HomeMy WebLinkAbout043-230-010 EHWS15-0196 Well LogState of California
Well Completion Report
Form DWR 188 Complete 2/4/2016
WCR2016-000339
Owner's Well Number Date Work Began 043-230-010-000 12/29/2015 Date Work Ended 12/29/2015
Local Permit Agency Butte County Public Health
Secondary Permit Agency Permit Number EHWS15-0196 Permit Date 12/29/2015
Well Location
940 1st Street ST Address
Chico City 95926Zip ButteCounty
Latitude
Deg.Min.Sec.
N Longitude
Deg.Min.Sec.
W
Dec. Lat. 39.7256729 Dec. Long. -121.8494712
Vertical Datum Horizontal Datum WGS84
Location Accuracy >50 FT Location Determination Method Derived from
Address
043-230-010-000APN
22 NTownship
01 ERange
27Section
Mount DiabloBaseline Meridian
Ground Surface Elevation
Elevation Accuracy
Elevation Determination Method
Destruction Details:
Dig down 5' around the well casing. Cut the casing off 48\" below surface grade. Fill the entire volume of casing from the bottom with a 10 sack cement
slurry; leaving a mushroom cap above. Back fill the site with native material.
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
21 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 WELL INDUSTRIES INC
Person, Firm or Corporation
3282 HIGHWAY 32 CHICO 95973CA
Address City State Zip
Signed electronic signature received
C-57 Licensed Water Well Contractor
01/13/2016
Date Signed
812678
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