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MOMTORT.NG WELL INSTALLAZZON REPORT <br /> Date: ` CONSTRUCTION <br /> Premise Address: 2�i 3 7 .4irpvi! �✓ Tonal Depth 7 <br /> Screen Length (gym). (,"7 ' (to) S' 7' <br /> WeE No.: �'I GJ/3 Filter Pacts (from) (,-7• s (to) ss <br /> Bentonite (from) ss ' (to) 5- 31 <br /> Inspector. O Grout (from) S 3 (to) <br /> Drilling ng type l/v rn u <br /> Pe-=it No. ©i s 8(v c7 Auger O.D. e ff I.D. <br /> Completion- Stove pi.e/chrisrie bot- (circle one) <br /> Drilling Company: G re <br /> Dtllle_*: <br /> —♦ <br /> _ <br /> t height- <br /> Consultant s S a s 1._/• <br /> ABOVE-GrICUND <br /> =W—FI MN <br /> S7ECIAL, P^R Al T INFO. Gramd Surra= <br /> Distance to sewer line ?� I <br /> Domestic well or. site - (y 1W <br /> if yes, location and distance - P4 <br /> » _I ♦ <br /> S LING s <br /> -folding �a <br /> Method <br /> S� ethod <br /> T, cring Sheet - (y/ a) <br /> SPOILS <br /> Storage Method /n on S 1P MAT..RIAIS/DEVELOPN EN <br /> Contamination Noted - (y/D <br /> Storage Location Casing type <br /> Blank fr. 11 Screen /C? <br /> ft <br /> Slot size_-, v Z <br /> GROUT ITNG Bags – <br /> Buckets bentonite <br /> Depth to ware_* S- Bags sand/gravel Y <br /> Mix Rarios =ilter?ark typesize D Z <br /> Installarion Method .> Surge Block - (Q/ n ) <br /> Quantity Installed Discussed with geologist: - C y/ n ) <br /> Type of method <br /> E moi 29 29 <br />