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STATE OF OREGON R. S t a d e l i & Sons WELL I.D.LABEL#L WATER SUPPLY WELL REPORT Well & Pump, Inc. START CARD# 217014 (as required by ORS 537.765&OAR 690-205-0210) ORIGINAL LOG# oN , 9299 (1)LAND OWNER 4385 Stadeli Lane NE - Owner Well ID. 7 First Name Alex Last Name Snegirev 5 I l V E("t O Il, OR �9(J LOCATION OF WELL(legal description) Company county MARION Twp 6 S N/S Range I E E/W WM Address 6747 Tessa Lane City Silverton Smote OR Zip 97381 Sec 29 NW 1/4 of the NW 1/4 Tax Lot 2201 Well Deepening Conversion Tax Map Number Lot (2)TYPE OF WORK • ❑New n n Lat "or DMS or DD Alteration(complete 2a&10) nAbandonment(complete 5a) (2a)PRE-ALTERATION Long "or DMS or DD Dia + From To Gauge Si! Piste Wid Thrd (it" Street address of well C'Nearest address Casing: 6 0 51 .250 (D) 1 ❑ 6747 Tessa Lane,Silverton,OR 97381 Material From To Amt acks/lbs Seal: I- I 1 (3)DRILL METHOD (10)STATIC WATER LEVEL ❑Rotary Air (Rotary Mud Cable LIAuger (Cable Mud Date SWL(psi) + SWL ft Existing Well/Pre-Alteration 12-15-2020 • 37 (Reverse Rotary C Other Pump Hoist Completed Well 12-15-2020 • 20 (4)PROPOSED USE L Domestic HIrrigation I (Community Flowing Artesian?fl Dry Hole? I Industrial/Commericial n Livestock fDewatering WATER BEARING ZONES Depth water was first found H Thermal nlnjection EC.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/ I Dia From To Material From To Amt Ibs Cement 0 146 49 S 1 I l Calculated 27 Calculated (11)WELL LOG Ground Elevation How was seal placed: Method nA ❑B { lC ❑D HE Material From To � �Uther 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: L Yes Type Amount :5a)ABANDONMENT USING UNHYDRATEly ir,iivi.ixi, Proposed Amount Pounds Actual Amount Pounds `,6)CASING/LINER Casin• Liner Dia + _From To Gauge Sti Piste Wld Thrd �_� 6 L 2 51 .250 ® ( ; 0 EI Q • C • • �•�W L NM _ _ MOM L WO: Shoe LiInside ❑ _Outside _Other Location of shoe(s) Temp casing1Yes Dia From +[] To 7)PERFORATIONS/SCREENS Knife Perforations Method Mills Screens Type Material Date Started 12-15-2020 Completed 12-15-2020 Perf/S Casing/Screen Sent/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 0 Pump O Bailer 0 Air 0 Flowing Artesian Yield gal/min Drawdown Drill stem/Pump depth Duration(br) (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 ElYes By Water gnuality concerns? Yes(describe below)TDS amount License Number 87 ate 12-30-2020 tfrom To Description Amount Units Signed % Contact Info(optional) ORIGINAL-WATER RESOURCES DEPARTMENT THIS REPORT MUST BE SUBMITTED TO THE WATER RESOURCES DEPARTMENT WITHIN 30 DAYS OF COMPLETION OF WORK Form Version: 0.95