Form 603 - Montana Well Log Report/well Log Supplement
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1
2MONTANA WELL LOG REPORT
Form No. 603 R2-04
Well ID# _______________________
This log reports the activities of a licensed Montana well driller and serves as the official record of work done within the borehole and casing and describes
the amount of water encountered.
This form is to be completed by the driller and filed with Mt. Bureau of Mines & Geology within 60 days of
completion of the work.
Acquiring Water Rights is the well owner’s responsibility and is not accomplished by the filing of this report.
Well log information is stored in the Groundwater Information Center at the Montana Bureau of Mines and Geology (Butte) and water right information is
stored in the Water Rights Bureau records (Helena).
For fields that are not applicable, enter NA. Optional fields have a grayed background. Record additional information in the REMARKS section.
Test - 1 hour minimum
1. WELL OWNER:
Drawdown is the amount water level is lowered below static level.
Name __________________________________________________
All depth measurements shall be from the top of the well casing.
Mailing address _________________________________________
Time of recovery is hours/minutes since pumping stopped.
Air test*
_______________________________________________________
_______ gpm with drill stem set at _______ ft. for ______ hours
2. WELL LOCATION:
List ¼ from smallest to largest
Time of recovery ______ hrs/min. Recovery water level ____ ft.
_______ ¼ ______ ¼ ______ ¼ ______ ¼, Section ___________
OR Bailer test*
Township ___ N/S
Range ___ E/W
County _________________
_____ gpm with _____ ft. of drawdown after _____ hours
Lot _____ , Tract/Blk ____ Subdivision Name __________________
Time of recovery ______ hrs/min. Recovery water level ____ ft.
Well Address ____________________________________________
OR Pump test*
l Yes
l No
GPS
Depth pump set for test ______ ft.
Latitude ____________________ Longitude ___________________
___ gpm pump rate with ____ ft. of drawdown after ___ hrs pumping
_ +
Error as reported by GPS locator (
feet) _________________
Time of recovery _____ hrs/min. Recovery water level ____ ft.
l NAD27
l WGS84
Horizontal datum
OR Flowing Artesian*
l Domestic
l Stock
l Irrigation
3. PROPOSED USE:
_________ gpm for ________ hours
l Public water supply l Monitoring Well
l Other: ________
Flow controlled by ______________
4. TYPE OF WORK:
*During the well test the discharge rate shall be as uniform as possible. This rate may or may
l New well
l Deepen existing well
l Abandon existing well
not be the sustainable yield of the well. Sustainable yield does not include the resevoir of the
well casing.
Method: l Cable
l Rotary
l Other: ____________________
7. WELL LOG:
5. WELL CONSTRUCTION DETAILS:
Material:
Depth, Feet
Borehole:
color/rock and type/descriptor (example: blue/shale/hard,
From
To
Dia. _____________ in. from ____________ ft. to _____________ ft.
or brown/gravel/water, or brown/sand/heaving)
Dia. _____________ in. from ____________ ft. to _____________ ft.
Dia. _____________ in. from ____________ ft. to _____________ ft.
Casing:
Wall thickness __________ l Threaded
l Welded
Steel:
Dia. _____________ in. from ____________ ft. to _____________ ft.
Dia. _____________ in. from ____________ ft. to _____________ ft.
Plastic: Pressure Rating _________ lbs. l Threaded l Welded
Dia. _____________ in. from ____________ ft. to _____________ ft.
Perforations/Slotted Pipe:
Type of perforator used ____________________
Size of perforations/slots ______ in. by _________ in.
_____ no. of perforations/slots from _________ ft. to __________ ft.
_____ no. of perforations/slots from _________ ft. to __________ ft.
l Yes
l No
Screens:
Material ____________________
Dia. _________ Slot size _________ from _______ ft. to _______ ft.
Dia. _________ Slot size _________ from _______ ft. to _______ ft.
l Yes
l No
Gravel Packed:
Size of gravel _________
Gravel placed from ________________ ft. to _________________ ft.
l Yes
l No
Packer:
l ADDITIONAL SHEETS ATTACHED
Type _____________________ Depth(s) _____________________
8. DATE WELL COMPLETED: ______________________
Grout:
Material used _________________________
9. REMARKS: _____________________________________________
l Continuous feed
Depth from ________ ft. to ________ ft. OR
_________________________________________________________
6. WELL TEST DATA:
10. DRILLER/CONTRACTOR’S CERTIFICATION:
A well test is required for all wells. ( See details on well log report cover. )
All work performed and reported in this well log is in compliance with the
l Static water level _________ ft. below top of casing or
Montana well construction standards. This report is true to the best of my
l Closed-in artesian pressure ______ psi.
knowledge.
Name, firm, or corporation (print) _______________________________
How was test flow measured:
bucket/stopwatch, weir, flume, flowmeter, etc _______________
Address ___________________________________________________
o
ellowstone Controlled Groundwater Area - Water Temperature ______
F
Y
Signature __________________________________________________
l
AQUIFER TEST DATA FORM ATTACHED
Date ______________________ License no. _____________________
Montana Bureau of Mines & Geology
MBMG ID#
The University of Montana
1300 West Park Street
Butte, MT 59701
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