Well Information
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Identification
Type of Report: Water Well
Type of Work: NEW
Well Report: POLK 53096 View Log Groundwater Site
Well Label: 104629
Start Card: 1011385
Original Report:
Owner Well Nbr: W
Company Job Nbr:
Primary Use: DOMESTIC
Complete Date: 09/09/2010
Land Owner
Name: BOGDAN CACEU
Company:
Address: 6722 SE REED COLLEGE PLACE

PORTLAND, OR 97202
Location
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Latitude/Longitude
Latitude: 44.90501345
Longitude: -123.34335975
Horiz. Error: 100.00 ft.
Location
County: POLK
TRSQQ: WM8.00S5.00W6NWSE
Tax Map:
Tax Lot: 1800
Lot:
Block:
Subdivision:
Street of Well: E OF 2557 LIBERTY 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: 09/08/2010
Completed Date: 09/09/2010
Drill Method: Rotary Air
Depth of Completed Well: 198.00
Est. Depth Drilled: 198.00
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
RowCasing/LinerDiameter (in)Above Land SurfaceFrom DepthTo (ft)GaugeMaterialWeldGlueThreadShoe
Inside		Shoe
Outside		Shoe
Other		Shoe
Location
1Casing6.00 1.00 39.00 .250 Steel ● 34.00
2Liner4.00 57.00 117.00 .160 Plastic ● 34.00
3Liner4.00 158.00 198.00 .160 Plastic ● 34.00
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: 52 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: 62.00
Pre-Static Water Level:
Pre-Static Water Level Date:
Post-Static Water Level: 59.00
Post-Static Water Level Date: 09/10/2010
Static Water Level
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Material
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Well Constructor
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Bonded Driller Name: WILLIAM A BLAIR
Bonded Driller Company: DICKERSON WELL DRILLING
Bonded Driller Number: 1571
Bonded Date Signed:
Unbonded Name:
Unbonded Company:
Unbonded Number:
Unbonded Date Signed:
Other Name:
Other Affiliation:
Other License Nbr:
Geologist Engineer:
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Documents
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TitleDocument TypeSourceDownload ImageReceived Date
POLK 53096WELL REPORTDRILLERImage9/27/2010