Well Information
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Identification
Type of Report: Water Well
Type of Work:
Well Report: JACK 52340 View Log
Well Label: 26320
Start Card:
Original Report:
Owner Well Nbr:
Company Job Nbr:
Primary Use:
Complete Date:
Land Owner
Name: LENTZ
Company: WAGON WHEEL MOBILE HOME PARK
Address: 20727 HWY 62

SHADY RIVER COVE, OR 97539
Location
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Latitude/Longitude
Latitude:
Longitude:
Horiz. Error: ft.
Location
County: JACK
TRSQQ: WM34.00S1.00W21NE
Tax Map:
Tax Lot: 1004
Lot:
Block:
Subdivision:
Street of Well: 20727 HWY 62
WM District: 13
Surface Elev:
Well Report Mapping Tool
Tax Lots

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Well Construction
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Construction
Start Date:
Completed Date:
Drill Method:
Depth of Completed Well: 175.00
Est. Depth Drilled:
Special Standards:
Seal Placed Method:
Abandonment Start Date:
Abandonment Completed Date:
Backfill
Backfill Placement:
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
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Well Test
Temperature: F
Lab Analysis:
Lab Analysis Done By:
Total Dissolved Solids:
Water Quality Concerns:
Well Test
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: 77.0
Post-Static Water Level Date:
Static Water Level
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Materal
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Well Constructor
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Bonded Driller Name:
Bonded Driller Company:
Bonded Driller Number:
Bonded Date Signed:
Unbonded Name:
Unbonded Company:
Unbonded Number:
Unbonded Date Signed:
Other Name:
Other Affiliation:
Other License Nbr:
Geologist Engineer:
Geologist Date Signed:
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