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Well Completion Report (Tabs) - v21

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Well Completion Report (Tabs) - v21

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Well Completion Report [V17.0]

If you require assistance in completing your form please call the Drilling Inspector on (08) 8463 6841 or mobile 0428 828 569.

Fields marked with * are required

Before you start

1. You must be connected to the internet to:

•Access any of the internet links in the form
•Verify your licence or retrieve permit details
•Save your form.
•Submit your form.
•If you are not connected to the internet then the browser page (form) can be left open and the computer put into sleep or hibernate mode (or left on for any mobile device) until you have regained internet connectivity.
2. Fields marked with an asterisk (*) are mandatory.

3. To fill in this form you will need:

•Your Well Driller Licence Number and your name as it appears on the licence
•The relevant Well Construction Permit Number and the name of at least one of the permit holders as it appears on the permit
•The well construction details
•An electronic copy of any other material to be attached to the report

Verify Details

Fields marked with * are required

Well drillers licence details

Well Driller Licence Number *

Please enter your full name as it appears on the licence.
For example : Gregory John Smith / NOT GJ & AB Smith *

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message

Contact Details of the licensed well driller

Phone

Update

New Phone

Mobile Phone

Update

New Mobile Phone

Email Address

Update

New Email Address

Was work carried out by another driller under your supervision

Yes

No

Details of Well driller under supervision

Well Driller Licence Number (if applicable)

Full name

Mobile Phone

Email Address

Well Permit Details

Permit details can be viewed on the NRM Register at http://www.waterconnect.sa.gov.au/systems/WLPR

Well Permit Number *

Please enter the full name of ONE holder as it appears on the permit.
For example : Gregory John Smith / NOT GJ & AB Smith *

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message

Well Permit Summary

Approval Date

Expiry Date

Activity

Well Use

Well number

-

Conditions

Notes

Well Summary

Fields marked with * are required

Work carried out *

Date work commenced *

Date work completed *

New Well Identification

Well Purpose *

GPS coordinates of well location

Easting/Northing

Longitude/Latitude

Easting *

Northing *

Zone *

Datum *

Longitude *

Latitude *

Datum *

Was the well successful ?

Yes

No

Site ID *

Please complete the construction details for alternative wells on a separate form.

New Well Identification

Well Purpose *

GPS coordinates of well location

Easting/Northing

Longitude/Latitude

Easting *

Northing *

Zone *

Datum *

Longitude *

Latitude *

Datum *

Was the well successful ?

Yes

No

Site ID *

Existing Well Identification

Well number

-

GPS coordinates of well location

Easting/Northing

Longitude/Latitude

Easting *

Northing *

Zone *

Datum *

Longitude *

Latitude *

Datum *

Existing Well Details

Casing Material

Internal Diameter (mm)	Wall Thickness (mm)	Casing Depth (m)	Water level (m)
Diameter (mm)	Wall Thickness (mm)	Total depth of hole (m)	Water level (m)

Was the replaced existing well backfilled (decommissioned) ?

Yes

No

Reason for not backfilling well *

Date work commenced *

Date work completed *

Backfill details can be completed on the Decommission tab.

Press Continue to proceed with entry of new well construction details.

Existing Well Identification

Well number

-

GPS coordinates of well location

Easting/Northing

Longitude/Latitude

Easting *

Northing *

Zone *

Datum *

Longitude *

Latitude *

Datum *

Existing Well Details

Casing Material

Internal Diameter (mm)	Wall Thickness (mm)	Casing Depth (m)	Water level (m)
Diameter (mm)	Wall Thickness (mm)	Total depth of hole (m)	Water level (m)

How was the well construction altered?

Was the work carried out successful ?

Yes

No

Was the existing well backfilled (decommissioned)?

Yes

No

Was a replacement well drilled?

Yes

No

Existing Well Identification

Well number

-

GPS coordinates of well location

Easting/Northing

Longitude/Latitude

Easting *

Northing *

Zone *

Datum *

Longitude *

Latitude *

Datum *

Existing Well Details

Casing material

Internal Diameter (mm)	Wall Thickness (mm)	Casing Depth (m)	Water level (m)
Diameter (mm)	Wall Thickness (mm)	Total depth of hole (m)	Water level (m)

Reason for decommissioning well *

Please retrieve Water licence holder details on the "Start TAB" before visiting this TAB

Drilling

Fields marked with * are required

From (m)	To (m)	Diameter (mm)	Drill Method test
From (m)	To (m)	Diameter (mm)	Drill Method

Water Cut Details

Date

Water Cut From (m)

Water Cut To (m)

Standing water level (m)

Estimated yield (L/sec)

Hole depth at test (m)

Casing at test (m)

Flow measurement Method

Test Method

Water Quality

Water Quality Unit

Salinity measurement Method

Please retrieve Water licence holder details on the "Start TAB" before visiting this TAB

Production Zone

Fields marked with * are required

Construction at Production Level

Completion Method

From (m)

To (m)

Aperture (mm)

Internal Diameter (mm)

Final Depth (m)

Material

Temperature

High

Low

Wall Thickness (mm)

Type of PVC

PN

Other

Type of Steel

Grade

Schedule

Method of Slotting

Slot Alignment

Perforations

From (m)	To (m)	Diameter (mm)	Aperture (mm)
From (m)	To (m)	Diameter (mm)	Aperture (mm)

Was a filter sock installed ?

Yes

No

Gravel Pack?

Yes

No

Choose the closest comparable Gravel Pack Size from the list below. These values are taken from the Classification of Granular Materials and Approximate Slot Size for Naturally Developed Wells table on page 89 of the Minimum Construction Requirements for Water Bores in Australia, edition 3.

Size

Material

Type of PVC

PN

Other

Type of Steel

Grade

Schedule

Gravel Pack?

Yes

No

Size

Liner Seal?

Yes

No

Material

Other

Depth (m)

Diameter (mm)

Liner Seal Type

Riser Pipe?

Yes

No

From (m)

To (m)

Diameter (mm)

Material

Temperature

High

Low

Wall Thickness (mm)

Type of PVC

PN

Other

Type of Steel

Grade

Schedule

Sump?

Yes

No

From (m)

To (m)

Diameter (mm)

Completion of Base

Describe

Please retrieve Water licence holder details on the "Start TAB" before visiting this TAB

Development

Fields marked with * are required

Was any development performed on the well?

Yes

No

Final Standing Water Level (m)

Item

Method

Time (hours)

Time (minutes)

Pumping Test (measurements from natural surface to nearest 0.1m)

Was a pumping test performed?

Yes

No

Production Interval From (m)

Production Interval To (m)

Water level at start of test (m)

Water level at end of test (m)

Water level at end of recovery (m)

Test method

Intake depth (m)

Discharge rate (L/sec)

Discharge measurement method

Hours pumped

Maximum draw down (m)

Pump Test Readings

File:

Please retrieve Water licence holder details on the "Start TAB" before visiting this TAB

Formation Log

Fields marked with * are required

Complete this section if a formation log is available.
View guidelines for rock classification and description at https://www.waterconnect.sa.gov.au/Content/Reference%20Material/Minimum-Construction-Requirements%203rd%20Edition.pdf

From (m)	To (m)	Major Lithology	Description of Material
From (m)	To (m)		Description of Material

Attachment

Upload (formation log, maps, diagrams etc)

File:

Please retrieve Water licence holder details on the "Start TAB" before visiting this TAB

Decommission

Fields marked with * are required

Decommission New Well

From (m)

To (m)

Backfill Material

Cement in KGs

Grout type

Specify %

Water (L)

Other additives

Fill type

Placement Method

Decommission Existing Well

From (m)

To (m)

Backfill Material

Cement in KGs

Grout type

Specify %

Water (L)

Other additives

Fill type

Placement Method

Please retrieve Water licence holder details on the "Start TAB" before visiting this TAB

Declaration

Fields marked with * are required

The licensed well driller is responsible for providing a report of the well construction activity. In the event that the person filling out this report is not the licensed well driller, the declaration is based on that person's understanding of the information they have been given.

I declare that the information that has been provided on this document is true and correct *

Details of the person supplying the Well Completion Report:

Name *

Role *

Telephone *

Email address *

Privacy statement

The Government of South Australia is committed to protecting the privacy of your information. In 1989, the Government of South Australia issued a set of Information Privacy Principles (IPPs) to regulate the way personal information can be collected, used, stored and disclosed. These principles have been re-issued a number of times, including in May 2020. The Privacy statement can be found at http://www.sa.gov.au/privacy.

Your form has been successfully submitted. Please keep a copy of this acknowledgement for your records.

Date and Time:

Receipt Number:

To save or print a copy of the completed form and acknowledgement go to the "File" menu and select "Save as" or "Print".

Please ensure you have verified your well drillers licence and well permit details on the Verify Details tab prior to continuing

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Well Completion Report [V17.0]

Verify Details

Well Summary

Drilling

Casing Strings

Sealing

Production Zone

Development

Item

Formation Log

Attachment

Decommission

Declaration