Well Information
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Identification
Type of Report: Water Well
Type of Work:
Well Report: JEFF 50790 View Log
Well Label: 59949
Start Card:
Original Report:
Owner Well Nbr:
Company Job Nbr:
Primary Use:
Complete Date:
Land Owner
Name:
Company: LAKE CREEK LODGE INC.
Address: 13375 SW FS RD 1419

CAMP SHERMAN, OR 97730
Location
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Latitude/Longitude
Latitude:
Longitude:
Horiz. Error: ft.
Location
County: JEFF
TRSQQ: WM13.00S9.00E15
Tax Map:
Tax Lot: 301
Lot:
Block:
Subdivision:
Street of Well: 13375 SW FS RD 1419
WM District: 11
Surface Elev:
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Tax Lots

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Well Construction
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Construction
Start Date:
Completed Date:
Drill Method:
Depth of Completed Well:
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
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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Materal
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Well Constructor
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Bonded Driller Name: WELL ID APPLICATION
Bonded Driller Company: WELL ID APPLICATION
Bonded Driller Number: 99999
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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