HomeMy WebLinkAboutWellLog_VanDyken_1999 C� S 61�D�' RT 3 7 �
MONTANA WELL LOG REPO Well ID#
Form No.603 F12-99
This log reports the activities of a licensed Montana well driller and serves as the official record of work done within the borehole and casing and describes
the amount of water encountered. This form is to be completed by the driller and filed with DNRC within 60 days of etion of the work.
Acquiring Water Rights is the well owner's responsibility and is not accomplished by the filing of this report.
W log information is stored in the Groundwater Information Center at the Montana Bureau of Mines and Geology(Butte)and water right information is
s red in the Water Rights Bureau records(Helena).
For fields that are no pplicable,enter NA. -Optional fields have a grayed background. Record additional information in the REMARKS section.
1. WELL OWNER: / Test-1 hour minimum
rn Drawdown is the amount water level is lowered below static level.
Name All depth measurements shall be from the top of the well casing.
Mailing address b L� Time of recovery is hours/minutes since pumping stopped.
�1Ze�110.V\t V1��i` �cl7l� Air test`
gpm with drill stem set at�ft.for hours
2. WELL OCATION: List'/a from smallest to largest Time of recovery hrs/min. Recovery water level��ft.
y4 2r r+/4�y, 1/4, Section _ OR Bailer test'
Township N/Q Range County gpm with ft.of drawdown after hours
Lot ,Tract/Blk_Subdivision Name Time of recovery hrs/min. Recovery water level _ft.
Well Address 6yn e �'�" � OR Pump test
GPS ❑Yes ❑'No Depth pump set for test ft.'
Latitude _Longitude _ gpm pump rate with _ft.of drawdown after_ hrs pumping
Error as reported by GPS locator(±feet) Time of recovery hrs/min. Recovery water level ft.
Horizontal datum ❑NAD27 ❑WGS84
3. PROPOSED USE: (Domestic ElStock ❑Irrigation OR Flowing Artesian'
❑ Public water supply_ I Monitoring Well ❑Other: gpm for hours
Flow controlled by
4. TYPE OF WORK: -During the well test the discharge rate shall be as uniform as possible.This rate may or may
New well [IDeepen existing well ElAbandon existing well not be the sustainable yield of the well. Sustainable yield doe no in ude the resevoir of the
well casing.
Method: ❑Cable ❑Rotary C Other:
7. WELL LOG:
5. WELL CONSTRUCTION DETAILS: Depth,Feet Material:
Borehole: �/,^ color/rock and type/descriptor (example: blue/shale/hard,
Dia. in.from ft.to �3 ft. From To or brown/gravel/w ter,or brown/sand/heaving)
Dia. in.from ft.to ft. V //
Dia. in.from ft.to ft. L d
Casing: L d
Steel: Wall hickness • ! Threaded W Ided
Dia. in.from 'r ft.to !!!CA ft.
Dia. in.from ft.to ft.
Plastic: Pressure Rating lbs.❑Threaded ❑Welded
Dia. in.from ft.to ft.
Perforations/Slotted Pipe:
Type of perforator used
Size of perforations/slots in.by in.
no.of perforations/slots from ft.to ft.
no.of perforations/slots from ft.to ft.
Screens: ❑Yes No
Material
Dia. Slot size from ft.to ft.
Dia. Slot size from ft.to ft.
Gravel Packed: ❑Yes �lo
Size of gravel
Gravel placed from 111!!! ft.to ft.
Packer: El Yes XJ No El ADDITIONAL SHEETS ATTACHED
/I � 7
Type Depth(s) 8. DATE WELL COMPLETED:
Grout: Material used f oirl i^ 9. REMARKS:
Depth from ft.to ft. OR ontinuous feed
6. WELL TEST DATA: 10.DRILLER/CONTRACTOR'S CERTIFICATION:
A well test is required for all wells.(See details on well log report cover.) All work performed and reported in this well log is in compliance with the
Static water level ft.below top of casing or Montana well construction standards.Thi r ort is tr e t be'st o my
Closed-in artesian pressure psi. knowledge. / r
How was test flow measured: Name,firm, or oration rint)bucket/stopwatc , •r,flume,flowmeter, etc Address �' 11_ 2 a
Yellowstone group water closure area only-Water Temperature OF Signature
AQUIFER TEST DATA FORM ATTACHED Date License no.
MBMG ID#
1�1Montana DNRC P.O.BOX 201601 HELENA, MT 59620- 601 444-66101-7-7117
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