ /sJ' - � ` S� � Reviewer/lnsPaator Camplyirrg Work
v.
Street Route Telephone Number Nonco Ytpl dr 's
� �ollow up Nece&sary
ty,Stater ip Code
DNRICOUNTY