Well Information
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Identification
Type of Report: Water Well
Type of Work: ALTERATION
Well Report: POLK 54853 View Log
Well Label: 127718
Start Card: 218174
Original Report: POLK 54117 View Original Log
Owner Well Nbr:
Company Job Nbr:
Primary Use: DOMESTIC
Complete Date: 08/28/2023
Land Owner
Name: JON LAUER
Company:
Address: BETHEL HEIGHTS RD NW

SALEM, OR 97304
Location
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Latitude/Longitude
Latitude: 45.04550000
Longitude: -123.15590000
Horiz. Error: 50.00 ft.
Location
County: POLK
TRSQQ: WM6.00S4.00W15SESE
Tax Map:
Tax Lot: 600
Lot:
Block:
Subdivision:
Street of Well: BETHEL HEIGHTS RD NW
WM District: 22
Surface Elev:
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Well Construction
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Construction
Start Date: 08/11/2023
Completed Date: 08/28/2023
Drill Method: OTHER - EXCAVATOR
Depth of Completed Well: 216.00
Est. Depth Drilled:
Special Standards:
Seal Placed Method: OTHER - FILLED FR TOP W DRY BENT
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
Seal
RowMaterialFrom (ft)To (ft)AmountAmount Calc.
1Bentonite 2.006.001.000.55
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:
Pre-Static Water Level Date:
Post-Static Water Level:
Post-Static Water Level Date:
Static Water Level
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Material
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Well Constructor
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Bonded Driller Name: RONALD SPENGLER
Bonded Driller Company: RON ROBINSON WELL DRILLING
Bonded Driller Number: 1585
Bonded Date Signed: 10/26/2023
Unbonded Name:
Unbonded Company:
Unbonded Number:
Unbonded Date Signed:
Other Name:
Other Affiliation:
Other License Nbr:
Geologist Engineer:
Comments
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Comments
Well Bore and Casing was not Disturbed. Installed seal from 2' below ground to bottom of Well pit @ 6'. 10" Sawn tube was installed around 6" casing and filled to the top with Bentonite. 3/4-Rock was back-filled to 2.5'then Cement from Pitless adapter to Rock. Cement was contoured to a 2" Drain line. Drain line ran Down-gradient to daylight. Back flow device was installed. Manhole cap installed with gasket seal. Manhole cap has Water Well Marked on top. Previous log POLK 54117
Documents
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TitleDocument TypeSourceDownload Image
Special Standards ApprovalSPECIAL STANDARD FINAL ORDEROWRDImage
POLK 54853WELL REPORTDRILLERImage