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MO*RING Wv-: INS'ALI_-\ ICN P----OCRT <br /> Date: �3 /!l'/3/ CONSTRUCTION <br /> premise address: 7Y ! C�G -�f Total Depth <br /> Seeen Length (l 'om)—k221 - (Co) / _ <br /> Well NO.: �(�� -/F Filter ?ack (from)-- 3 y <br /> n Benromte (from) (3%t (to) /0/2- <br /> Grout <br /> 0/zGrout (from)--!OZ—'L'—(to) 0 <br /> q 4'/ DrIling rig type 3 <br /> pe-^-.ir No. /2' 3L Y 7 Auger OD. S z <br /> Completion - Stove pip jmrsae bo (circ a one) <br /> Drilling Company. <br /> Driller <br /> Consultant <br /> Geologist - <br /> raYL <br /> S?cciAL ?QRMT INFO. 3Is <br /> SD - <br /> Distance to sewer <line <br /> Domestic well on sire - (y(a) <br /> If yes, location and distance - <br /> SA V?LIN.G <br /> Holdi,.g Temperature <br /> .fir F� 3 <br /> Me�hod t <br /> Screening Mer-hod ! 38 <br /> Tracking Sheet - y n ) b <br /> SPOILS - <br /> Srorage Method Qk f G �� MA 7-R! LVOEVELOPMEN-7 <br /> conrami[tatioa Noted • n) ming type vs !/ <br /> Storage Location qt. ft <br /> Blank fr. Skeen <br /> Slot size <br /> GROUT NG Bags cemen[ <br /> Bucketberltp ' e - <br /> Deprh to water. �Z Bags sanv <br /> Mix Rados�� ^ ° r �` o Filter Pack type/size 8 <br /> Insralladon Method - Surge 31od - (Y <br /> Quandy Installed 3 ^^x Discussed with geologies - (y/ n) <br /> Type of me hod Y✓ 4 <br />