Well Information
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Identification
Type of Report: Water Well
Type of Work: ALTERATION
Well Report: JACK 63396 View Log
Well Label: 114621
Start Card: 1038171
Original Report: JACK 61947 View Original Log
Owner Well Nbr:
Company Job Nbr:
Primary Use: DOMESTIC
Complete Date: 03/21/2018
Land Owner
Name:
Company: HAYS RANDOLPH LLC
Address: PO BOX 1220

MEDFORD, OR 97501
Location
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Latitude/Longitude
Latitude: 42.50340000
Longitude: -122.90254800
Horiz. Error: 99.00 ft.
Location
County: JACK
TRSQQ: WM35.00S2.00W26NWNE
Tax Map:
Tax Lot: 106
Lot:
Block:
Subdivision:
Street of Well: 13325 ANTIOCH RD. WHITE CITY, OR 97503
WM District: 13
Surface Elev:
Well Report Mapping Tool
Tax Lots

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Well Construction
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Construction
Start Date: 03/21/2018
Completed Date: 03/21/2018
Drill Method: Rotary Air
Depth of Completed Well: 500.00
Est. Depth Drilled: 500.00
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)
110.000.0033.00
26.0033.00500.00
Seal
RowMaterialFrom (ft)To (ft)AmountAmount Calc.
2Bentonite Chips0.0033.0017.0015.06
Abandonment Log
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Casing/Liner
RowCasing/LinerDiameter (in)Above Land SurfaceFrom DepthTo (ft)GaugeMaterialWeldGlueThreadShoe
Inside		Shoe
Outside		Shoe
Other		Shoe
Location
1(Casing)Pre-Alteration6.00 ● 1.50 38.50 .250 Steel ● ● 38.50
2Casing6.00 ● 1.50 38.50 .250 Steel ● ● 38.50
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: 55 F
Lab Analysis:
Lab Analysis Done By:
Total Dissolved Solids: 220.00 ppm
Water Quality Concerns:
Well Test
Analysis
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Static Water Level
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Static Water Level
Depth First Water: 237.00
Pre-Static Water Level: 89.00
Pre-Static Water Level Date: 03/21/2018
Post-Static Water Level: 89.00
Post-Static Water Level Date: 03/21/2018
Static Water Level
RowDateFrom(ft)To(ft)SWLEst. Flow RatePSI
13/21/2018237.00239.0089.000.5 
23/21/2018370.00375.0089.001.0 
Lithology
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Material
RowFromToMaterialStatic Water Level
10.00500.00WELL 3 SACKS SHORT OF CALC. BENT SEAL 
20.00500.00PULLED PUMP OVERDRILLED CASING- 0'-33' 
30.00500.00DRY POURED 17 SACKS OF BENT. 3/8" CHIPS 
Well Constructor
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Bonded Driller Name: KEVIN GILL
Bonded Driller Company: CLOUSER DRILLING INC
Bonded Driller Number: 1835
Bonded Date Signed: 04/23/2018
Unbonded Name: SPLIETHOF,JUSTIN
Unbonded Company: CLOUSER DRILLING INC
Unbonded Number: 1945
Unbonded Date Signed: 04/23/2018
Other Name:
Other Affiliation:
Other License Nbr:
Geologist Engineer:
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Documents
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TitleDocument TypeSourceDownload Image
JACK 63396EXEMPT USE MAPDRILLERImage
JACK 63396WELL REPORTDRILLERImage