Report (94) t 44.
RECEIVEDI -. s , zd .
- .sax 1050 DEC
2 s 2018 INVOICE# 08250
GAPoB OR 97119 .
503-522-2727CITY OF TIGARD
BUILDING DIVISION DATE 4(217
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503-687-2381 FAX
�` JOB#Ct STI' TECHNICIAN_ 6 .#-
CUSTOMER t4\T D WIT
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CITY i Gf4r-t) STATE — ZIP a 2
522-2727 HOME PHONE# ( )
CONTACT'# ( 'G3 ) Cll ff-1-1
CCB#202772 i
DLI#WESTSSD874BC , FAX# ) .. TIME 114�2 r 00 A 1,
El •
YES DAYS GUARANTEE NO TIME OUT �� ; d AM/F 11
DRAIN NEED FLAT/ RUTH WORK PERFORMED DRAIN CLEANING
SURV. HOURLY
ADD,DRAINS •
MAIN LINE HOURLY rusE0 ( ,ir,t SEPG PUMP LJI,Q
KITCHEN SINK FLAT p ss VewMr1me51 cmc-jP,IIC. GREASE PUMP
LAUNDRY LINE FLAT VIDEO INSPECTION
BATH SINK FLAT WATER JETTING ;
BATH TUB FLAT PLUMBING
SHOWER FLAT EXCAVATIONCk)
URINAL FLAT if, PRODUCTS s
TOILET FLAT PARTS
FLOOR DRAIN FLAT LABOR 'S''
+
AREA DRAIN HOURLY DIAGNOSIS FEE l
RAIN DRAIN HOURLY CA 1 COrsiCt2err fiti-t4 LINE LOCATE
SEPTIC GAL. 550—`A ne-re_ .. Mo t 1 ROOF/2ND FLOOR
SECOND MAN
APPROVAL CODE# CHECK#
PARTS RECOMMENDATIONS
' tj
QTY. PART#! DESCRIPTION PRICE ❑ENZYME TREATMENT ❑VIDEO INSPECTION
I ❑ROOT KILLER 0 PIPE REPAIR/REPLACEMENT TAX
❑ANNUAL MAINTENANCE El CLEANOUT/INSTALLATION TOTAL 5"5 —
____ PAYMENT RECEIVED
-- �-- - -❑WATER JETTING ❑ __ BALANCE DUE Q
ADDITIONAL TERMS AND CONDITIONS CONTAINED ON -
THE REVERSE SIDE OF THIS SHEET X 0 K tilj
r, "CERN E ' . j j9
WWW.WESTSIDEDRAINANDPLUMBING.COM ACCEPTANCE OF EST MATE AND TERMS AND CONDITIONS ACKNO LEDGEMENT OF COMPLETION
STATE OF OREGON WELL ID#L _ane
WATER SUPPLY WELL REPORT
(as required by ORS 537.765) SK('XLES DRILLI NG r INC. START CARD# W 1034 Q0
Instructions for completing this report are on the last page of this to ,r , -
(1)OWNER: Well Number: of . (9)LOCATION OF WELL by legal description:
county Washington_. Latitude Longitude
Name United Excavators,inc. _ -_ . _T_T Township 2SOUTH N or S. Range 1 WEST E or W.of WM.
Address 4804.NWBethanyBlvd.Ste.1-2P_MB..151__ _ .
City _ Portland _State OR_Zip 97220— — Sectionl _ 07_ __ SE .._ _B. 1/4 _NE 114
Tax lot 012Q0._ Lot Block _ Subdivision
(2)TYPE OF WORK: Street Address of Well(or nearest address) 14992,SW,Roy,Rogers
New Well .__Deepening LAheretion(repalrfrecondition) !Abandonment Rd.Sltetaetood,S?R
- (10)STATIC WATER LEVEL:
(3)DRILL METHOD: ft.below land surface. Date
_ t60_ _ 5131201.7_
X Rotary Air Rotary Mud Cable DAuger Artesian pressure lb.per square inch. Date
Other
_.__ ___ (11)WATER BEARING ZONES:
(4)PROPOSED USE: Depth at which water was first found NIA _ __..____
).Domestic 0 Community ❑Industrial D irrigation ___
-Thermal ❑Injection 0 Livestock "•Other !acre To - Estim ttagFM,,rN Rale, _.S_WL.
(5)BORE HOLE CONSTRUCTION:
Special Construction approval j.
-.Yes
Yes Gii:No Depth of Completed Well )� ft. ___ . _
Explosives used Cl Yes _ .No Type _ Amount
HOLE SEAL Amount
Diameter From To Material From To i sacks or pounds (12)WELL LOG:
6 _j_.�._ _,„Cement w/5%_ .:„...30.0_1_1 _ __ Ground elevation
!_ . _.1,.._.__1 bentonite 13 50 Sacks
}. Material From - To ,_SWL
! tttQ
. _ ! nite__ ._ ._13I ,
.. _.144..SAKS. _ , bnndpnment Only, ___
_ i Calculated _. ____i__ 52 Sacks Cement Seal-Unable to Perforate
How was seal placed: Method A .B C _D ,"–IE S �G ��
X Other Pumped at bottom;poured bentonite . _ FL ►'►T , _
Backlit!placed from ft.to ft. Material _ __ 503458.2
Gravel placed from ft.to _ fl Size of gravel_ _ y
(6)CA DiiaameterNE From To Gauge ! Steel Plastic Welded Threaded
Casing: S ' 4! 48 ,2501 lc D fic.j 0 -
Existng___:.^ .1
Liner. None__ .. 0 .
Drive Shoe used _Inside .Outside :None
Final location of shoes)�A ____ -
(7)PERFORATIONS/SCREENS:
Perforations Method _ _
Screens Type Material • -- -.
From To SlotizeNumber Diameter Tele/pipe Casing Liner
None _,
___ __ Date started 513121117 _ __.__.- ..Completed 5/4/2017 .__ -..--__
(unbonded)Water Well Constructor Certification:
I certify that the work I performed on the construction,alteration,or abandon-
_ meat 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 —FlowingArtesian knowledge and belief.
WWC Number 1884
Yield gatimin Drawdown Drill stem at Time Signed _ //.. `
rjy pate 514/2017
N/A__
Skyles_Drillinq,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 wen
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 .1592
Salty . Muddy Odor -Colored TOther Signed , ., / � i ""'7 Date 5/4/2017
Depth of strata: -__ Skyles Drilling,Inc.
ORIGINAL-WATER RESOURCES DEPARTMENT FIRST COPY-CONSTRUCTOR SECOND COPY-CUSTOMER