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STATE OF OREGON R. S t a d e l i & Sons WELL LD.LABEL#L WATER SUPPLY WELL REPORT Well & Pump, Inc. START CARD# 217014 (as required by ORS 537.765&OAR 690-205-0210) 4 3 8-5 J t ad @ l! I.a n$ N E ORIGINAL LOG# MA1Uox I 9299 (1)LAND OWNER Owner Well ID. First Name Alex Last Name Snegirev Silverton, OR �73 9)LOCATION OF WELL(legal description) Company County MARION Twp 6 S N/S Range 1 E E/W WM Address 6747 Tessa Lane Silverton State OR Zip 97381 Sec 29 NW 1/4 of the NW 1/4 Tax Lot 2201 City Tax Map Number Lot (2)TYPE OF WORK New Well (Deepening n Conversion Lat "or DMS or DD Alteration(complete 2a&10) IXf Abandonment(complete 5a) ° "or DMS or DD (2a)PRE-ALTERATION Long Dia + From To Gauge St Piste Wld Thrd (16' Street address of well (1 Nearest address Casing: 6 1 0 51 .250 (•) (1 1: Material From To Amt sacks/lbs 6747 Tessa Lane,Silverton,OR 97381 Seal:! I I 1 (3)DRILL METHOD (10)STATIC WATER LEVEL i Rotary Air n Rotary Mud C Cable ❑Auger ( Date SWL(psi)Mud (ps) + SWL ft Reverse Rotary C Other p Hoist Existing Well/Pie-Alteration 12-15-2020 37 Completed Well 12-15-2020 MI 20 (4)PROPOSED USE C Domestic HIrrigation Community Flowing Artesian?n Dry Hole? I Industrial/Commericial n Livestock fDewatering WATER BEARING ZONES Depth water was first found LIThermal nlnjection U Other Abandonment SWL Date From To Est Flow SWL(psi) + SWL(ft) (5)BORE HOLE CONSTRUCTION Special Standard! (Attach copy) Depth of Completed Well 0 ft. ' BORE HOLE SEAL sacks/ 1 Dia From To Material From To Amt lbs f Cement 0 146 49 S • 1 Calculated 27 Calculated (11)WELL LOG Ground Elevation How was seal placed: Method nA ❑B nC ED LiE Material From To ❑Other Original well drilled for Gary Wolfard(06/23/1965) Backfill placed from ft.to ft. Material (MARI 9299). Filter pack from ft.to ft.Material Size Well abandoned due to conflict with newly proposed septic system for new home site. Explosives used: U Yes Type Amount :5a)ABANDONMENT USING UNHYDRATEL,i>n.i.i•;i;iiL Proposed Amount Pounds Actual Amount Pounds ,6)CASING/LINER Casin• Liner Dia + From To Gauge St! Piste W�ld Thrd LOAM 6 2 51 .250 CS) (JI^1 E. 0 • •MN — C�� C C4ZO _ _ II_� L C�ZM _ Shoe^ Inside UOutside ! I Other Location of shoe(s) Temp casingnyes Dia From +E] To 7)PERFORATIONS/SCREENS Knife Perforations Method Mills Screens Type Material Date Started12-15-2020 Completed 12-15-2020 Perf/S Casing/Screen Scm/slot Slot #of Tele/ creen Liner Dia From To width length slots pipe size (unbonded)Water Well Constructor Certification Casing 6 _ 2 51 .375 1.5 196 I certify that the work I performed on the construction, deepening, alteration, or abandonment 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 knowledge and belief. License Number Date 8)WELL TESTS:Minimum testing time is 1 hour Signed Q Pump Q Bailer Q Air Q Flowing Artesian Yield gal/min Drawdown D ill stem/Pump depth Duration(hr) (bonded)Water Well Constructor Certification I accept responsibility for the construction, deepening, alteration, or abandonment work performed on this well during the construction dates reported above. All work performed during this time is in compliance with Oregon water supply well construction standards. This report is true to the best of my knowledge and belief Temperature °F Lab analysis❑Yes By Water_quality concerns? ❑Yes(describe below)TDS amount License Number 87 ate 12-30-2020 tfrom To Description Amount Units Signed 4 x Contact Info(optional) ORIGINAL-WATER RESOURCES DEPARTMENT THIS REPORT MUST BE SUBMI I IED TO THE WATER RESOURCES DEPARTMENT WITHIN 30 DAYS OF COMPLETION OF WORK Form Version: 0.95