Report (101) 1S—it-k5 11. 15, —t\, .
STATE OF OREGON gu/���/ 1-5.(c'WELL ID#L
WATER SUPPLY WELL REPORT None
(as required by ORS 537.765) ,. ,.INC. START CARD# W1037958
Instructions for completing this report are on the last page of this form +•
(1)OWNER: Well Number: 01 (9)LOCATION OF WELL by legal description:
Name County WaS on Latitude Longitude
United Excavators,IncJ Polygon b)iogt
Address 4804 NW BethanyBL�cd,Ste L-2_P_�iB 369 Township 2SOlJTJ N or S. Range 1WEST E or W.of WM.
City Portland State OR Zip gunSection 08DC wit__114_�E .- tla
Tax lot 00102 Lot— Block Subdivision _
(2)TYPE OF WORK: Street Address of Well(or nearest address)1574LLSW_150th Ave,-_
.New Well ❑Deepening ❑Alteration(repair/recondition) IX Abandonment Ttg3Cd,OR
(3)DRILL METHOD: (10)STATIC WATER LEVEL:
216 ft.below land surface. Date 212712018
X'Rotary Air El Rotary Mud ❑Cable ❑Auger Artesian pressure lb.per square inch. Date
Other
(11)WATER BEARING ZONES:
(4)PROPOSED USE: Depth at which water was first found ism
),--(i Domestic ❑Community 71 Industrial ❑Irrigation
Thermal ❑Injection ❑Livestock ❑Other r- From To R I
(5)BORE HOLE CONSTRUCTION:
i Q
Special Construction approval 7Yes Xf No Depth of Completed Well 0 fL ! i DEC 1 8 2010 ........
Explosives used Ell yes ;X1 No Type Amount
HOLE SEAL Amount
Diameter From To Material From To I sacks orp ounds (12)WELL LOG: CITY OF TIGARD
_.__6 I Cement Wl5°t° 390 Ground eley i�ILDING DIVISION
i bentonite —_ 4 107 Sacks Material From To SWL
Bentonite 4 0 i 1 Sack iWell Abandonment Only
— _ Calculated----._� s_. L65 Sacks - -- -
Flow was seal placed: Method ❑.A -- _____-- _
i-IB :IC LID LE
x Other Primped at-ktottorn; Poured bentonite __
Backfill placed from ft.to ft. Material —
Gravel placed from ft.to ft Size of gravel SK1�LE�a—IQRl i�i.lrN _$ e._
(6)CASING/LINER:
Diameter From To Gauge. Steel Plastic Welded Threaded ' —
Casing— 6 I 0 401 .250 2 ❑ Lx1
Existng_1 L r—I ❑ —.
n _I --
L ' ❑ ❑ Li —
Drive Shoe used ❑inside ❑Outside ❑Nona
Final location of shoe(s) NI/A
(7)PERFORATIONS/SCREENS:
kPerforations Method Air Perforator__ _
Screens Type Material
Slot Tele/pipe
From To size Number Diameter size Casing Liner
_. 0__ 40 1118x1 550 • iX' ❑
- ; _-.. - Date started 2/27/2018 __- Completed 8(11201 tl
1 -- LII (unbonded)Water Well Constructor Certification:
_ - i I certify that the work I performed on the construction,alteration,or abandon-
ment of this well is in compliance with Oregon water supply well construction
(8)WELL TESTS: Minimum testing time is 1 hour standards.Materials used and information reported above are true to the best of my
Pump Bailer 7Air ❑Flowing Artesian knowledge and belief..
Yield gni/min Drawdown Drill stem at Time Signed WWC Number 1$84
Date 311/208 -
— NIA Sk es Drilling,Inc.
(bonded)Water Well Constructor Certification:
- -- I accept responsibility for the construction, alteration, or abandonment work
performed on this wet 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 done? _;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? Li Too little -•••-, WWC Number 1938
__Salty ;Muddy ❑Odor ❑Colored ❑Other
Signed _ Date 31112U18
Depth of strata:
•Skyles Drilling,Inc.
ORIGINAL-WATER RESOURCES DEPARTMENT FIRST COPY-CONSTRUCTOR SECOND COPY-CUSTOMER
7— emy5.6 RECEIVED
DEC 18 2018
CITY OF TIGARD
BUILDING DIVISION
.., „ 1
RO.BOX 1050
yBOy Il
k! C;r 'ivd, /'r c
I VtiELN
GASTON,OR 97119 _. INVQ C E# 64
503-522-2727 OFFICE /
""` 603-687-2381 FAX DATE .> • 7`• //1?
"" ORIGINATION 6S4i\) TECHNICIAN Su ,1
CUSTOMER Uhh I
(503) lis
�'` � ADDRESS 1 FSI i` S+,J ►_S0""
_`� . t t ; � CITY -'�s�____.. STATE CJ R ZI P R?01'�T_
522-2727 , f 4. BEST PHONE (yam / - 7 641) '
3 � -
CONTACT# ( )_
GCB#202772 i
— --- — —.-- --
DEQ#38783 FAX# I 1 TIME IN re9, '11
PLUMBING#P81466 ❑YES DAYS GUARANTEE '
_ ®NO TIME OUT�,,: ._�/pp,3
DRAIN CLEANING NEED FLAT/ $ AUTHSURV.'HOURLY WORK PERFORMED
ADD.DRAINS "
MAIN Lh1E HOUR i
#1,,, �P 1 < "'II (,7 G? SEPTIC PUMP
KITCHEN,SINK FLAT /
gumr l ■�. ,• s ,,� �, GREASE PUMP 53.°LAUNDRY LINE VIDEO INSPECTION
BATH SINK MEI FLAT 1=11PIPE LOCATE '
BATH TUBMI WATER JETTING
FLAT
VIDEO HOURLY
EXCAVATION
TOILET 111331111.111111111111 PRODUCTS
FLOOR DRAIN FLAT / I PARTS
AREA DRAIN HOURLY f LABOR
RAIN DRAIN HOURLY /uv►a'"' DIAGNOSIS FEE
SEPTIC/GREASE GAL. i � SERVICE CALL
VIDEO MN HOURLY �� ROOF/2ND FLOOR
SECOND MAN
APPROVAL CODE# CHECK# • PLUMBING
PARTS RECOMMENDATIOP '
QTY. ! PART#) DESCRIPTION PRICE ZNZYME TREATMENT VVIDEO INSPECTION
_❑_OOT KILLER D PIPE REPAIR/REPLACEMENT 5%CC FEE
1 L./ANNUAL MAINTENANCE ❑CLEANOUT/INSTALLATION TOTAL 75'77
ISO WATER JETTING ElPAYMENT RECEIVED '101-
BALANCE DUE 5
ADDITIONAL TERMS AND CONDITIONS CONTAINED ON
THE REVERSE SIDE OF THIS SHEET
WEBSITE:WESTSIDEDRAIN.COM XX
EMAIL:WESTSIDEDRAIN@ICLOUD.COM ACCEPTANCE OF E I+' _-.; TERMS AND CON ONS . %' ACKNOWLEDeLIVMT OF COMPLETION
• 4 •
w
.. SITE
Y
4 CITY OF TIGARD BUILDING PERMIT
_. COMMUNITY DEVELOPMENT Permit#: BUP2017-00156
-F(G;ig-Ly. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13!2017
Parcel: 2S108DC01402
Site address: 15745 SW 150TH AVE Jurisdiction: Tigard
Project River Terrace Crossing Subdivision: None
Project Description: Demo(1)2,356 sf dwelling on septic,(1)66 sf accessory structure,(1)593 accessory structure,and(1)850 ll,- Lot: None
accessory structure. UPON FINAL INSPECTION,SDC CREDITS MAY APPLY.
Contractor NORTHWEST EARTHMOVERS INC Owner:
PO BOX 1609
14517 RS,SE REGINE I&GUNARS K
SHERWOOD,OR 97140 14517 SE 178TH PL
RENTON,WA 98058
PHONE: 503-625-3100 PHONE:
FAX: 503-625-3108
Specifics: FEES
Type of Use: SF Description Date
Amount
Class of Work: DEM Type of Const Permit Fee-Additions,Alterations, 07/13/2017 $453.95
Occupancy Grp: Occupancy Load: Demolition
Dwelling Units: 1 Info Process/Archiving-Sm$0.50(up to 07/13/2017 $0.50
11x17)
Stories: Height: ft Erosion Control w/Development
Bedrooms: P 07!13/2017 $80.70
Bathrooms:
Value: $24,900
1.
Floor Areas:
Total Area:
Accessory Structs
Basement
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
.'.' Total $535.15
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State 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 180 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 952-001-00090. You�tmayayobtain a a/copopyy off the rules or direct questions to OUNC by calling 503 232 1987 or 1.800.332.2344.
Issued By: / /—Le JY --"P e?'. Permittee Signature: c:,; •
I--' .,^.�jy//�/ 'q 13
.L7if Call 503.639.4175 b�0 a.m.for the next available inspection date.L-_ / �V l
This permit card shall be kept in a conspicuous place on the job site 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.: Aj {ia?o/7 G /5
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
Building(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
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 final 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 final
Sanitary 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
y
797 Final LIDA inspection 810 MFG-Structure set-up
798 Final erosion control 899 MFG-Structure final
y I:\Building\Forms\Inspection Cards\AOP Insp Card By Case\InspCard_All_031816.doct
•
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1 / // / 1,_ -/ / / • \ \ \ \'T EXISTING 2.356 O STRUCTURE -__-` TO RE REMOVED _
! TREE PROTECTION FENCE \
// / f/ / / // ! 5 TO BE REMOVED. -1t9'
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LEGEND
I I SIDEWALK --Mo— STORM DRAIN LINE ) GUY WIRE Or TELEPHONE RISER /' _
—US WATER LINE 0 SANITARY SEWER MANHOLE 41 DITCH INLET / �"//
(—I PAVEMENT
GRAVEL —
So--• ELECTRIC LINE ® STORM DRAIN MANHOLE Q VERIZON ELECTRICAL BOX
MT
IT---1 BUILDING TELEPHONE LINE V, FIRE HYDRANT OO IRRIGATION CONTROL VALVE
F.,."-:,
WETLANDS —AG GAS LINE v SIGN 0 UTILITY RISER
_ STREAM —O— TREE PROTECTION FENCE 1 WATER METER M GAS VALVE
FENCE 'Q' UTILITY POLE • WATER VALVE i FLOW DIRECTION
Q —X—X— `'
—Lon—OVERHEAD WIRES 0 LIGHT POLE ® CURB INLET X TREE TO BE REMOVED
—_ —_-SANITARY SEWER LINE ID ELECTRICAL RISER ® MAILBOX /
NX55 R mi¢ro•ssw¢ms is mrsam
C+ A/10 .
gs
•rtd = 4
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