Report (93) RECEIVED ;\�-`t - _.
DEC 2 6 2018 \?, yE, \O � - � .
P.O.BOX 10 CITY OF TIGARD I NVO I C E# o 7 8 2 7 `'
� ;` # �� GASTON,OR 97 97119 -
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. t 503-522-2727 BUILDING DIVISION
r ,." "" 503-687-2381 FAX DATE Z� .
JOB# e C. ;.51-`;Y1` TECHNICIAN 051..1 .# 1 .S
t�` k ... CUSTOMER tivt :4-e Ex r et v '.c-r'.S
(503) --',------, , , , ADDRESS ._>'3._x.1_S_.__.__..w 207 1Dtc► r.rs
522
! CITY i dr STATE L" ZIP 7 2.2/
-2727 . : 1,----,' HOME PHONE# (SO) ) `T/C/- 7166, R r>
., . . CONTACT#
CCB#202772 ...-; FAX#
DU#WESTSSD874BC ) TIME IN I Q_yS- afPM
E YES DAYSGUARANTEE NO01 TIME OUT J( 3 0 M
DRAIN NEED I FLAT/ $ AUTH. DRAIN CLEANING
SURV. OURLY WO E R Ft}R M E D ADD.DRAINS
MAIN LINE IIIIIIII HOURLY SJ SEPTIC PUMP
•..Le - .„ w r / i Tt`C- WW1. �+1
KITCHEN SINK FLAT .-
. .'t GREASE PUMP
. h,
LAUNDRY LINE =I FLAT VIDEO INSPECTION
BATH SINK FLAT WATER JETTING •-)
BATH TUB FLAT PLUMBING
SHOWER FLAT - EXCAVATION N
URINAL I FLAT y PRODUCTS
TOILET 111111 FLAT PARTS I
FLOOR DRAIN NM FLAT LABOR
AREA DRAIN HOURLY DIAGNOSIS FEE
RAIN DRAIN HOURLY
LINE LOCATE
SEPTICtr+ s moo I GAL, S 50" ROOF/2ND FLOOR
A[h 6.(rid rtS 1 L1SECOND MAN N)
J I APPROVAL CODE# CHECK# ("'rttc,k F-c r _ I SO l
PARTS RECOMMENDATIONS
QTY. PART# DESCRIPTION PRICE 0 ENZYME TREATMENT LI VIDEO INSPECTION
0 ROOT KILLER ❑PIPE REPAIR/REPLACEMENT TAX
❑ANNUAL MAINTENANCE EICLEANOUT/INSTALLATION TOTAL 1
— PAYMENT RECEIVED _el--
- - —0 WATER JETTING ❑ BALANCE DUE 1 S O.--
ADDITIONAL
''ADDITIONAL TERMS AND CONDITIONS CONTAINED ON
THE REVERSE SIDE OF THIS SHEETr� yx
B r 1 O VQ!r (3 k 0 v
X 0
WWW.WESTSIDEDRAINANDPLUMBING.COM ACCEPTANCE OF ESTIMATE AND RMS AND CONDITIONS I ACKNOWLEDGEMENT OF COMPLETION
s
STATE OF OREGON WELL ID#L None
WATER SUPPLY WELL REPORT
(as required by ORS 537.765) SKYLES DRILLING, INC. START CARD# W1033225
Instructions for completing this report are on the last page of this form
(1)OWNER: well Number: 01 (9)LOCATION CountyWashington.OFWELLby legal description:
Latitude Longitude
Name
United Excavators,Inc_ Township N or S. Range E or W.of WM.
Address 4504 NW Bethany Blvd,Ste 12 FMB 36.1 2S-OUTH 1 WEST
city Portland .._.._ _State OR Zip 9722 .. section 06DB NW 1/4 SE 1/4 Tax lot 24300 Lot Block Subdivision
(2)TYPE OF WORK: Street Address of Well(or nearest address) 13015 SW Roy Rogers
New Well Deepening Alteration(repair/recondition) )(Abandonment Rd,Beaverton,OR
(10)STATIC WATER LEVEL:
(3)DRILL METHOD: 136_ ft.below land surface. Date 12/14/2016
X Rotary Air _Rotary Mud :_Cable LjAuger Artesian pressure lb.per square Inch. Date
_Other
- — (11)WATER BEARING ZONES:
(4)PROPOSED USE: Depth at which water was first found NIA
X Domestic :Community .-1 industrial Iirrigation
Thermal _Injection __,Livestock Daher From _To Estimated Flow Rate SWL
(5)BORE HOLE CONSTRUCTION:
t
Special Construction approval Yes ,X No Depth of Completed Well 0 ft.
,
Explosives used ..:Yes J(No Type _ Amount _
HOLE SEAL Amount (12)WELL LOG:
Diameter From To Material From To 1 sacks or pounds
5.5 ,Cement w/5% 190. _i_ Ground elevation
_bentonite 16 ti _Sacks Material From To SWL
Bentonite. 16, 0i4Sacks Abandonment Only.
_Calculated .33 Sacks
How was seal placed: Method ,_A _ B . C ^D EE SKYLES DRILLING, INC.
IC Other Eumpe4 at bottom;poured.bentonite_.-..____ __ -603-656-2683
Backfill placed from ft.to ft. Material
Gravel placed from _ ft.to _ ft. Size of gravel
(6)CASING/LINER:From To Gauge Steel Plastic Welded Threaded
Casing: 5_5 0 45. .250 x x
Existng _
Liner: None LT-7 -
Drive Shoe used inside Outside None -
Final location of shoe(s) N fA
(7)PERFORATIONS/SCREENS:
X Perforations Method Air.Perforator.
Screens Type Material
Slot Tele/pipe
From To size Number Diameter size Casing Liner
0 45.1/8x1 650 'x
Date started 12/14/2016 .-- Completed 12/1.9/2016 .,
(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
(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 Air . l Flowing Artesian knowledge and belief.
' WWC Number 1884
Yield gal/min Drawdown Drill stem at Time Signed - ,:, %` :,. ` Date 1/4/2017
N/A _ — --'- _.. ! Skil—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 done? Yes By whom construction stand ds. This report is true to vie best yf my knowledge and belief.
Did any strata contain water not suitable for Intended use? •Too little 7 ..) WWC Number 1592
Salty Muddy --Odor -Colored Other Signed e ';t t..: ( Date 1/4/2017
Depth of strata: Skies Drilling,Inc.'
ORIGINAL-WATER RESOURCES DEPARTMENT FIRST COPY-CONSTRUCTOR SECOND COPY-CUSTOMER
r
ft
STATE OF OREGON WELL ID#L None . .
WATER SUPPLY WELL REPORT
(as required by ORS 537.765) SKYLESDRI * INC. START CARD# W1.03322..6
Instructions for completing this report are on the last page of this form ,y
___ ------ ___. .._ _.__ _____ www
(1)OWNER: Well Number: 02 (9)LOCATION OF WELL by legal description:
Name United Excavators,Inc County Washington Latitude Longitude
Township 2S.DUTH N or S. Range 1 WEST E or W.of WM.
Address 4804 NW Bethany Blvd,Ste 1-2.P_MB_361 ____ section 06DB NW 1/4 SE_ 1J4
City _Portland_ ___ _ . State OR. Zip 97229- _ Tax lot 24000 Lot Block Subdivision
(2)TYPE OF WORK: Street Address of Well(or nearest address) Nearest 13015 SW Roy
New Well Deepening Alteration(repair/recondition) )(Abandonment Rogers Rd,Beano ton,OR
DRILL METHOD: 10 STATIC WATER LEVEL:
(3) 138 ft.below land surface. Date 12/22/2016
X Rotary Air 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 N/A
X Domestic Community Industrial LInigation
Thermal _Injection Livestock LOther From To Estimated Flow Rate _.SWL
(5)BORE HOLE CONSTRUCTION:
Special Construction approval ; Yes .X No Depth of Completed Well 0 ft.
Explosives used Yes t(No Type _ __ Amount _
HOLE SEAL Amount
Diameter From To Material From To sacks or pounds (12)WELL LOG:
.
6 _cement w15Yr _294 Ground elevation
I
_t bentonite 1. 47 Sacks . Material From To SM..
t BQntonite_ 1., 0 t 1 Sack Abandonment Only.
Calculated '.31 Sacks
How was seal placed: Method A 8 . C D ,.. E $KYLES DAH NG, INC.
X Other Pumped at bottom;poured bentonite '5034110441113
Backfill placed from ft.to ft. Material
Gravel placed fromft.to _ _ ft. Size of gravel
(6)CASING/LINER:
Diameter From To Gauge Steel Plastic Welded Threaded
Casing: _ 6 0 30 .250 'x; x_ ]
) Xistng f 7
Liner: None
Drive Shoe used Inside Outside None
Final location of shoes) .N/A__
(7)PERFORATIONS/SCREENS:
X Perforations Method Air Perforator. .
Screens Type Material
Slot Tele/pipe
From To size Number Diameter size Casing Liner
0 30 118x1 . 350 x
Date started 12122/2Q16._._ Completed 12/23/2016 .
. _ (unbonded)Water Well Constructor Certification:
I certify that the work I performed on the construction,alteration,or abandon-
_a._____ 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 Air :Flowing Artesian knowledge and belief.
WWC Number 1884
Yield gal/min Drawdown Drill stem at Time Signed -a+'.0 Date 1/4/2017
N/A .Skyles 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 done? 'Yes By whom _ construction standards. This report is true to the r, st of my knowledge and belief.
Did any strata contain water not suitable for Intended–use? Too little ((,^} '/ WWC Number 1592
Sally Muddy Odor Colored Other Signed Date 1/4/2017
Depth of strata: S yies Drilling, 1 Inc.
ORIGINAL-WATER RESOURCES DEPARTMENT FIRST COPY-CONSTRUCTOR SECOND COPY-CUSTOMER