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w,,,fI'ORING WELL INSTALLATION REPORT <br /> Date: Z/�7 CONSTRUCTION <br /> Premise Address: 3��U S. �'� lb� �D Total Depth S / <br /> S <br /> Screen Length (from) (to) <br /> Well No.: ,- # Filter Pack (from) �S1 (to) 3 <br /> Bentonite (from) 3 3 (to) U <br /> Inspector: Grout (from . (to) <br /> n Drilling rig type S <br /> Permit No. i' Z — l d 1 Auger O.D. /T * I.D. y <br /> Completion - Stove pipe/christie box (circle one) <br /> Consultant O �� <br /> Geologist sddc-up0CHRISTY43OX, <br /> T <br /> SPECIAL PERMIT INFO. ASOVE-GROUND <br /> Distance to sewer line <br /> C�7` COMPLETION Grou `C-OMPL$T10N <br /> _ .� v <br /> Domestic well on site - o/ n ) �Surface <br /> If yes, location and distance - grout <br /> , -so ft. <br /> ft. <br /> SAMPLING <br /> Holding Temperature sloned "•* <br /> Method sac�on <br /> Screening Method l ('� 9M+W pack <br /> Tracking Sheet - / n) <br /> ft. <br /> SPOILS <br /> Storage Method 61-k-- MATERIALS/DEVELOPMENT <br /> Contamination Notes - y n) -� Ii <br /> Storage Location Jam' Casing type <br /> Blank Z ft. Screen 70 h. <br /> Slot size 0'2- o <br /> Bags cement <br /> GROUTING Buckets bentonite t <br /> Bags sand/gravel C2.� <br /> Depth to water 3 Filter Pack type/sit <br /> Mix Ratios Surge Block: - (y <br /> Installation Method Discussed with geologist. - y n ) <br /> Quantity Installed % Type of method <br />