20240823Attachment D.pdf

Office Use Only
(610 rm 23 IDAHO DEPARTMENT OF WATER RESOURCES Well ID No.
WELL DRILLERS REPORT Inspected by
1. WELL TAG NO,D 6V Twp Rge Sec 1/4 1/4 1/4
DRILLING PERMIT NO
Water Right or Injection Well No 12, WELL TESTS: Lat: : Long:
❑Pump ❑Bailer O Air ❑Flowing Artesian
Z. OWNER: Yield gal./min. Drawdown Pumping Level Tines
Name
Address
City Stateya Zip
Water Temp. Bottom hole temp
1 LOCATION OF WELL by legal description: Water Quality test or comments*
You must provi e address or Lot,Blk,Sub or Directions to well.
Twp North or South ❑ _. Depth first Water Encounter
Rge East �rr,'� st ❑ 13.LITHOLOGIC LOG: (Describe repairs or abandonment) Water
Sec. 1/4 1'rc.a114 )�1/4 Bore From To Remarks: Lithology Water Quality&Temperature Y N
Gov r't Lot `+0�nisy a e acres Dia i
a 4
Lat: Long: !
i
Address of Well Site 4.4I
City L`
Y Lf
lGivo ac teem name or road.°islanae W Road or Lend—N
Lt Blk Sub Name
t
� 3 _
4 USE: oil l
❑Domestic i Municipal ❑Monitor , Irrigation �f
❑Thermal ❑Injection ❑Other 1�
5, TYPE OF WORK check all that apply (Replacement etc)
New Well ❑Modify ❑Abandonment ❑Other
i
6: DlL METHOD:
Air Rotary 0 Cable ❑Mud Rotary i]Other I
3
I
7.. SEALING PROCEDURES
i
Seat Njaierial _ From To Weight lEvolurne Seal Placement Method
TIE
Was drive shoe used? ❑Y U.N Shoe Depths) i
Was drive shoe seat tested? ❑Y ❑N How? I
f '•
JUN
8. CASING/LINER:
Diameter From To Gauge feria Casing Liner Welded Threaded '
1 El Zr Elstiment of ste r US TO"',
❑ ❑ ❑ ❑ ----
Length of Headpipe Length of Tailpipe SAY I
Packer ❑Y ❑N Type y
a
9. PER FORATIONS/SCF;EN§PACKER TYPE
Perforation Method
Screen Type&Method of Installation W12 Itallietee
From To Slot Size Number Diameter Vateriai Casing Liner
_ I
❑ Completed Depth (Measurable)
❑ ❑ Date: Started ;'t � Completed i
❑ ❑ 14.DRILLER'S CERTIFICATION
10.FILTER PACK [Me certify that all minimum well construction standards were complied with at the i
Filter Material From To Weight/Volume Placement Method time the rig was r ved I
Company Name Firm No S�Lt�
11 STATIC WATER LEVEL OR ARTESIAN PRESSURE: Principal Driller ...ZII.� Date ����
it below ground Artesian pressure lb. and i
Depth flow encountered ft De cube etc port or control devices: Driller or Operator If Date
&af ��•• Operator I Date
Principal Driller and Rig Operator Required.
Operator I must have signature of Driller/Operator II.
FORWARD WHITE COPY TO WATER RESOURCES

Form 238-7
6/07 IDAHO DEPARTMENT OF WATER RESOURCES
�� r WELL DRILLER'S REPORT
1.WELL TAG NO.D 12.STATIC WATER LEVEL and WELL TESTS:
Drilling Permit No.
Depth first water encountered(ft) q Z I Static water level(ft)
Water right or injection well# Water temp.(°F) Bottom hole temp (°F)
2.OWNER: \\ Describe access port
Namee_C//,.,\ ..n .re Well test: Test method:
Address Lam nc\.�nc .�' L�\. Sfiz, Drawdown(feet) Discharge or Test duration pump Bailer Air Flowing
field la m1 !minutes artesian
City Slate Z] l Zip DC:> ❑ ❑ ❑
3.WELL LOCATION: ❑ ❑ ❑ ❑
4 North or South R e '3Y East Water quality test or comments:
Twp. ® ❑ g � or West❑
Sec. ? 1/4 Sl,J 1/4 1/4 13.LITHOLOGIC LOG and/or repairs or abandonment:
— 760— Bore From To Remarks,litholo Water
r Dia. gy or description of repairs or
Gov't Lot o County
�} �-,G�'� (in) (it) (ft) abandonment,, y N
ll r donment water temp.
Lat. J ° / L' (Deg_and Decimal minutes) 4
Long. 5,] (Deg 11and Decimal minutes)
Address of Well Site��, i, t In, ✓_ Z �J
City Z-C
rv0 P•00 • � p on T I � -
Lot Bilk �� _ Sub.
4.USE:
❑Domestic Mt pal. ❑Monitor Irrigation ❑Thermal ❑Injection
21 Other I Lnici C
5.TYPE OF WORK:
,.New well ❑Replacement well ❑Modify existing well
❑Abandonment ❑Other
6.DRILL METHOD:
fA Air Rotary ❑Mud Rotary ❑Cable ❑Other
7.SEALING PROCEDURES:
Seal matenall- From'III To Sft Quantity Ibs
- or ft Piacemen[melhodlprCceduro
v
8.CASING/LINER:
Diameter From(ft) To(ft) Gauge/ Material Casing Liner Threaded Welded —
(nominal) Schedule
+Z' 92 W ®- ❑ ❑ 51
Was drive shoe used? ❑Y ❑N Shoe Depth(s)
9.PERFORATIONS/SCREENS: _
Perforations ®Y 0,V Method
Manufactured screen V9 Y ❑1N Type
Method of installation w
From(it) To(ft) Slot size Number/ft Diameter Material Gauge or Schedule
(nominal) Completed Depth(Measurable):
Date Started: Date Completed:7 `Z Z 0
14.DRILLER'S CERTIFICATION:
I/We certify that all minimum well construction standards were complied with at
Length of Headpipe Length of Tailpipe the time the rig s removed
Packer tHY [:IN Type K Company Na Co.No.��I�_
10.FILTER PACK: 'Principal Driller 4y:✓�; ti�� DateZU
Filter Material From(it) To(ft) Quantity(Ibs or ft3) Placement method T— qq
"Driller Date /
"Operator II Date
11.FLOWING ARTESIAN: Operator 1. Date
Flowing Artesian? ❑Y ❑N Artesian Pressure(PSIG) "Signature of Principal Driller and rig operator are required.
Describe control device