1. 0) 1 ' .< "- .,*


     State of Wisconsin
,Department of Natural Resources
         Box 7921
   Madison. Wisconsin 53707


          NOTE:
White Copy  -  Division's Copy
Green Copy  -  Driller's Copy
Yellow Copy -  Owner's Copy


  WELL CONSTRUCTOR'S REPORT
  Form 3300-15          Rev. 12-76
~ WELL #2


  COUNTY                              CHECK (I) ONE:                          Name
           DAM                         I Town           VIa ge         city           BIKY.,YN
              ', Section Section  Township  Range   3. NAME L OWNER EJAGENT AT TIME OF DRILLING CHECK (A ONE
2. LOCATION     NW3 1              ..   5N         IQE     BB3OKLYN
  OR    - Grid or Street No. Street Name                     ADDRESS

  AND - If available subdivision name, lot'& block No.  POST OFFICE
                                                           BIEOKLYN
                                                    Saiay.lg.Sw   r I     CIA~             or I... .rm_ " .. e,'. rAi.. . ...- _ r


4. Distance in feet from well  Building   Sanitary Bldg. Drain
   to nearest: (Record             C.I.     Other
   answer in appropriate
   h IrckiI


c.I.


Other   C.I. Sewer rther Sewer


C.... ... . . .             Ote      Cl...Othe


Street Sewer  Other Sewers Foundation Drain Connected to Sewage Sump Ilearwater Septic Holding Sewage Absorption Unit
                           .....OiSwSewage        C..   Other     Sump    Tank  Tank  Seepage Pit
 San. Storm  C.i. Other   Sewer [     Sump    [.                                           ..               ..
                              uwmpr rw                                                Seepage Bed
                          Dr.         SumP      ...                                       .pa rench
Privy Pet  Pit:_Nonconforming Existing Subsurface Pumproom Barn Animal Animal Silo Glass Lined Silo Earthen Silage
      Waste -                                            Gutter Barn   Yard  With Pit Storage wy/o Storage Trench Or
      Pit    Well                   Nonconforming Existing      Pen                Facility  Pit  Pit
      I      Pump
      I      Tank
Temporary   Watertight  Solid Manure Subsurface Waste Pond or Land  Other (Give Description)
Manure      Liquid Manure Storage   Gasoline or Disposal Unit
Stack       Tank        Structure   Oil Tank  (Specify Type)

5. Welt is intended to supply water for:                   9. FORMATIONS
                              V]1A t    Well No.2                           Kind                 From (ft.) 1  To(ft.)
6. DRILLHOLE
Dia. in.) From (it.) To (ft.) Die. (in.) From (ft.)  To (ft.) Silty sand             Surface

  16      Surface   176j      10       285          670      Clay w/sand & b       d               7     .       10

  15      176       Z1085   _                                Sand,          Cobles, & Boulders        10          82
    7.WSNI      E  gt    P I CREEN                                        /    d& 1 a1. ,Sl8217
 Die. (in.)  & Method of Assembly    From (ft.)  To (ft.)     an      rvl                           ...172 1275
         R.L.  N    steel P.E.                       ' Sand stone w/&olcmite & shale                 175        179
  16     62.58 IG A.53 Welded        Surface     176          _.S/1mit'                &    W~1 '    17Q         7'i6
        BI-New steel P.E.           .-3,                     Sandstone RedBrc       nTan             256        285
  10     40.48 1B A-53 Welded        .    .      283        Sandg-one. Bl         -ree-White         2853

                                                            Sancstone- tan & bran                    348        376
        _s__ ____ 1________....                              sandstoe mwhite                   1      _376      670

        jro's44n3 t ,' r *0%I                              [10. TYPE OF DRILLING MACHINE USED
                                                                                    Rotary-hammer
8. GROUT OR OTHER SEALING MATERIAL                              L_ Cable Tool       mudcbar             ) Jettingi
                                                                   Rotary-air       R otary-hammer        0    Air
                Kind                 From (ft.)  To (ft.)       Li w/drilling mud 0 & air                  0J Water
                                                                   R otary-w/drilling
    Neat Cement                      Surface     285            L-J mud           Li Rvers Rotary

                                                            Well construction completed on  January_6_      9.
 l I. MISCELLANEOUS DATA                                                          1[ 3            o0e   finalg
      . lM.. .     83TML .at.5900                     GPM Well is terminated  42!    inches  0 beow

      Depth from surface to normal water level  .811  Ft.  Well disinfected upon completion  130 Yes M  No
      Depth of water level
      whenpumping   _1Q60__ Ft. Stabilized  ) Yes E0 No.Well sealed watertight upon completion  [XI Yes 0  No


or


Water sample sent to WS, Stat .A of %N19 m .'Q/{(+ laboratory on_19-_6


Your opinion concerning other pollution hazards, information concerning difficulties encountered, and data relating to nearby wells, saeens, seals, method or
finishing the well, amount of cement used in pouting, blasting, etc., should be given on reverse side.


Signature
  layne--Nrthwest


Cc  Complete Mail Address
    w   L. to(30 e                 W229N5005 DPlainville Pd., Pewaukee, WI 53072
              Registered Well Driller


Sanitary Bldg. Sewer cr;ipor uro


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