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WTORING WELL INSTALLATION REPOPf <br /> Date: �!'l��` / sCONSTRUCTION <br /> Premise Address: X17T4 Total Depth . <br /> ''/ Screen Length (from) 35 (to) 0 l <br /> Well No.: lRa 02 Filter Pack (from) 35 (to) /LF' <br /> Bentonite (from) / (to) <br /> Inspector: __A Grout (from) /!o (to) <br /> 7 Drilling rig type &4 � .�O <br /> Permit No. /� �,31r Auger O.D. S/„4 I.D. Z <br /> _ n � L Completion - Stove ge stie box (circle one) <br /> Drilling Company: ��/ ' .o <br /> casing <br /> Driller: �� height <br /> Consultant <br /> Geologist V.11 e� ABOVE-GROUND <br /> COMPLET CHRISTY-BOX <br /> COMPLETION <br /> Ground Surface <br /> SPECIAL PERMIT INFO. <br /> � grout <br /> Distance to sewer line X00 <br /> Domestic well on site - (y/(D ft. <br /> If yes, location and distance - <br /> — a <br /> _ o <br /> = o` <br /> slotted — c <br /> SAMPLING / sacton — <br /> Holding Te pe azure �i4/0a'vW'ack <br /> Methods <br /> Screening Method -_ <br /> Tracking Sheet - ( y/ n ) — <br /> �ft. <br /> 3 G.3 �_ tJe+r✓� <br /> SPOILS /. <br /> Storage Method_ � v 7 MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/44) J o2 - '/O �C <br /> Storage Location Casing type Y <br /> Blank Zfl ft. Screen 15' h. <br /> Slot size <br /> GROUTING Bags cement5 id <br /> If Buckets bentonite ?^ <br /> Depth to water Z.3 Bags sand/gravel 7 <br /> Mix Ratios /Oc.e✓ Filter Pack type/size <br /> Installation Method ALS H � Surge Block: - n ) <br /> Quantity Installed Discussed with geolo ist: - / n/ <br /> y 1 <br /> Type of method /d Z <br /> X12 / / Z <br />