Well Information
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Identification
Type of Report: Water Well
Type of Work: NEW
Well Report: POLK 50089 View Log Groundwater Site
Well Label:
Start Card: 10670
Original Report:
Owner Well Nbr: 4
Company Job Nbr:
Primary Use: COMMUNITY
Complete Date: 07/28/1989
Land Owner
Name:
Company: PERRYDALE DOMESTIC WATER ASSOC.
Address: 11475 W PERRYDALE RD

AMITY, OR 97101
Location
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Latitude/Longitude
Latitude: 45.00789841
Longitude: -123.07763230
Horiz. Error: 6.00 ft.
Location
County: POLK
TRSQQ: WM6.00S3.00W32SWNE
Tax Map:
Tax Lot: 302
Lot:
Block:
Subdivision:
Street of Well:
WM District: 22
Surface Elev:
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Tax Lots

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Well Construction
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Construction
Start Date: 07/28/1989
Completed Date: 07/28/1989
Drill Method: Rotary Air
Depth of Completed Well: 408.00
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
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: 155.00
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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Materal
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Well Constructor
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Bonded Driller Name:
Bonded Driller Company: STACO WELL SERVICES
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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