Form 603 "Montana Well Log Report" - Montana

What Is Form 603?

This is a legal form that was released by the Montana Department of Natural Resources and Conservation - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2004;
  • The latest edition provided by the Montana Department of Natural Resources and Conservation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 603 by clicking the link below or browse more documents and templates provided by the Montana Department of Natural Resources and Conservation.

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MONTANA 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 offi cial 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 MBMG 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 fi elds that are not applicable, enter NA. Record additional information in the REMARKS section.
1. WELL OWNER:
Test - 1 hour minimum
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.
Certifi cate of Survey ________________________________________
Well Address ____________________________________________
OR Pump test*
Yes
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.
 NAD27
 WGS84
Horizontal datum
OR Flowing Artesian*
Domestic
Stock
Irrigation
3. PROPOSED USE:
 Public water supply
 Monitoring Well
_________ gpm for _________ hours
 Geothermal
 Closed System
 Open System
 Reinjection
Flow controlled by _______________
 Extraction
*During the well test the discharge rate shall be as uniform as possible. This rate
H 2 O Temp ______
Number of Wells in System ______
may or may not be the sustainable yield of the well. Sustainable yield does not
 Other: ___________________________
include the reservoir of the well casing.
4. TYPE OF WORK:
7. WELL LOG:
Record depth(s) that water is encountered.
 New well
 Deepen existing well  Abandon existing well
Method:  Cable
 Rotary
 Other: ____________________
Depth, Feet
Material:
color/rock and type/descriptor (example: blue/shale/hard,
From
To
5. WELL CONSTRUCTION DETAILS:
or brown/gravel/water, or brown/sand/heaving)
Borehole:
Dia. ______________ in. from ____________ ft. to _____________ ft.
Dia. ______________ in. from ____________ ft. to _____________ ft.
Dia. ______________ in. from ____________ ft. to _____________ ft.
Casing:
Wall thickness ___________  Threaded
 Welded
Steel:
Dia. ______________ in. from ____________ ft. to _____________ ft.
Dia. ______________ in. from ____________ ft. to _____________ ft.
Yes
No
Casing Shoe:
 Threaded  Welded
Plastic: Pressure Rating__________ lbs.
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.
Yes
No
Screens:
Material _____________________
Dia. __________ Slot size _________ from _________ft. to _______ ft.
Dia. __________ Slot size _________ from ________ft. to _______ ft.
Yes
No
 ADDITIONAL SHEETS ATTACHED
Gravel Packed:
Size of gravel _________
8. DATE WELL COMPLETED: _________________
Gravel placed from _________________ ft. to __________________ ft.
Yes
No
Packer:
9. REMARKS:
____________________________________________
Type _____________________ Depth(s) _______________________
__________________________________________________________
Grout:
Material used __________________________
 Continuous feed
Depth from ________ ft. to _________ ft. OR
10. DRILLER/CONTRACTOR’S CERTIFICATION:
6. WELL TEST DATA:
All work performed and reported in this well log is in compliance with the
A well test is required for all wells. ( See details on well log report cover. )
Montana well construction standards. This report is true to the best of my
Static water level __________ ft. below top of casing or
knowledge.
Closed-in artesian pressure _______ psi.
Name, fi rm, or corporation (print) ________________________________
Address ____________________________________________________
How was test fl ow measured:
bucket/stopwatch, weir, fl ume, fl owmeter, etc _________________
Signature ___________________________________________________
Date _______________________ License no. ______________________
o
ellowstone Controlled Groundwater Area - Water Temperature ______
F
Y
License type: MWC
WWC
WWD
AQUIFER TEST DATA FORM ATTACHED
Montana Bureau of Mines & Geology
The University of Montana
1300 West Park Street
Butte, MT 59701
MONTANA 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 offi cial 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 MBMG 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 fi elds that are not applicable, enter NA. Record additional information in the REMARKS section.
1. WELL OWNER:
Test - 1 hour minimum
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.
Certifi cate of Survey ________________________________________
Well Address ____________________________________________
OR Pump test*
Yes
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.
 NAD27
 WGS84
Horizontal datum
OR Flowing Artesian*
Domestic
Stock
Irrigation
3. PROPOSED USE:
 Public water supply
 Monitoring Well
_________ gpm for _________ hours
 Geothermal
 Closed System
 Open System
 Reinjection
Flow controlled by _______________
 Extraction
*During the well test the discharge rate shall be as uniform as possible. This rate
H 2 O Temp ______
Number of Wells in System ______
may or may not be the sustainable yield of the well. Sustainable yield does not
 Other: ___________________________
include the reservoir of the well casing.
4. TYPE OF WORK:
7. WELL LOG:
Record depth(s) that water is encountered.
 New well
 Deepen existing well  Abandon existing well
Method:  Cable
 Rotary
 Other: ____________________
Depth, Feet
Material:
color/rock and type/descriptor (example: blue/shale/hard,
From
To
5. WELL CONSTRUCTION DETAILS:
or brown/gravel/water, or brown/sand/heaving)
Borehole:
Dia. ______________ in. from ____________ ft. to _____________ ft.
Dia. ______________ in. from ____________ ft. to _____________ ft.
Dia. ______________ in. from ____________ ft. to _____________ ft.
Casing:
Wall thickness ___________  Threaded
 Welded
Steel:
Dia. ______________ in. from ____________ ft. to _____________ ft.
Dia. ______________ in. from ____________ ft. to _____________ ft.
Yes
No
Casing Shoe:
 Threaded  Welded
Plastic: Pressure Rating__________ lbs.
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.
Yes
No
Screens:
Material _____________________
Dia. __________ Slot size _________ from _________ft. to _______ ft.
Dia. __________ Slot size _________ from ________ft. to _______ ft.
Yes
No
 ADDITIONAL SHEETS ATTACHED
Gravel Packed:
Size of gravel _________
8. DATE WELL COMPLETED: _________________
Gravel placed from _________________ ft. to __________________ ft.
Yes
No
Packer:
9. REMARKS:
____________________________________________
Type _____________________ Depth(s) _______________________
__________________________________________________________
Grout:
Material used __________________________
 Continuous feed
Depth from ________ ft. to _________ ft. OR
10. DRILLER/CONTRACTOR’S CERTIFICATION:
6. WELL TEST DATA:
All work performed and reported in this well log is in compliance with the
A well test is required for all wells. ( See details on well log report cover. )
Montana well construction standards. This report is true to the best of my
Static water level __________ ft. below top of casing or
knowledge.
Closed-in artesian pressure _______ psi.
Name, fi rm, or corporation (print) ________________________________
Address ____________________________________________________
How was test fl ow measured:
bucket/stopwatch, weir, fl ume, fl owmeter, etc _________________
Signature ___________________________________________________
Date _______________________ License no. ______________________
o
ellowstone Controlled Groundwater Area - Water Temperature ______
F
Y
License type: MWC
WWC
WWD
AQUIFER TEST DATA FORM ATTACHED
Montana Bureau of Mines & Geology
The University of Montana
1300 West Park Street
Butte, MT 59701