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TORING WELL INSTALLATION ORT <br /> { <br /> Date: {`ly"1 CONSTRUCIION i <br /> Premise Address: 0(c> v+- 00AfL "'A( Total Depth S5 t5 ' <br /> Screen Length (from)_' (to) 25�— k <br /> Iw-S Zw-6 T -7 FiltetPack (from) 13 (to) <br /> Well No.:. 25 <br /> ' Bentonite' (from) 1®' (to) IT � <br /> Inspector: J. o A v Grout (from)T_Cto) 10 <br /> Drilling rig type BK' <br /> Permit No. ap68613 Auger O.D. 1Z' <br /> Completion- Stove pip christie box (circle one) <br /> Drilling Company: V D�wN <br /> Driller: casing <br /> height <br /> Consultant AAf i 5 1 • <br /> ND RCw OaM > �. <br /> Geologist R y �.BOVE•GROUNp <br /> • COhrr'Lc-TION Gk WAS f1'�OX <br /> cot,7PlFi loN { <br /> SPECIAL PERMIT INFO. suixe -- <br /> provt 1 <br /> Distance to sewer line <br /> If yes, location and distance- I ; tt• <br /> ft. # <br /> m i <br /> 0 <br /> SAMPLING <br /> Holding Temperature yo�' — Q"�P <br /> ac <br /> .w = <br /> Method W5 c4tvr w IL£ <br /> Screening Method '• <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method SS MATE RLALS/DEVELOPMENT <br /> Contamination Noted- n) Casing tv� PVG <br /> Storage Location .No P COPE Blank ISe ft. Screen <br /> Slot size <br /> GROUTING Bags cement �'* Qul1'-c."'E Co ax-TE - •/y(9y,� ^3 <br /> Buckets bentonite L`'=C0 A60wM ahPS .y 50 lbs � <br /> Depth to water 13, ` Bags sand/gravel Ccn+cx - 12. 570165 BAGS <br /> ,u, 9-" - TT to ic.M <br /> Mix Ratios Filter Pack type/ e M <br /> Installation Method - _-.juga B1osk:_n-) <br /> Discussed with geologist <br /> Quantity Installed : - n) <br /> Type of method 5-r"L-SAtc02 <br /> EH 29 29 <br /> 1 <br />