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_*,.dTTORING WELL INSTALLATION REPO: . <br /> Date: 1 O M c +-c k ! Q 3 CONSTRUCTION <br /> Premise Address: 16 X12 E , C ti Cr M n e Total Depth -7 '9 <br /> Screen Length (from) 7 8 (to) S 51 <br /> Well No.: M W — M W— f!"6 W Filter Pack (from) 7 $ (to) 5 (� <br /> Bentonite (from) 56 (to) S 2 <br /> Inspector. -60)(from) (to) <br /> Drilling rig type 1=:,6 1 E3 -5 7 <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pip Christie o (circle one) <br /> Drilling Company: I�c'cd wu r[� �}r,i,l,n� _---- <br /> Driller: _r i cF c r S 5�r O vA casing <br /> - � he_ght <br /> Consultant_ o c q'� Q I R kcl T- M 'd '4 WT <br /> Geologist_K e y;n M �l�; bio e vt l T <br /> Ser ;5 AsovE-GacuN13 <br /> cot���rsorr a��.srr-aox <br /> cOMPLE ca <br /> SPECIAL PERMIT INFO. ' j ��+� Ground Swlws <br /> Distance to sewer line <br /> Domestic well on site - (y/n) ' �� it. <br /> If yes, location and distance - _ 7 6 ft. <br /> ft. <br /> A tJ� 1 CC:f 1.'. ly 1�C: • <br /> SAMPLING <br /> s[orad = <br /> saC.cn <br /> Holding Temperature ci -P S(A a e- <br /> Methodc c k 9MVW park�.: <br /> Screening Method P <br /> Tracking Sheet - (y/ n <br /> ft. , <br /> SPOILS 1 <br /> k <br /> t <br /> i <br /> Storage Method O7 i 5'j 7 e , 0 n q �'r I{ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type i " y C <br /> Blank S R ft. Screen 2.0fr. <br /> Slot size . D <br /> GROUTING Bags cement <br /> Buckets bentonite/L-j1--) b bXQ_ <br /> Depth to water 6 7 Bags sand/gravel �1 _ <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - y n ) ` <br /> Quantity Installed Discussed with eologist: - / n ) <br /> Type of method -3 b 10 f1 <br /> EH 29 29 E <br /> ►UC7p 1 �/ -� .70 r PVC 1'/y ��Gilla� 1yL hate <br />