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HomeMy WebLinkAboutwell log and disinfection statment (1)State of California Well Completion Report Form DWR 188 Submitted 8/27/2023 WCR2023-009380 Owner's Well Number Date Work Began 1 02/15/2023 Date Work Ended 02/17/2023 Local Permit Agency Butte County Public Health Secondary Permit Agency Permit Number EHWS23-0013 Permit Date 01/24/2023 Well Location 0 Oregon Gulch RD Address Oroville City 95965Zip ButteCounty 39 Latitude 33 40.8959 Deg.Min.Sec. N -121Longitude 30 52.272 Deg.Min.Sec. W Dec. Lat. 39.56136 Dec. Long. -121.51452 Vertical Datum Horizontal Datum WGS84 Location Accuracy Location Determination Method 041-290-004APN 20 NTownship 04 ERange 27Section Mount DiabloBaseline Meridian Ground Surface Elevation Elevation Accuracy Elevation Determination Method Geologic Log - Lite Depth from Surface Feet to Feet Material Type Material Color Material Texture Material Description 0 11 Clay Red 11 18 Clay Red Broken 18 98 Rock Blue Very Hard 98 99 Rock Blue Fractured 99 186 Rock Blue Very Hard 186 187 Rock White Quartz 187 250 Rock Blue Hard 250 265 Rock Blue Soft Sticky 265 380 Rock Blue Hard Well Owner (must remain confidential pursuant to Water Code 13752) Alexandra Hernandez Name Mailing Address 1380 Lytle Rd yuba City caState 95993Zip Planned Use and Activity Planned Use Activity Water Supply Domestic New Well Borehole Information Drilling Method Orientation Total Depth of Boring 380 Downhole Rotary Hammer Vertical 380 Total Depth of Completed Well Drilling Fluid Air Feet Feet Specify Water Level and Yield of Completed Well 98Depth to first water Depth to Static 60Water Level 0.75Estimated Yield* 2Test Length *May not be representative of a well's long term yield. (Feet below surface) (Feet) (GPM) (Hours) Date Measured 02/17/2023 Air LiftTest Type Total Drawdown 0 (feet) Page 1 of 2 Form DWR 188 rev. 12/19/2017 Other Observations: Certification Statement I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief Name BIG'N & SON DRILLING INC Person, Firm or Corporation PO BOX 902 PALERMO 95968CA Address City State Zip Signed electronic signature received C-57 Licensed Water Well Contractor 08/27/2023 Date Signed 1100071 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) 0 21 10.58 21 22 8.63 22 380 6 Casings Casing # Depth from Surface Feet to Feet Casing Type Material Casings Specificatons Wall Thickness (inches) Outside Diameter (inches) Screen Type Slot Size if any (inches) Description 1 0 22 Blank PVC OD: 6.625 in. | SDR: 32.5 | Thickness: 0.204 in. 0.204 6.625 F-480 1 22 380 No Casing Installed Other N/A NONE Annular Material Depth from Surface Feet to Feet Fill Fill Type Details Filter Pack Size Description 0 21 Bentonite High Solids 21 380 Other Fill See description.NONE Page 2 of 2 Form DWR 188 rev. 12/19/2017