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Home My WebLink AboutIDWR Well Abandonment_Cache Creek_9_7_21 V1CUEIDR IAy APPROVED DATE 08/03/22 FIEF NUMBER: FPS-zazzaoze State of Idaho Department of Water Resources GENERAL INSTRUCTIONS TO COMPLETE FORM 238(4)-2 AUTHORIZATION TO ABANDON (DECOMMISSION) A WELL ion forms(s) must be complete. Incomplete form(s) will be returned to applicant. n provided on form(s) must be accurate. Incorrect information may invalidate authorization. C. Abandonment must be performed by a well driller licensed in the State of Idaho per Idaho Code 42-238 unless a waiver has been granted. D. The well must be abandoned in a manner compliant with IDAPA 37.03.09 Well Construction Standards Rules. E. There is no fee for an Authorization to Abandon a Well. F. Form(s) shall be submitted to the IDWR region in which the abandonment is to occur at least seventy- two (72) hours prior to abandonment. Authorization for abandonment must be granted before abandonment work commences. Signed Original forms must be submitted to the IDWR region in which the abandonment takes place. Western Region Idaho Department of Water Resources 2735 Airport Way Boise, ID 83705-5082 Phone: (208) 334-2190 Northern Region Idaho Department of Water Resources 7600 North Mineral Drive, STE 100 Coeur d'Alene, ID 83815 Phone: (208) 762-2800 Eastern Region Idaho Department of Water Resources 900 North Skyline Drive STE A Idaho Falls, ID 83402-1718 Phone: (208) 525-7161 Southern Region Idaho Department of Water Resources 650 Addison Ave W, Ste 500 Twin Falls, ID 83301-5858 Phone: (208) 736-3033 014 ID NUMBER State of Idaho Department of Water Resources APPROVED AUTHORIZATION TO ABANDON (DECOMMISSION) A WELL DATE: 08/03/22 NER INFORMATION: (The well owner is the person who legally owns the property.) FILE NUMBER: FPS --21- Schultz Current Mailing Address: P.O. Box 1115 City: Meridian State: Idaho Zip Code: 83680 Telephone: ( ) 2. WELL LOCATION: (GPS required in Degrees Decimal Minutes.) Twp. 3N Rge.1 E Sec.19 1 /4 SE 1 /4 SE (10) (40) Gov't Lot No. County Ada Lat.43 34.550'N Long. Street Address of Well Location: 1560 E. Victory Rd. City: Meridian Lot, block and subdivision: Lt. 1; Blk.1; Kachina Estates 3. TYPE OF WELL: 1/4 (160) 116 22.500'W 0 DOMESTIC ❑ MONITORING ❑ IRRIGATION ❑ OTHER (Describe) 4. WELL INFORMATION: (*Casing size, well depth & static water level data are required.) Well Tag Number: NSA Previous Drilling Permit Number: N/A Water Right Number: NIA _ Well Log on File? (Provide if available) ❑Yes ONo *Casing Size:6" *Material: Steel *Current Static Water Level:33' 5. REASON FOR ABANDONMENT OF WELL: New subdivision going in where well is. Temperature: bless than 85°F ❑greater than 85°F *Well Depth223' (measured) _(measured) Flowing Artesian? ❑ Yes ❑✓ No 6. PROPOSED METHOD OF ABANDONMENT: (Must be consistent with IDAPA 37.03.09. This Application must be reviewed prior to commencement of abandonment.) Perforate the 6" casing, run treme pipe to bottom, mix & pump cement grout, cut casing off below the surface, weld metal plate on top and bury. 7. Drilling company name: Dennis Phipps Well Drilling Inc. company lic. No. 332 8. Date of abandonment: 9i2/21 9. Applicants signature: 10. Title: Driller date: 9/2/21 ACTION OF THE DEPARTMENT OF WATER RESOURCES This application for abandonment has been reviewed by IDWR on This review does not constitute an endorsement by IDWR of the proper abandonment of this well. Pursuant to Section 42-238(12), Idaho Code, all abandonments must meet the requirements of the Administrative Rules for Well Construction Standards. Abandonment of this well will require the services of a well driller licensed in the State of Idaho unless a waiver has been granted. Signature of Authorized Department Representative Title /2010 Matt h u l tz APPROVED DATE: 08/03/22 %1,MBER: FPW02-0e T PROCEDURES: NUMBER: ABANDONMENT REPORT Must describe all details of work performed, including perforations, sealing materials, and how casing was removed. PROCEDURE: FROM: TO: WEIGHT/VOLUME: Perforated the 6" casing, ran treme pipe to -3 223' 2798 lbs. bottom of well, mixed and pumped the cement grout, cut casing off below the surface, welded metal plate on top, and buried. DRILLER'S CERTIFICATION I/We certify that all minimum well construction standards were complied with: Drilling Company: Dennis Phipps Well Drilling Inc. License # 332 Principal Driller: Date: 9/2/21 Operator: Date: