HomeMy WebLinkAbout042-140-077 EHWS23-0042 WELL DESTRUCT WELL LOG FROM DWRState of California
Well Completion Report
Form DWR 188 Complete 9/28/2023
WCR2023-008333
Owner's Well Number Date Work Began 06/24/2023 Date Work Ended 06/24/2023
Local Permit Agency Butte County Public Health
Secondary Permit Agency Permit Number EHWS23-0042 Permit Date 06/01/2023
Well Location
2240 Nord AVE Address
Chico City 95926Zip ButteCounty
39 Latitude 44 24.4644
Deg.Min.Sec.
N -121Longitude 52 41.5185
Deg.Min.Sec.
W
Dec. Lat. 39.740129 Dec. Long. -121.8781996
Vertical Datum Horizontal Datum WGS84
Location Accuracy Location Determination
Method
042-140-077APN
22 NTownship
01 ERange
21Section
Mount DiabloBaseline Meridian
Ground Surface Elevation
Elevation Accuracy
Elevation Determination Method
Destruction Details:
We dug down 5' around outside of casing and cut off casing. Then fill bottom of well up to the depth of 20' with pea gravel. Filled the rest of the well with
bentonite, then backfilled with native soil.
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
200 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 W.S. HEITMAN DRILLING & PUMPS
Person, Firm or Corporation
623 BUCKINGHAM PLACE CHICO 95973CA
Address City State Zip
Signed electronic signature received
C-57 Licensed Water Well Contractor
07/28/2023
Date Signed
386577
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