Well Information
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Identification
Type of Report: Water Well
Type of Work: NEW
Well Report: POLK 52349 View Log Groundwater Site
Well Label: 82052
Start Card: 183631
Original Report:
Owner Well Nbr: 3
Company Job Nbr:
Primary Use: COMMUNITY
Complete Date: 04/20/2006
Land Owner
Name:
Company: CITY OF INDEPENDENCE
Address: PO BOX 7

INDEPENDENCE, OR 97351
Location
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Latitude/Longitude
Latitude: 44.84464837
Longitude: -123.18670613
Horiz. Error: 25.00 ft.
Location
County: POLK
TRSQQ: WM8.00S4.00W28SENW
Tax Map:
Tax Lot: 3000
Lot:
Block:
Subdivision:
Street of Well: RIVER OAK RD; END OF RD; N OF BRIAR RD
WM District: 22
Surface Elev:
Well Report Mapping Tool
Tax Lots

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Well Construction
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Construction
Start Date: 04/03/2006
Completed Date: 04/20/2006
Drill Method: Rotary Air
Depth of Completed Well: 80.00
Est. Depth Drilled: 80.00
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: 54 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: 24.00
Pre-Static Water Level:
Pre-Static Water Level Date:
Post-Static Water Level: 30.7
Post-Static Water Level Date: 04/20/2006
Static Water Level
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Materal
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Well Constructor
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Bonded Driller Name: FLOYD G SIPPEL
Bonded Driller Company: SIPPEL WELL DRILLING INC.
Bonded Driller Number: 1273
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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