Well Information
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Identification
Type of Report: Water Well
Type of Work: ALTERATION
Well Report: JACK 66789 View Log Groundwater Site
Well Label: 153334
Start Card: 1080476
Original Report: JACK 66413 View Original Log
Owner Well Nbr:
Company Job Nbr:
Primary Use: DOMESTIC
Complete Date: 11/12/2025
Land Owner
Name: CODY KIME
Company:
Address: 5501 W GRIFFIN CREEK RD

MEDFORD, OR 97501
Location
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Latitude/Longitude
Latitude: 42.27988000
Longitude: -122.95649000
Horiz. Error: 99.00 ft.
Location
County: JACK
TRSQQ: WM38.00S2.00W8SENE
Tax Map:
Tax Lot: 100
Lot:
Block:
Subdivision:
Street of Well: 5501 W GRIFFIN CREEK RD, MEDFORD, OR 97501
WM District: 13
Surface Elev: 2663.41 FT
Well Report Mapping Tool
Tax Lots

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Well Construction
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Construction
Start Date: 11/12/2025
Completed Date: 11/12/2025
Drill Method: Rotary Air
Depth of Completed Well: 400.00
Est. Depth Drilled: 400.00
Special Standards:
Seal Placed Method: OTHER - NOT DISTURBED
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)
112.000.0018.00
26.0018.00400.00
Seal
RowMaterialFrom (ft)To (ft)AmountAmount Calc.
2Bentonite Chips0.0018.0017.0014.47
Abandonment Log
No data matches search criteria.
Casing/Liner
RowCasing/LinerDiameter (in)Above Land SurfaceFrom DepthTo (ft)GaugeMaterialWeldGlueThreadShoe
Inside		Shoe
Outside		Shoe
Other		Shoe
Location
1(Casing)Pre-Alteration6.00 ● 2.00 18.00 0.250 - Gauge Steel  
2Casing6.00 ● 2.00 18.00 0.250 - Gauge Steel ● ● 18.00
3Liner4.00 0.00 400.00 Sch 40 PVC Plastic ●  
Temporary Casing
No data matches search criteria.
Perforations
RowMethodMaterialCasing/LinerDiameter (in)From (ft)To (ft)Perforation
Size		Screen/Slot
Size Width		Slot LengthNbr of Slots
1LAZER/SAW Liner4.00340.00380.00 0.0321.0006232
2LAZER/SAW Liner4.00380.00400.00 0.1884.00060
Screens
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Well Test
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Well Test
Temperature: 56 F
Lab Analysis:
Lab Analysis Done By:
Total Dissolved Solids: 303.00 ppm
Water Quality Concerns:
Well Test
Analysis
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Static Water Level
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Static Water Level
Depth First Water: 350.00
Pre-Static Water Level: 208.00
Pre-Static Water Level Date: 11/12/2025
Post-Static Water Level: 208.00
Post-Static Water Level Date: 11/12/2025
Static Water Level
RowDateFrom(ft)To(ft)SWLEst. Flow RatePSI
111/12/2025350.00360.00208.001.0 
Lithology
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Material
RowFromToMaterialStatic Water Level
10.00400.00EXISTING BOREHOLE JACK 66413 
20.00400.00SWL 208'/ TDS 303 PPM 
30.00400.00CLEAN & DEVELOP EXISTING BOREHOLE 
40.00400.00INSTALL 4" LINER 
Well Constructor
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Bonded Driller Name: KEVIN GILL
Bonded Driller Company: CLOUSER DRILLING INC
Bonded Driller Number: 1835
Bonded Date Signed: 11/17/2025
Unbonded Name: HOOD,JARED
Unbonded Company: CLOUSER DRILLING INC
Unbonded Number: 2095
Unbonded Date Signed: 11/17/2025
Other Name:
Other Affiliation:
Other License Nbr:
Geologist Engineer:
Comments
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Comments
THIS WELL IS 1 GPM
Documents
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TitleDocument TypeSourceDownload ImageReceived Date
JACK 66789EXEMPT USE MAPDRILLERImage11/18/2025
JACK 66789WELL REPORTDRILLERImage11/18/2025