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ATORING WELL INSTALLATION REP04 <br /> Date: 1,1Z i ZO©V CONSTRUCTION <br /> Premise Address: Total Depth <br /> ���q Screen Length (from) (to)_�9-5 <br /> Well No.: 4•" y Filter Pack (from) Ill- (to) <br /> Bentonite (from) (o-5 (to) 3- fo <br /> Inspector: _ Grout (from) b-(b (to) <br /> �q , 5�/ Drilling rig type 15 <br /> Permit No. ` ( Y Auger O.D. 10 I.D. (e <br /> Completion - tove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: int <br /> h fight <br /> Consultant , <br /> Geologist A80VE GROU <br /> COMP N CHRZ-rY-8Ox <br /> COMPLETION <br /> SPECIAL PERMIT INFO. ���Ground BuAacs + <br /> ? <br /> M-10 6c.511Js. grout <br /> Distance to sewer line__ <br /> Domestic well on site - (y/ n ) 7 73- <br /> If yes, location and distance - 'Q ft. <br /> SAMPLING sloited = 8 <br /> Bacton <br /> Holding Temperature = GsvW Pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/ n) qq�� <br /> /7•Sft — ft. <br /> SPOILS <br /> Storage Method �Ir' Lam'` °`^ MATERIALS/DEVELOPMENT <br /> Contamination Noted'. (y n 4.t �J� 4p <br /> Storage Location Casing type <br /> Blank 79•5+A. —ft. Screen 2�_n- <br /> Slot size 02C� <br /> GROUTING Bags cement t <br /> Bucketsbentonite t 'd <br /> Depth to water, � Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method Surge Block: - (y� �-.�� <br /> Quantity Installed Discussed with geo ogtst: - (y CJ <br /> Type of method <br /> EH 29 29 <br /> gil3 <br />