A06.Coldwater North Artesian AV690.pdf

Well Construction Report

WISCONSIN UNIQUE WELL NUMBER

Property Owner

Mailing Address

City

County

Drinking Water and Groundwater - DG/5 Department of Natural Resources, Box 7921 Madison WI 53707

Form 3300-077A

Phone #

Co. Permit # Completed

State Zip Code

AV690

US DEPT OF INTERIOR

1 FEDERAL DR

FT SNELLING ST PAUL MN 55111-4056

(612)725-3580

Vernon 10-07-1993

Well Constructor (Business Name) Lic. # Facility ID # (Public Wells)

KEYS WELL DRILLING CO 338

Address 413 N LEXINGTON AVE

ST PAUL MN 55104

Well Plan Approval #

Approval Date (mm-dd-yyyy)

06-24-1993

Hicap Permanent Well # Common Well #

1030 02R

Specific Capacity

3. Well serves

Private,potable

Heat Exchange____# of drillholes

Hicap Well ?

Hicap Property ?

# of FISH HATCHERY Yes

Yes

1. Well Location

Town of GENOA

Fire # (if avail.)

55631

Street Address or Road Name and Number

RT 1 BOX 185 HWY 35

Subdivision Name Lot # Block #

Method Code

GPS008

SE SW Section Township Range or Govt Lot # 9 N 7 W12

2. Well Type of previous unique well # constructed in

New Well

Reason for replaced or reconstructed well ?

SEAL BROKE FLOWING WELL

Construction Type Drilled

5. Drillhole Dimensions and Construction Method

Upper Enlarged Drillhole

Lower Open Bedrock

Rotary - Mud Circulation

Rotary - Air

Rotary - Air & Foam

Drill-Through Casing Hammer

Reverse Rotary

Yes

Yes

Cable-tool Bit ____in. dia...

Temp. Outer Casing ____in. dia

Removed? ____depth ft. (If NO explain on back side)

Dual Rotary

Dia. (in.) From (ft.) To (ft.)

17.50 Surface 115

11.75 115 254

8 254 630

Geology Codes

8. Geology Type, Caving/Noncaving, Color, Hardness, etc...

From (ft.) To (ft.)

D DRIFT Surface 115

L LIMESTONE 115 119

N H SANDSTONE/SHALE 119 320

N SANDSTONE 320 535

N H SANDSTONE/SHALE 535 630

6. Casing, Liner, Screen

Dia. (in.) Material, Weight, Specification Manufacturer & Method of Assembly

From (ft.) To (ft.)

12 53.52 #/FT STEEL, .406 WALL WELDED Surface 115

8 28.55 #/FT STEEL, .322 WALL WELDED 115 254

Dia. (in.) Screen type, material & slot size From (ft.) To (ft.)

7. Grout or Other Sealing Material

Method

Kind of Sealing Material From (ft.) To (ft.) # Sacks Cement

NEAT CEMENT Surface 115 93 S

NEAT CEMENT 115 254 99 S

4. Potential Contamination Sources - ON REVERSE SIDE

9. Static Water Level

1 ft. above ground surface

10. Pump Test

Pumping level _____ ft. below surface

Pumping at 230 GP M for _____ Hrs.

11. Well Is

12 in. above grade

Developed ?

Disinfected ?

Capped ?

No

No

No

12. Notified Owner of need to fill & seal ?

Filled & Sealed Well(s) as needed?

13. Constructor / Supervisory Driller

Drill Rig Operator

MC

Lic #

Lic or Reg #

Date Signed

Date Signed

10-21-1993

Pumping Method ?

Yes

Notification #

Hicap Potable ?

WISCONSIN UNIQUE WELL NUMBER AV690

4a. Potential Contamination Sources Is the well located in floodplain ? Yes

Comment:

Water Quality Text:

Water Quantity Text:

Difficulty Text:

Created On: 09-01-1994 Created by: HFRC LOAD Updated On: 09-01-1994 Updated by: MIGRATION

WISCONSIN UNIQUE WELL NUMBER AV690