Well Information
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Identification
Type of Report: Water Well
Type of Work: ALTERATION
Well Report: JACK 64465 View Log
Well Label: 138491
Start Card: 1048194
Original Report:
Owner Well Nbr:
Company Job Nbr:
Primary Use: DOMESTIC
Complete Date: 07/17/2020
Land Owner
Name:
Company: DARK HOLLOW WATER ASSN
Address: 4 PIONEER RD.

MEDFORD, OR 97501
Location
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Latitude/Longitude
Latitude: 42.28240000
Longitude: -122.89114000
Horiz. Error: 99.00 ft.
Location
County: JACK
TRSQQ: WM38.00S2.00W12SWNW
Tax Map:
Tax Lot: 1200
Lot:
Block:
Subdivision:
Street of Well: 0 DARK HOLLOW RD. MEDFORD OR 97501
WM District: 13
Surface Elev:
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Tax Lots

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Well Construction
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Construction
Start Date: 07/17/2020
Completed Date: 07/17/2020
Drill Method: Rotary Air
Depth of Completed Well:
Est. Depth Drilled:
Special Standards:
Seal Placed Method:
Abandonment Start Date:
Abandonment Completed Date:
Backfill
Backfill Placement: ft to ft
Backfill Material:
Explosives Used:
Explosive Type:
Explosive Amount:
Filter Pack
Filter Pack:
Filter Pack Material:
Filter Pack Size:
Bore Hole
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Seal
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Abandonment Log
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Casing/Liner
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Temporary Casing
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Perforations
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Screens
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Well Test
Temperature:
Lab Analysis:
Lab Analysis Done By:
Total Dissolved Solids:
Water Quality Concerns:
Well Test
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Analysis
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Static Water Level
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Static Water Level
Depth First Water:
Pre-Static Water Level:
Pre-Static Water Level Date:
Post-Static Water Level:
Post-Static Water Level Date:
Static Water Level
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Lithology
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Materal
RowFromToMaterialStatic Water Level
10.00260.00WELDED 20" PIECE OF CASING TO WELL HEAD 
20.00260.00ATTACH ID TAG 138491 
Well Constructor
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Bonded Driller Name: KEVIN GILL
Bonded Driller Company: CLOUSER DRILLING INC
Bonded Driller Number: 1835
Bonded Date Signed: 07/20/2020
Unbonded Name: SPLIETHOF,JUSTIN
Unbonded Company: CLOUSER DRILLING INC
Unbonded Number: 1945
Unbonded Date Signed: 07/20/2020
Other Name:
Other Affiliation:
Other License Nbr:
Geologist Engineer:
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Documents
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TitleDocument TypeSourceDownload Image
JACK 64465WELL REPORTDRILLERImage