HomeMy WebLinkAboutWell Driller's Certification with State of Idaho for Well No 4-----_ ---- -- T
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USE TYPEWRITER OR
BALL POINT PEN
State law requ ~ 1
State o -idaho
De artment ~. ater Administration
WE. ~, I~L~R'S REPORT
t.~hisr. a ~j~e~ as IJirector, Depart>Inent of Water Administration within 30
s aftertla~ ,.;. ` tion or abandonmernt of the well.
1. WELL OWNER "'*~ ` ~°.~ .~ ~.~~~ f '"~'~~,
Name City ~~, ~ ~~~~~ 7. WATER LEVEL
Static water. le . I _~_ feet below land surface
~
?~
Address.~~~d~ay-+ ~d~ i3>fi42 Flowing? C7`
Yes ®No G.P.M. flow _
Tempefature ° F. Quality-
.Owner's Permit Nb. Artesi8rt closed-in pressure p.s.i.
Contr'tied by ^ Valve ^ Cap_ ^ Plug
2. NATURF:~OF WORK
^ New well ^ Deepened ^ Replacement 8. WELL TEST DATA
^ Pump ^ Bailer ^ Other
Discharge G.P.M. Draw Down Hours Pumped
^ Abandoned (describe method of abandoning)
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3. PROPOSED USE
`
^ Domestic ^ Irrigation ^ Test
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9. LITI~.OGIC LOG
"'~ Hole De pt,. Water
"~;.a^ MuniClpal ^ IndustFlel ^ StOCk Diam. Frdm To Material Yes No
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4. METHOD DRILLED "~. 3 Kasd Pan
'' ~ C~a>cs~ band tZ Glealtll
~ ^ Cable. ,> l~ Rator~ ^ Dug q Other
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,,
` 8 oW,n s 8 rave z
5. WELL CONSTRUCT~~„ ~ ~
' .., °% ;~, ~, ' ~. )~ Tea • ~ 8i ~ e Rai
~+
Diameter of hole ~_ inches , Total dmpth ~~ :feet
! ~p,aia! S nd 8 (~a1-el Cl!!in
Q-Concrete
Casing schedule: (~ Steel
~ G@a=a• 5a,ad ~ Ssalllt' brave
'Prgm Tn
Thick~ss Diameter ~~ ~XN $a~ g GraVe~.
inched ~,:':. inches +_ '~ fest~.iQ 3'~ fleet ~~ ~~a
inchAs ~--..inches ~ feet. ,,.,_ feet ~~ ~~ pd
inches inches feet #eet ~ ~~' ~ ,~
inches inches feet feet'
e .,-:. ~~ ~;
;.
Was a packer or seal ~~? ^ Yes No
Perforated? ll Yes ;~ . • ~ ~
' -
rfe ~ '^ Torch
How perforated;' ~ ,Factairy ^ Kn
'
Size of perforatiE>~n
inches 4y inches
Number Fram To
I
perforations feet
feet -
perforationa feet fee's
perforations feet feet
Well screen installed? fa Yes ^ No
.Manufacturer's name d0~o ~~ '~~ ~; , .,
Type Saud ~s~ Model No
Diameter~.QSlot size Set from ~~ feet to~ ~ feet!
Diameter- Slot size Set from feet to felt
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Gravel packed? ]C] Yes CI No Size of gravel ~~aM
Placed from EOM feet to ~'~~~ feet
Surface seal?; ^ Yes >~ NO To what depth- feet , y __ -
Material used in seal ^ Cement grout ^ Puddling clay _
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