Report (95) 5 Sw 1 So--M
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STATE OF OREGON —
WATER SUPPLY WELL REPORT � WELL ID#L None _
(as required by ORS 537.765) S ES LUNG- 04 w START CARD# W103 958
Instructions for completing this report are on the last page of this form iota
$6,.1 OWNER: Well Number
01 (9)LOCATION OF WELL by legal description:
Name United Excavators,Inc!Polygon County Waslt)Dgton Latitude Longitude
Address 4804 NW Bethany MIA.Ste 1-2 PMB 361 Township 2SOu�N or S. Range ��y r E or W.of WM.
Section
City Portland. State OR Zip 97228 (HocSYfL 1/4_�E_--- 1/4Tax lot 001.02 Lot Block Subdivision __
(2)TYPE OF WORK: Street Address of Well(or nearest address)_157455SW 1501hAxe, ___
.New Well [I Deepening [: on
Alteration(repair/recdition) [Aban �donment rd,OR
(3)DRILL METHOD: (10)STATIC WATER LEVEL:
216 ft.below land surface. Date 212712018_,.
X Rotary Air ❑Rotary Mud ❑Cable Fr Auger Artesian pressure lb.per square inch. Date
Other
(11)WATER BEARING ZONES:
(4)PROPOSED USE:
X!Domestic Depth at which water was first found I11A
❑Community ❑Industrial ❑Irrigation
Thermal ❑Injection ❑Livestock ❑Other From To Estimated Flow Rate SWL
(5)BORE HOLE CONSTRUCTION:
Special Construction approval ❑Yes Xf No Depth of Completed Well 0 ft. ! I ---
Explosives used fives ❑X No Type Amount
HOLE SEAL Amount —_._
Diameter From To ' Material From To 1 sacks or pounds (12)WELL LOG:
Ground elevation
_._ 6 Cement w/5% 390
l bentonite 4 107 Sacks
Material +Vle.. M L...T ,lr
Bentonite 4 I d 11 Sack ®
-- {Well A4andpntgen_t Only
.. . .... ...., _
Calculated____-•- L6 �acks_ __.
__. DELIA Zt�18__
was seal placed: Method ❑A J8 EC OD
❑E �L____________—
How
X other pumped atbattolst:Poured bentQnite CITY OF 1 IG` ARD
Backfill placed from ft.to ft. Material r BU�L��NV1 DIVISION
(5�0�
Gravel placed from ft to ft Size of gravel ���y�y�r(,��yy�� ■yp■.{�p�yyi
»r�IR� i*1w
(6)CASING/LINER:
--------
Diameter From To Gauge. Steel Plastic Welded Threaded
Casing:_ 6 ! 0 40 i .250 [] ❑ 12 g
Exisig.H ❑ n 0 --
1 ri n u
n , _
Liner. Removed ElI❑ D ;.�________-...—
i IT ❑ El --
Drive Shoe used ID Inside L1 Outside ❑None
Final location of shoe(s) N/A
(7)PERFORATIONS/SCREENS:
,Perforations Method Air Perforator
--
Screens Type Material
Slot Tele/pipe
From To size Number Diameter size Casing Liner
.._oma 401118x1 550 t)(
I i'l i Date started 2/2712018 Completed 3/11201$
(unbonded)Water Well Constructor Certification:
- -
Pi I certify that the work I performed on the construction,alteration,or abandon-
(8)WELL TESTS: Minimum testing time is 1 hour ment of this well is in compliance with Oregon water supply well construction
standards.Materials used and information reported above are true to the best of my
Pump J Bailer i Air _j Flowing Artesian knowledge and belief..
WWC Number 1$84
Yield gal/min Drawdown Drill stem at Time Signed Date 31112018
N/A S es Drilling,Inc.
(bonded)Water Well Constructor Certification:
— I accept responsibility for the construction, alteration, or abandonment work
performed on this well during the construction dates reported above. All work
Temperature of Water Depth Artesian Flow found performed during this time is in compliance with Oregon water supply well
Was a water analysis dons? ;_;Yes By whom construction standards. This report is true to the best of my knowledge and belief.
Did any strata contain water not suitable for intended use? ❑Too little ..--- WWC Number 1998
_Salty `;Muddy ❑Odor [❑Colored ❑Other Signed , Date 3/1/2018
Depth of strata: Skyies Drilling,inc.
ORIGINAL-WATER RESOURCES DEPARTMENT FIRST COPY-CONSTRUCTOR SECOND COPY-CUSTOMER
•
ENED
V
c� cF•-s N
Ro.BOX,oSD ysoy N c:.,' /"d' INVOICE# 09 64
6ASTON,OR 07119 S , (` ,
47
.i 4/ --(,
. 503-522 2727 OFFICE i �t�
` 503-587-2381• FAX DATE _i/
_` LORIGINATION 1.114,35 TECHNICIAN �v ( # I(e�
1-14. t•-xc
(503) ADDRESS CUSTOMER 5:-)Cif S+j t S-D fr".
CITY `'rd STATE OP ZIP ?*12S
522-2727 t c BEST PHON # (5e ) CM/ - 7/G(P -
CONTACT# I )
CCB#202772
DEQ#38783 ' FAX# { I TIME IN ``td F1
PLUMBING#PB1466 O YES DAYS GUARANTEE ®NO TIME OUT .'/ b/PM
NEED FLAT/
DRAIN SURD HOURLY $ AUTH. WORK PERFORM
FO f I IYi MED DRAIN CLEANING
ADD.DRAINS •
MAIN LINE HOURLY a.�,7"//. d _.�lr t ,«s • 0 SEPTIC PUMP 0
KITCHEEKSINK FLAT I� r'7yj MITIa�i„ • „, , . 41GREASE PUMP
LAUNDRY LINE FLAT VIDEO INSPECTION
BATH SINK FLAT j PIPE LOCATE
BATH TUB FLAT WATER JETTING
VIDEO HOURLY EXCAVATION
TOILET FLAT PRODUCTS
FLOOR DRAIN FLAT "'" PARTS
AREA DRAIN HOURLY LABOR
RAIN DRAIN HOURLY j4"E G""
1 _.''^. DIAGNOSIS FEE
1 ---
SEPTIC/GREASE GAL. SERVICE CALL
VIDEO HOURLY ROOF/2ND FLOOR
SECOND MAN
APPROVAL CODE# rCHECK# iPLUMBING
PARTS /F RECOMMENDATION '
QTY. PART#I DESCRIPTION PRICE � dEIVZYMETREATMENT {'VIDEO INSPECTION
_ T KILLER _ 0 PIPE REPAIR/REPLACEMENT 5%CCFEE
ANNUAL MAINTENANCE ❑CLEANOUT/INSTALLATION TOTAL 5-S°
/
1PAYMENT
RECEIVED -,er
-- --- --- firWATER-JETTING BALANCE DUE
SSD T
ADDITIONAL TERMS AND CONDITIONS CONTAINED ON
THE REVERSE SIDE OF THIS SHEET _ __-
WEBSITE:WESTSIDEDRAIN COM x f .. y""�
EMAIL:WESTSIDEDRAIN@IGLOUO.COM ACCEPTANCE OF ETMh '-'!"!c TERMS AND CON, IONS ACKNOWLEDQ@RIENT OFCOMPLETION
rt CITY OF TIGARD SITE COPY BUILDING PERMIT
= COMMUNITY DEVELOPMENT Permit a: BUP2017-00304
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12!06/2017
Parcel: 251080800200
Jurisdiction: Tigard
Site address: 15475 SW 150TH AVE
Project: River Terrace Crossing Subdivision: None Lot: None
Project Description: Demolition of 4,238 sf residence and 1,368 sf accessory structure on septic.UPON FINAL INSPECTION,DEMO
CREDITS FOR SDC FEES MAY APPLY.
Contractor: NORTHWEST EARTHMOVERS INC Owner: KADEL,ROGER A TRUST
PO BOX 1609 KADEL,JANET S TRUST
SHERWOOD,OR 97140 15475 SW 150TH AVE
TIGARD,OR 97224
PHONE: 503-625-3100 PHONE: ,
FAX:503-625-3108
Specifics: FEES
Description Date Amount
Type of Use: SEM
Class of Work: DEM Type of Const: Permil Fee-Additions,Alterations, 12/0612017 5531.09
Occupancy Grp: Occupancy Load: Demolition
Info Process/Archiving-Sm$0.50(up to 12106!2017 $0.50
Dwelling Units: 0 11x17)
Stories: 0 Height: 0 ft Erosion Control w/Developmenl 12/06/2017 $107.60
Bedrooms: 0 Bathrooms: 0
Value: $31,620
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $639.19
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet: 1 Ersn Cntr1503-639-0175
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit Is Issued subject to the regulations contained in the Tigard Municipal Code,Slate of OR.Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans.This permit will expire if work is not started within /80 days of issuance,or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth In OAR
952.001-0010 through OAR 052-001-0000.You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:`^l�J��/[/L„y.�,.�yo _ Permittee Signature: ON 4 0,o7 / 'C/}-T7 C7"/"/
Call 503.639.4175 by 7:00 a.m.for the next available inspection dale.
This permit card shall be kept in a conspicuous piece on the job nit.until completion of the project
Approved plans are required on the job site at the time of each Inspection.
Inspections Required for I nit No.: 4.7/./ ?CI// O 3 `/
IVR Code Type Permit Description IVR Code Type. Permit Description
01 BUP Building—structural 07 SIT Site Work
02 ELC Electrical 08 SWR Sewer Connection
03 ELR Restricted Energy 09 FPS Fire Protection
04 MEC Mechanical 10 RER Re-Roof
05 MST Master—residential combination 11 CMS Commercial Manufact.Structure
06 PLM Plumbing 12 SFM Single-Family Manufact Structure
J Req'd Code I Inspection Description J Req'd Code Inspection Description
Buildin (structural)Inspections Electrical Inspections
205 Footing 105 Underground/slab cover
210 Foundation walls 110 Temporary electrical service
215 Footing drain 115 Electrical service
220 Slab 120 Electrical rough-in
225 Post/beam structural 125 Wall.cover
230 Underfloor insulation 130 Ceiling cover
240 Exterior shearwall 135 Low voltage rough-in
242 Interior shearwall 140 Sign installation
245 Firewall 145 A/C or heating unit circuit
250 Roof nailing 150 Hot tub/spa/pool
255 Wtr proofing basement walls 195 Misc.inspection
260 Tilt-up panel 198 Low voltage final
265 Masonry 199 Electrical final
270 Reinforcing steel(rebar) '..
275 Framing Mechanical Inspections
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling ,615 Mechanical rough-in
289 Approach/sidewalk 620 Hydronic piping
295 Misc.inspection 625 Duct work
, 299 Final inspection 630 Fire damper
K.,
635 Smoke detector shutdown
Fire Protection System Inspections ,640 Exhaust hood
901 Sprinkler supply lines 645 Grease duct test
905 Sprinkler underfloor/slab 695 Misc.inspection
906 Flush test 699 Mechanical final
907 Sprinkler hydro test
910 Sprinkler rough-in/test Plumbing Inspections
915 Fire alarm rough-in 305 Plumbing underslab
920 Suppression trip test 310 Crawl drain
995 Misc.inspection 312 Backwater valve
998 Alarm fmal 315 Post/beam plumbing
999 Sprinkler final 320 Plumbing rough-in
322 Shower pan
Site Work Inspections 330 Water service
405 Excavation. 335 Rain drain
410 Fill 340 Storm sewer
415 Grading '.345 Culvert/catch basin
495 Misc Inspection 350 Septic tank
499 Final Inspection 395 Misc.inspection
399 Plumbing fmal
Sanita Sewer Inspections
505 Sanitary sewer
Erosion Control Inspections 585 Misc.inspection
}" 750 Initial erosion control 599 Final inspection
752 LIDA on-site facility inspection
755 Regular erosion control Manufactured Structure Inspections
797 Final LIDA inspection 810 MFG-Structure set-up
}� 798 Final erosion control 899 MFG-Structure final
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LEGEND —
CITY Y CF TIGARD
fIOWIS NAM LINT
S GUY WIRE
® Ly Planning
r-: -wry WATERLINE ® UNITARY SEWER NANXOLE ® TELEPHONE BSER
Approver!
l__] PAVEMENT
�J GRAVEL
�xE— ELECTRIC NE Ta STORM DAIN...OLE Q NEWTON¢ECTRICAL EAI( Date: it/P1/0 {.�tl l
! TELEPHONE LINE
2; Fla N um' Q IRK-441 AI CMFROLVALVE 6)YNPE
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OVERHEAD WIRES
_ SANITARY SEWER UNE E ELECTRICAL NEER ® MNLBO% River Terrace
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Construction Documents
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