Report (4) e
t .
STATE OF OFtEGON
WATER SUPPLY WELL REPORT k-.S1,(.--..1 (-2.-A.S..... �-0-S 1 �� c � . WELL ID#L
_NLQn __
(as required by ORS 537.765) SKYLES DRILLING, INC. START CARD# Atip27437
Instructions for completing this report are on the last page of this form 3
(1)OWNER: Well Number: ga _ __ _- (9)LOCATION OF WELL by legal description:
Nana _llctiiedExca(atorS,InrlPo1ygonProJect 2 _
County •.--Washington_ _.Latitude _ _ Longitude .__
Address ,4804,NW Bethany Blvd,ate 1-2 PMB.30 Section p 2SOUTH N or S. Range 1 WEST_ E or W.of /4
City Portland State QR_�91229 �10n 06_ — . SW. t/a _-S v4
(2)TYPE OF WORK: Tax ion wog Lot ._ Block ___ _ subdivision
Street Address of Well(or manlier-address) .13i 9SW Roy Rogers_
New Well _Deepening Alteration(repair/recondiUcn) x Abandonment Rd..Tigard,.OR - .___ ___.__.__ __-.
(3j DRILL METHOD: (10)STATIC WATER LEVEL:
135 ft below land surface. Date 8/3/201.5
_gt Rotary Air Li Rotary Mud _Cable L Auger Artesian pressure Ib.per square Inch. Date
Other
(4)PROPOSED USE: (11)WATER BEARING ZONES:
X Domestic _,Community ❑_industrial Depth at which water was first found NLA_ —
❑Irrigation
Thermal ^Injection Uvestock 0 Other Jen- TO Estimated Flow-Fiat® _.SWC_.
(5)BORE HOLE CONSTRUCTION: — _
Special Construction approval m Yes ;X No Depth of Completed Well g _ft. __
Explosives used ',Yes g No Type Amount
HOLE BEAL Amount
Diameter From To Material From To sacks or pounds (12)WELL LOG:
6_ Bentonite_ _ _ 110.153 Ground elevation
it1._t 46 cks
cementm/5m ____! � __ ._ ._:From ._?o.,_.._SWL
-5 - - -- [Abandonfflertt Only o WASH 11512. ...
.bentonite_ i_ 9_l_ e_ _
Calculated ,. ' 1 S10ke .
How was seal placed: Method _A L,B _iC ❑D DEI SKYLES'DRIL UNG, INC.
X-Other Poslred llen(onitt};Ixurttped cemeniat_53' ( ..� . 5O3 656-2883— -- y
Backfill placed from ft to ft Material
Gravel placed from ft to ft Size of gravel — — —
�_,,j _
VIE
(6)CASING/LINER:
Diameter From To Gauge II Steel Plastic Welded Threaded
Casing:__..._ 6_.tng_. ___Q�15_ ..?.59_i x' ( ( ki
BSis .._._.__. -._..__j ❑_ — ���
Liner one� ... . t \ t''
Drive Shoe used -1Inside Outside `l None
Final location of shoe(s)jJIA,
(7)PERFORATIONS/SCREENS:
X Perforations Method Air Perforator
Screens Type Material -
Slot
From To size Number Diameter Tel
size� Casing Liner
_Q_-_-_3..-j11LXL _SQO___ # 2C.J C .
❑ Date started 813/2015 Completed 813/201.5_____._
❑ (unbonded)Water Well Constructor Certification;
---- - ❑ 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
standards.Materials used and information reported above are true to the test of my
Pump ,_Bailer _Air El Flowing Artesian knowledge and belief.
WWC Number 1884_
Yield gal/min Drawdown Drill stem at Time Signed *('.r.N-e-'-'— Dale 8/111201.5
. _ N/A_ „ _ _. , �' Skyles Drilling,Inc.
(bonded)Water Well Constructor Certification:
__ I accept responsibility for the construction. alteration. or abandonment work
TDS Amount, __L. _145 ppm 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? 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 1.592
Salty Muddy Odor Colored =Other Signed G.�-.`si Date 8111/2015
Depth of strata: Skyles Drilling,Inc.
ORIGINAL-WATER RESOURCES DEPARTMENT FIRST COPY-CONSTRUCTOR SECOND COPY-CUSTOMER
4 6,6'uV,2 0 /5 — 0Q .2 0
STATE OF OREGON
WATER SUPPLY WELL REPORT WELL iD#L None
(as required by ORS 537,765) SKYLES DRILLING, INC. START CARD# wi027461
Instructions(or completing this report are on the last page of this form
583-656-2883
(1)OWNER: Well Number: 02 (9)LOCATION OF WELL by legal description: .
Name_Uy� c tors..lnc/PDlygon.Plojeci#2_ ._ Co my Washington___ _ Latitude Longitude _
Address 480_4 NW Bethany Blvd,lite 1.52 PM1 36.1 Townshipection2SDt1T_l1 N or S. Range _..1 WESmT E or W.of WM.
city _P�rtland state Zip section 05._ _— SW.. _..-- _ 1/4 SE 1/4
OR. P 07229_ Tax lot lot Block Subdivision
(2)TYPE OF WORK: 03000`. _--
Street Address of Well(or nearest address) 1381(9Boy Rogers _
_New Well l_Deepening ,,;Alteration(repair/recondition) ;1(;Abandonment Bd,_Tlgard,.O.B
(3)DRILL METHOD: (10)STATIC WATER LEVEL:
137. ft below land surface. Dale 8/3/20155
X Rotary Air ,Rotary Mud `Cable i_ry Auger Artesian pressurelb.per square Groh. Date
Other —
(4)PROPOSED USE: (11)WATER BEARING ZONES:
Depth at which water was first found N/A
X Domestic Community _i Industrial ;.__I irrigation
Thermal DIn)ection :::;Uvestodc _..
0Other I From, To g_t___ied Flow Ra ee__ _
(5)BORE HOLE CONSTRUCTION: --- — i_-
Speciai Construction approval {_i Yes a No Depth of Completed Well 11 ft.
Explosives Explosives used :Yes rtNo Type Amount
HOLE SEAL Amount
Diameter From To Material From To sacks or pounds (12)WELL LOG:
6 _. en e _i 165. 30 43_Bach__ Ground elevation
—.I Caictt�ani_.__1_ 48,Sacks —— —
! !tem w/5%bend 1 30 4.4.•$egks ►.bah
_ Material From __ SWL
donin 1Y,-- _.
Bentonite_ ___J____ 0 3 da._____ —
— CpIculated_ .8Sacks.,____
Now was seal placed: Method f A _^•B _C OD OE 'SKYLES
-DRILLING, INC: -- - _ --. _ _ - __
X_Other P_oure 1 bentonite;pumped..cement.et.SQ'_ l 3 2 11 _�_._
Backfill placed from �---- ft.to _ ft. Material _—
Gravel placed from IL to ,_ ft. Size of gravel
(6)CASING/LINER: ' j { —
Diameter From To Gauge Steel Plastic Welded Threaded E y ET
).—
Casing-. 6 0 30,_.x.5,19..1 i 1
EX tag--_ — • =; 0 0 Q C 31 2018
-
Liner. ism_ . __._y D CITYYOF flGA610
_
Drive Shoe used _Inside . Outside :None --------
Final location of shoe(s) NIA__. ...__.___..__ ___._._. ..._..____ —
(7)PERFORATIONS/SCREENS: —
DIV1, ..:
• ,Perforations Method Air..P_erforator_
iT Screens Type _ Material —
S
From To size Number Diameter Te size Casing Liner
0 . 301111xt__ 450 _._ .. I --- Ic;
ii
Date started 8/3/201.5 _ _ Completed 8(4/2015_
(unbonded)Water Well Constructor Certification:
I certify that the work I performed on the construction,alteration,or abandon-
(8)WELL TESTS:Minimum testing time is 1 hour abandon-
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 ..1Sailer l Air 0 Flowing Artesian knowledge and belief.
WWC Number 1884_
Yield gal/min Drawdown Drill stem at Time Signed
_.4„„.- 1, Date 8/11/201.5 _
iVIA , L Shies Drilling,Inc.
-- ----- (bonded)Water Well Constructor Certification;
I accept responsibility for the construction, alteration,or abandonment work
TD_S Amount I 13Q ppm.- _ 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? I—Yes By whom construction s dards. This report is true to the best of my knowledge and belief.
Did any strata contain water not suitable for Intended use? [;Too little
:Salty ';Muddy :Odor , Colored ;Other Signed '� WWCN115
Depth of strata: __. _, �. mbe
�.� Dere 8/11/20IB_
S yles Drilling,Inc.
ORIGINAL-WATER RESOURCES DEPARTMENT FIRST COPY-CONSTRUCTOR SECOND COPY-CUSTOMER
RECEIVE .
DEC 311,01
CITY Or -; ,:,
cv
BUILDING ,.
I tiP o /5-00 aa.o
GAS ON,DR 050
19 INVOICE#
503-522-2727 t
503-687-2381 FAX DATE 157
JOB# ,r PA te' __. TECHNICIAN C,V,.r~•j #6,13
(503) . CUSTOMER (‘‘'I/021 f,A.C GO/A -o 5
ADDRESS ._ �W `Pr ti ._
'f CITY _ 1( (k & �'1 STATE ti ZIP_ �l �3
522-272( HOME PHONE« l 1
CCs#202772poli
CONTACT# (f03 ) IN.- 71(4 Qe ._
DLI#WESTSSOB74BC FAX# _ ._.._. _ TIME IN :Ob A
I_J YES DAYS _ _, GUARANTEE NO TIME OUT :qQ
NEEDRAIN SURDV HOURLY $ AUTH. WORK PERFORMED FLAT/ Doa(oRa N NTNG
MAIN LINE HOURLY 3 i • AA �.��e DIAGNOSIS FEE
KITCHEN SINK FLAT JJ N
l � iIITSEPTIC PUMP ilUr _
LAUNDRY LINE FLAT • WATER JETTING
BATH SINK FLAT VIDEO INSPECTION
BATH TUB FLAT LINE LOCATE
SHOWER FLAT ��� EXCAVATION
URINAL FLAT LABOR
TOILET FLAT ROOF/2N0 FLOOR
FLOOR DRAIN FLAT PLUMBING
AREA DRAIN HOURLYPRODUCTS
RAIN DRAIN HOURLY • PARTS
SEPTIC GAL. GREASE PUMP
SECOND MAN
APPROVAL CODE! CHECK**
PARTS RECOMMENDATIONS
OTY. I PART/L_ DESCRIPTION PRICE 0 ENZYME TREATMENT 0 VIDEO INSPECTION
---- I 0 ROOT KILLER 0 PIPE REPAIR/REPLACEMENT TAX
Or-
0 ANNIJAL MAINTENANCE 0 CLEANO UT/INSTALLATION TOTAL 9-
PAYMENT RECEIVED -0-
D WATER JETTING 0 ----»•
BALANCE DUE 4{50
ADDITIONAL TERMS AND CONDITIONS CONTAINED ON s
THE REVERSE SIDE OF THIS SHEET
x 0 �j X 4�t
WWW.WESTSIDEDRAINANDPLUMBING.COM . ACCEPTANCE OF ESTATE AND TERMS AND CONDITIONS ACKNI WLEDGEt(?NT OF COMPLETION
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