HomeMy WebLinkAbout038-220-008 EHWL18-0014 Well LogState of California
Well Completion Report
Form DWR 188 Complete 12/17/2018
WCR2018-009753
Owner's Well Number Date Work Began 09/06/2018 Date Work Ended 09/06/2018
Local Permit Agency Butte County Public Health
Secondary Permit Agency Permit Number EHWL18-0014 Permit Date 07/25/2018
Well Location
904 NELSON SHIPPEE RD Address
DURHAM City 95938Zip ButteCounty
39 Latitude 32 57.9119
Deg.Min.Sec.
N -121Longitude 43 35.184
Deg.Min.Sec.
W
Dec. Lat. 39.54942 Dec. Long. -121.72644
Vertical Datum Horizontal Datum WGS84
Location Accuracy Location Determination Method
038.220.008APN
20 NTownship
02 ERange
34Section
Mount DiabloBaseline Meridian
Ground Surface Elevation
Elevation Accuracy
Elevation Determination Method
Destruction Details:
CASING WAS CUT OFF 5\\\\\\\" BELOW GRADE
THE WELL WAS FILLED WITH 3/8" GRAVEL FROM 50' TO 400'
THE WELL HAS BEEN CEMENTED FROM 50' TO 5' BELOW SURFACE USING TREMIE PIPE AND CONCRETE PUMPER.
FROM 0' TO 5' HAS BEEN BACKFILLED WITH DIRT
Other Observations:
Well Owner (must remain confidential pursuant to Water Code 13752)
XXXXXXXXXXXXXXXXXXXX Name
Mailing Address XXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXX City XXState XXXXXZip
Former Use
Former Use
Activity
Water Supply
Destroy
Borehole Information
Drilling Method
Orientation
Total Depth of Boring
Vertical
Total Depth of Completed Well
Drilling Fluid
Feet
Feet
Specify
Water Level and Yield of Completed Well
Depth to first water
Depth to Static
Water Level
Estimated Yield*
Test Length
*May not be representative of a well's long term yield.
(Feet below surface)
(Feet)
(GPM)
(Hours)
Date Measured
Test Type
Total Drawdown (feet)
Page 1 of 2 Form DWR 188 rev. 12/19/2017
Certification Statement
I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief
Name SULLIVAN DRILLING INC
Person, Firm or Corporation
P O BOX 1227 ORLAND 95963CA
Address City State Zip
Signed electronic signature received
C-57 Licensed Water Well Contractor
10/29/2018
Date Signed
656504
C-57 License Number
DWR Use Only
CSG #State Well Number Site Code Local Well Number
N
Latitude Deg/Min/Sec Longitude Deg/Min/Sec
TRS:
APN:
W
Borehole Specifications
Depth from
Surface
Feet to Feet
Borehole Diameter (inches)
Page 2 of 2 Form DWR 188 rev. 12/19/2017