LANE 65205 <br />RECEIVED RECEIVED <br />SPATE OF OREGON <br />GEOTECHNICAL HOLE REPORT OW 05 2005 tot( <br />(as required by OAR 690-240-0035) fits' <br />WATER RESOUR I Instructions for completing this report ere on tla ftEw _ A~d <br />0 <br />(1) OWNER/PROJECT Hole Number <br />Name Janoll Klingman <br />Address 2780 Spring Blvd <br />City Eugene State OR Zip 97403 <br />(2) TYPE OF WORK <br />® New ❑ Deepening ❑ Alteration (repair/recondition) 0 Abandonment <br />(3) CONSTRUCTION <br />Rotary Air ❑ Hand Auger ❑ Hollow Stem Auger <br />❑ Rotary Mud ❑ Cable Tool ❑ Push Probe ❑ Other <br />(4) TYPE OF HOLE <br />0 Uncased Temporary ❑ Cased Permanent <br />❑ Uncased Permanent ❑ Slope Stability ❑ Other <br />(5) USE OF HOLE Cseothertnal heat loop <br />(6) BORE HOLE CONSTRUCTION <br />Special Construction approval: ❑ Yes (4 No Depth of Completed Well 250 ft. <br />HOLE SEAL <br />Diameter From To Material From To Sachs or Pounds <br />6° 0 250 Bentonite 0 250 15 sacks <br />Backftll placed from ft. to ft. <br />Material <br />Filter Pack placed from ft. to ft <br />. Size of pack <br />(7) CASING/SCREEN <br />Diameter From To Gauge <br />Steel Plastic Welded Threaded <br />Casing: <br />❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />0 <br />❑ <br />❑ <br />O <br />❑ ❑ <br />❑ <br />❑ <br />Scorn: <br />❑ ❑ <br />❑ <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />Slot size <br />(S) WELL TEST <br />❑ Pump ❑ Bailer <br />JZ Air <br />Permeability <br />Yield 2 <br />Conductivity <br />PH- <br />Temperature of water 57 <br />°F/C <br />Was a water analysis done? ❑ <br />Yes 0 No <br />By whom <br />❑ Flowing Artesian <br />GPM 10 <br />Depth artesian flow found ft <br />Depth of strata analyzed. From ft. to ft <br />Remarks: <br />(9) LOCATION OF HOLE (legal description) <br />County Lane <br />Tax Lot 100 #3 Lot <br />Township 18 South N or S Range 3 West E or W WM <br />Section 04 1/4 1/4 <br />Lat 44 _°_Lj_' 7 _Tl (degrees or decimal) <br />Long (degrees or decimal) <br />Street Address of Well (or nearest address) 2780 Spring Blvd, Eugene <br />Map with location identified must be attached. <br />(10) STATIC WATER LEVEL <br />95 ft. below land surface. Date 9-1-05 <br />Artesian pressure lb. per square inch. Date <br />(11) SUBSURFACE LOG <br />Ground Elevation <br />Material Description From To SWL <br />Top soil & clay 0 10 <br />Blue gray shale 10 260 95 <br />(12) ABANDONMENT LOG <br />Material Description From To Sacks or Pounds <br />Bentonft& 0 250 15 sacks <br />Date Started 9-9-05 Completed 9-1-05 <br />PROFESSIONAL CERTIFICATION <br />(to be signed by a licensed water supply or monitoring well constructor, or Oregon <br />registered geologist or civil engineer.) <br />I accept responsibility for the construction, alteration, or abandonment w,prk <br />performed during the construction dates reported above. All work performed <br />during this time is in compliance with Oregon's geptechnical hole construction <br />standards. This re rt i true to the best of my knowledge and belief. <br />11. 'y <br />ice r 7gstrationNurnber 1553/~ <br />Signed Date 46Y~j~ <br />Affiliation <br /> <br />THIS REPORT MUST BE SUBMITTED TO THE WATER RESOURCES DEPARTMENT WITHIN 30 DAYS OF COMPLETION OF WORK <br />Date Started 9-1 -05 Completed 9-1-05 <br />