Well Information
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Identification
Type of Report: Water Well
Type of Work: ALTERATION
Well Report: POLK 54117 View Log
Well Label: 127718
Start Card: 1037961
Original Report:
Owner Well Nbr: 3122
Company Job Nbr:
Primary Use: DOMESTIC
Complete Date: 04/04/2018
Land Owner
Name: JON LAUER
Company:
Address: 5955 BETHEL HEIGHTS RD, NW

SALEM, OR 97304
Location
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Latitude/Longitude
Latitude: 45.04558312
Longitude: -123.15598195
Horiz. Error: 99.00 ft.
Location
County: POLK
TRSQQ: WM6.00S4.00W15SESE
Tax Map:
Tax Lot: 600
Lot:
Block:
Subdivision:
Street of Well: 5955 BETHEL HEIGHTS RD, NW SALEM
WM District: 22
Surface Elev:
Well Report Mapping Tool
Tax Lots

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Well Construction
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Construction
Start Date: 04/03/2018
Completed Date: 04/04/2018
Drill Method: OTHER - EXCAVATOR
Depth of Completed Well: 216.00
Est. Depth Drilled: 216.00
Special Standards:
Seal Placed Method:
Abandonment Start Date:
Abandonment Completed Date:
Backfill
Backfill Placement: ft to ft
Backfill Material:
Explosives Used:
Explosive Type:
Explosive Amount:
Filter Pack
Filter Pack:
Filter Pack Material:
Filter Pack Size:
Bore Hole
RowDiameter (in)From (ft)To (ft)
110.000.006.00
26.006.00216.00
Seal
RowMaterialFrom (ft)To (ft)AmountAmount Calc.
1Granular Bentonite0.006.003.502.00
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: 97.00
Pre-Static Water Level Date: 04/03/2018
Post-Static Water Level: 97.00
Post-Static Water Level Date: 04/04/2018
Static Water Level
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Material
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Well Constructor
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Bonded Driller Name: DAVID PAYSINGER
Bonded Driller Company: BLUE WATER DRILLING CO INC
Bonded Driller Number: 1438
Bonded Date Signed: 04/18/2018
Unbonded Name:
Unbonded Company:
Unbonded Number:
Unbonded Date Signed:
Other Name:
Other Affiliation:
Other License Nbr:
Geologist Engineer:
Comments
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Comments
Work to install upper annular seal removed during construction excavation. Installed Well ID Badge #127718. Existing bentonite seal visibly intact at 6' bsg. 10" temp surface casing placed to 6'. Bentonite placed in dry annular to surface, (see sect 5b) Well disinfected. Unknown original well report. 6" well, 216' deep w/4" liner.
Documents
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TitleDocument TypeSourceDownload Image
ARCHIVE DOCUMENTSPECIAL STANDARD FINAL ORDERARCHIVEImage
POLK 54117WELL REPORTDRILLERImage