Well Information
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Identification
Type of Report: Water Well
Type of Work: NEW
Well Report: JACK 64922 View Log Groundwater Site
Well Label: 140784
Start Card: 1052278
Original Report:
Owner Well Nbr:
Company Job Nbr:
Primary Use: DOMESTIC
Complete Date: 06/08/2021
Land Owner
Name: KELLEY THOMAS
Company: FERN VALLEY FARMS LLC
Address: 4725 FERN VALLEY RD

MEDFORD, OR 97504
Location
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Latitude/Longitude
Latitude:
Longitude:
Horiz. Error: ft.
Location
County: JACK
TRSQQ: WM38.00S1.00W11SWNW
Tax Map:
Tax Lot: 1000
Lot:
Block:
Subdivision:
Street of Well: 4725 FERN VALLEY RD, MEDFORD, OR 97504
WM District: 13
Surface Elev:
Well Report Mapping Tool
Tax Lots

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Well Construction
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Construction
Start Date: 06/02/2021
Completed Date: 06/08/2021
Drill Method: Rotary Air
Depth of Completed Well: 200.00
Est. Depth Drilled: 200.00
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)
110.000.0019.00
26.0019.00200.00
Seal
RowMaterialFrom (ft)To (ft)AmountAmount Calc.
1Bentonite Chips0.0019.00600.00600.00
Abandonment Log
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Casing/Liner
Temporary Casing
Perforations
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: 155.00 ppm
Water Quality Concerns:
Well Test
Analysis
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Static Water Level
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Static Water Level
Depth First Water:
Pre-Static Water Level:
Pre-Static Water Level Date:
Post-Static Water Level: 18.00
Post-Static Water Level Date: 06/08/2021
Static Water Level
RowDateFrom(ft)To(ft)SWLEst. Flow RatePSI
16/8/2021105.00110.0018.006.0 
26/8/2021165.00170.0018.0030.0 
Lithology
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Material
RowFromToMaterialStatic Water Level
10.0010.00SHALE, BROWN 
210.00200.00SHALE, BLUE 
Well Constructor
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Bonded Driller Name: BRAD MILKOWSKI
Bonded Driller Company: GRIBBLE WELL DRILLING
Bonded Driller Number: 1661
Bonded Date Signed: 07/27/2021
Unbonded Name:
Unbonded Company:
Unbonded Number:
Unbonded Date Signed:
Other Name:
Other Affiliation:
Other License Nbr:
Geologist Engineer:
Comments
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Documents
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TitleDocument TypeSourceDownload Image
JACK 64922WELL REPORTDRILLERImage