Well Information
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Identification
Type of Report: Water Well
Type of Work: NEW
Well Report: JACK 66307 View Log Groundwater Site
Well Label: 153560
Start Card: 1075041
Original Report:
Owner Well Nbr:
Company Job Nbr:
Primary Use: IRRIGATION
Complete Date: 09/09/2024
Land Owner
Name: JACK ROZEWICZ
Company:
Address: 3350 BEAGLE RD

WHITE CITY, OR 97503
Location
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Latitude/Longitude
Latitude: 42.52931167
Longitude: -122.87224167
Horiz. Error: 99.00 ft.
Location
County: JACK
TRSQQ: WM35.00S1.00W18SWNW
Tax Map:
Tax Lot: 304
Lot:
Block:
Subdivision:
Street of Well: 3350 BEAGLE RD WHITE CITY OREGON 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: 08/25/2024
Completed Date: 09/09/2024
Drill Method: Cable
Depth of Completed Well: 300.00
Est. Depth Drilled: 300.00
Special Standards:
Seal Placed Method: OTHER - BENTONITE POURED DRY
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)
110.000.0025.00
26.0025.00300.00
Seal
RowMaterialFrom (ft)To (ft)AmountAmount Calc.
1Bentonite Chips0.0025.0016.00 
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 34.00 0.250 - Gauge Steel ● ● 34.00
2Liner4.00 0.00 300.00 Sch 40 PVC Plastic ●  
Temporary Casing
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Perforations
Screens
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Well Test
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Well Test
Temperature: 54 F
Lab Analysis:
Lab Analysis Done By:
Total Dissolved Solids: 430.00 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: 24.00
Post-Static Water Level Date: 09/09/2024
Static Water Level
RowDateFrom(ft)To(ft)SWLEst. Flow RatePSI
18/29/202477.0080.0024.003.0 
29/2/2024200.00205.0024.0012.0 
39/12/2024284.00290.0024.0030.0 
Lithology
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Material
RowFromToMaterialStatic Water Level
10.003.00SOIL {BROWN} 
23.0015.00FLAGSTONE {YELLOW} 
315.0020.00CLAYSTONE {GREEN} 
420.00300.00CLAYSTONE [BLUE} 
Well Constructor
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Bonded Driller Name: E SCOTT COFFMAN
Bonded Driller Company: ROGUE VALLEY DRILLING
Bonded Driller Number: 1705
Bonded Date Signed: 09/10/2024
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
JACK 66307EXEMPT USE MAPDRILLERImage9/10/2024
JACK 66307WELL REPORTDRILLERImage9/10/2024