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Report (96) RECEIVED er,2O/7-00:7)/D DEC 18 2018 STATE OF OREGON 1 ��j� a SU`) �$ ' CITY F 71GAR[ LL ID#L 6814_6_._......_____ WATER SUPPLY WELL REPORT J – las required byORS 537.765) SKY. LES 1t I )IVISIC t4RTCARD#y►v9Q37J9Q 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: County Washington_______.Latitude Longitude_ Name United Excavators,Inc --_' Township mum N or S. Range 1 WEST E or W.of WM. Address 4.804 NW Bethany B v 1,..Ste_1.2.PME Section 07 _NE 114 BE .. M 1/4 City Portland State OR-Zip.9.7229 Tax lot 01400 Lot Block Subdivision —-- (2)TYPE OF WORK: Street Address of Well(or nearest address) 1.5252.SW Roy Rogers ____ `New Well ❑Deepening ❑Alteration(repair/recondition) t1(Abandonment Rd.She►wco‘OR (3)DRILL METHOD (10)STATIC WATEReLEVEL: Date 200 1/30/2018 XRotary Air ii Rotary Mud ❑Cable ❑Auger Artesian pressure b.per square inch. Date - Other (11)WATER BEARING ZONES: (4)PROPOSED USE: Depth at which water was first found MIA_. X Domestic ,_;Community ',.._;Industrial ❑Irrigation __ __ _ Thermal Li Injection EI Livestock ;_I OtherII From To._� _Estimated Flaw Rate SWL _ i (5)BORE HOLE CONSTRUCTION: —� - Special Construction approval Eves ®No Depth of Completed Well 0 ft. Explosives used Lyes X No Type Amount HOLE SEAL Amount Diameter From ToMaterial From To sacks or pounds (12)WELL LOG: 6 _,._I_JQ inont w/5% 1 2631._ Ground elevation _ i ;bentonite I I 10 38_Sacks Bentonite Material 1 From To _ SWL Bentonite 10! u 3 Sachs INo PPerfgrati9na`POOtent.Seal� - -- Abandonment Only. I Calculated 37 Sacks How was seal placed: Method DA ❑B CC OD ❑E X Other Ettmped.,at bottom;..Bour_ed.bentonite. Backfill placed from ft.to ft Material Gravel placed from ft.to ft. Size of gravel_ (6)CASING/LINER: L SKYL LS.DRILLi G, INC.Diameter From To Gauge .Steel Plastic Welded Threaded i Casing: 6 I 0 1 58{ .2$O x' El �X' 0 ` Existng 1 I J + C] L i 0 i I l l ❑ J 0 1 - -- Liner: Removed t --1---- �Li 71 , 1 Drive Shoe used Inside ❑Outsidel None --—_- Final location of shoats) N/A _ _..__.__.____ - __ (7)PERFORATIONS/SCREENS: --- Perforations Method .. __ Screens Type Material Slot Tele/pipe _ From To size Number Diameter size Casing Liner None_ _ ❑ 0 — I 1 1 I n 0 Date started 1/31)12118 Completed 2/112018 _ . fl n (unbonded)Water Well Constructor Certification: G L! 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.Material. rid and Information reported above are true to the best of my Pump ❑BaiterC Air ❑Flowing Artesian knowledge a - WWC Number 2003 Yield gal/min Drawdown Drill stem at Time Signed Date 2/1/20.18___ NCA,_,_ 'des Drilling,Inc, .__ __ _. (b•)Water Well Constructor Certification: I .rrr, :pt 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 done? Li 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 ,..--'1,72 , WWC Number 1998 _.Salty —II Muddy '.Odor El Colored Li Other Sign' c.„_...— __ _._Date 21112018_. _ Depth of strata: Skyles Drilling,Inc. ORIGINAL-WATER RESOURCES DEPARTMENT FIRST COPY-CONSTRUCTOR SECOND COPY-CUSTOMER 1 , o. BOX gas e�ED/ "s�, ur�Qiv �G ,µ �, k,..t.1 GASTt1N,OR g suite. t/ - Forflewa tt' s 20� 7 3 503-522-2727 OFFICE 1 O( 4 7 a� ,r 5a3-$872381 FU., �Fl1GNR�lir � DATE /�'..��f' f,�"'�' C'U"- (503) Vt INATION k)( 5�'` 9 TECHNICIAN ,- � Via✓ #CUSTOMER tiN Xectvc .�... h ADDRESS /S.r� Sw ,F�a 522-2727 ��' CITY 7 a.+r STATE 0 .. ZIP l7� :.� ,�"" " ,..., \ BEST PHONE# ` 1'_ '_S�e .—7S�? ,F ,) W / oNTAcT# _..._CCB#202772 v ; �,�.. ( ) DEQ#38783FAX# / A. TIME IN _�! PLUMBING# PB1 466 El YES DAYS GUARANTEE ® NO TIME OUT xdo Afts } DRAIN NEED FLAT! AUTH. DRAIN CLEANING WORK PERFORMED SURV. HOURLY ADD.DRAINS MAIN LINE HOURLY Pfryl !? u" ' ` ` 1ri'; -POI- .-.1- .i-o SEPTIC PUMP r4/162KITCHEN SINK FLAT be d(C©rti►,,�.S5;�A • /;OCP Cocci GREASE PUMP tj LAUNDRY LINE FLAT VIDEO INSPECTION NBATH SINK FLAT PIPE LOCATE BATH TUB FLAT WATER JETTING VIDEO HOURLY EXCAVATION ` TOILET FLAT PRODUCTS FLOOR DRAIN FLAT ' PARTS AREA DRAIN HOURLY /7,---- _ LABOR onRAIN DRAIN HOURLY `n,��,476 t �' DIAGNOSIS FEE SEPTIC/GREASE GAL. tie? SERVICE CALL WZVIDEO HOURLY µ ROOF/2ND FLOOR SECOND MAN APPROVAL CODE# p CHECK# =. PLUMBING PARTS RECOMMENDATIONS QTY. 1 PART#1 DESCRIPTION PRICE 0 ENZYME TREATMENT 0 VIDEO INSPECTION 0 ROOT KILLER 0 PIPE REPAIR/REPLACEMENT 5%GC FEE ❑ANNUAL MAINTENANCE ❑CLEANOUT/INSTALLATION TOTAL IMO PAYMENT.RECEIVED ,Q•- ❑WATER JETTING I BALANCE DUE 41 Yd ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS SHEET •L.-„,.....,s. '' WEBSITE:WESTSIDEDRAIN.COM •. '".-..... 00 Ara` EMAIL WESTSIDEDRAIN ICLOUD.COM {CGEPTANGE OF ESTIMATE AND lD CONDITIONS ACKNOWLEDGEME 3 't•.MPLETION • t amu. CITY OF TIGARD SITE COPY BUILDING PERMIT 1r1-111 `° * COMMUNITY DEVELOPMENT m Permit#: BUP2017-00310 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 a Date Issued: 12/28/2017 1. Parcel: 2S1070001400 Jurisdiction: Tigard # Site address: 15252 SW ROY ROGERS RD ' Project: Polygon at River Terrace Edge 1711-111 7_ * 9 Subdivision: None Lot: None Project Description: Demolition of 4,205 sf residence on septic. UPON FINAL INSPECTION,DEMO CREDITS FOR SDC FEES MAY t i APPLY. r wP Contractor: NORTHWEST EARTHMOVERS INC t c Owner: POLYGON WLH LLC F 4 4 PO BOX 1609 109E 13TH ST STE 200 ir 144:7'. SHERWOOD,OR 97140 VANCOUVER,WA 98660 r t� 1 PHONE: 503-625-3100 PHONE: t' ':` FAX: 503-625-3108 i Specifics: FEES Description Date Amount a � Type of Use: SF ' ;? Class of Work: DEM TypePermit Fee-Additions,Alterations, 12/28/2017 $475.99 t a` of Const: Demolition a. Occupancy Grp: Occupancy Load: Info Process/Archiving-Sm$0.50(up to 12/28/2017 $2 00 11 Dwelling Units: 0 11x17) 11.144111 Stories: 0 Height: 0 ft Erosion Control w/Development 12/28/2017 $107.60 - Bedrooms: 0 Bathrooms: 0 - Value: $26,750 z ht111'1 7. Floor Areas: Total Area: 0 k" Accessory Struct: 0 14 : Basement: 0 r ', ", Carport: 0 S' Covered Porch: 0 -t-':'1' Deck: 0 Via,* ., Garage: 0 5, 5Mezzanine: 0 € '` Total $585.59 i b Required: Required Items and Reports(Conditions) t*., ! Fire Sprinkler: Parapet k i.. ,, Fire Alarm: Protected Corridors: .4:15.:,,,,,,,' ,-*"-Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 , 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 F days. ATTENTION: Oregon law requires 9 q you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952.001.0010 through OAR 952-001-0090_You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 800.332 234.4. z Issued By: ' �. / Permittee Signature: * �' Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 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 fol it No.: GI/" (/ 7— ! - �rm % IVR Code Type Permit Description IVR Code Type Permit Description 01 BLIP 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 Inspection Description J Req'd Code I 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 J� 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 • 797 Final LIDA inspection 810 MFG-Structure set-up r 798 Final erosion control 899 MFG-Structure final 1:\Bulding\Forms\Inspection Cards\AOP trap Card By Case\InspCard_A11_.131316.doca- i • • • �� � ' Ai \ \'.i ' '1 '\ I ';; \\ __-.... �'✓ > / / ; I ,( ,-ri , .�-�•= -fit f1\ . \\ - - xaw.Nx ,,:‘,:.‘,\,, \'' ;.`: `` �' / % / ; / % / i '� - - NOV297017 \ \\ '''\ - /.., '* o I /I ;r / \ :�,, _:„ ('ITS QFTtGr1R4 -� 'A ` A i,,I / ' 7 r 1 ' ' 1 1 / l ' / / /,‘',,}; ,\ ...11,7,..T.:',::,:....:‘,.:;„,:-1‘ \v-'+tr i 77T�/)(�y(�y w..n.TmmTMme emAce 1 ,',,,,,,,,,,,c.-.,.;,\\\ / _ i--------- -- ;' ,/4 4 / '/ / 1' ,r �' ' / Tom\ `,\, e�� -a - 1.11LDING mYisfor4 = — "rn. 41111" I\\ \ ' \`,„,,,,,t. - / ,---- , / 'i/ / / i ! r, / i, / / \\ \. \ ar i/5..2SoZ ,;,✓'^ts. .-.�>_ PANY `�I 1 - - n urun roN \Lr x-�x 1 X x-,-4,-,-,', \' , r / r/,' / ' 1 / ,' ' ,i / \'� \'\ \'-,'-- ----..-- m --.. _..�lOy./20fif7'_�/'�' ff i v,S \i -,10,\,,,\,',Q.,.. l I AII wI v ,, 1 f I , r ,, / ,l " ' .� ! , r , / ;F ,. v v a '"'"•°" POLYGONNW�OMONI 4� \V v0wvi�1ld, 1 IIv v�-v �• �\ y I t i 1 1 / !i f 1 \ \ q .wq� ,gV,y,p1.YCONHOM6iCOp1 +. 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Point Table Point Table Point Table R ( V\ \\\\ Pohl i 04ear411an Point I 044.681109 Pohl/ 0eecr4PRan d \\ Treelnvento { `\1 71144 DTR 8 nue 011130 71180 ETR 48 Inventory \\ TAX LO11, 71113 DTR 14 )1145 OTR 20 71 107 ETR 40 \\ 71142 912 2603 71185 ETR 50 71186 015 14 I \\ OTR 14 1 ( �- %\ 1 ]11{1 DTX 24 71164 ETR 10 )1165 0m u \` ]1110 DiR 14 71163 ETR 10 )1164 I 1 71139 DMR 10 71182 015 18X] 71181 0111 u 1 I �� 71138 810 10 71181 E188 74 71182 E15 48 1 1 71137 018 10 71188 DTR 20 71161 01R 20 @ ( I 1 71138 CIR 14 ]119 [TR 24 71180 D 20 `I ( '1., ��,. )11]9 DlR 1023 ]TIM ETR 24 )1159 ETR 10 SS 1( .py �'�± G 71134 DTR 12 ]IA] ETR 46 71154 OTR 20 IJ kryb' 71133 DIR 26 ]11]6 8111 15 ]119] DiR 20 1 I / / 70679 818 30 71173 810 16 1195 DIR 2482 II d 70299 011115 71174 EN?80 71155 DTX 24 e 1 I M ��' ]0298 DTII TI CROUP 711]] DTR 18 )116{ ETP 15 0ROE CT 0. 449.48 14 1 1 �n�.<f° rl. ]029] 818 38 ]11]2 DTR 20 7116] ElR 18 SCALE ]1149 DTX ZD 711]1 OIR 18 )I/9P DTR 14 4� 1 I I ]1116 DTR ZO >It>0 DTR i{ 71151 01R 12 11NC4.40 FEET { 1 1 71u] 017888203 71109 DTR 14 71150 01R f0 `1 11 i — ..ist• „:,,,,,,.,,,,,.•;,'4..,,>:',,,,,,:i.. t> F I ® L6fiENDo[cwwui Willi I,. 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Pwr°sEDroBouwi FENCES SHALL xmPLACE PRIOR roeTceAlnrcc°NsrAurTwxl .TRACT ll jn� q ROOT TOM.SEE TUTilFi'e FENCE PULL IDEAUT SE 1.04TrO ATT.WADI POILNETER Of THE Community Tsuc ,.•°T �+ MAN ND Design • I � P r .. _i '�� tt) r R7 50}941.9184 IFj S0}94I-9d85 • __ 1 N A. 11.E 4 ART ......... _ ] ' alma REVIEWED BY: Par `£a lx tl ,AA S_ am � TYPE. PLANNING b M 'rpNNTUB MORCIIDITdBX10 ma par 7c. '0...R.... NA DETAIL mr SHEET TIP. TO BE PROTECTED rMINDMAMR SECURED T01.102.STEEL OR AIORINIAI POSTS 1O TREE PROTEE DETAIL 12. 1 DIFF) `1 ! LEGEND ... __,..---. ,: coma= ) EEm --aco omsrwm¢roamsw[n Lj OM F3TFZII`I, try, i ' - ® O WON TG1X6TOKKTM O tom ru9i•1y, a ,.__ WON[MxTMisxm`°}["` [�U1v 1e.'UE ¢ �' rgR oPE IlL�Yit�'��Su➢ MOOS_ ; � ijil ��- ---7,,,,, —YT�mm ixAciV (Y}; xuiucEwl. F ilir(I rt -rata RAEtIrbc„ to ii 41714¢ ...:"'�� COMM xEssAxm DOM 1 AIIK" �+r�' C.,. ,,,p,,'m t t ...:Alga-n..... OEN Iti 1 - .:-..-e."--,�'�M �� .,.' 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