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WF*4TQRING WELL 1'$TAt.�tJWR, Z'QRTo- <br /> CONSTRUCTION <br /> Premise Aiii3zess5.. --^- Total.Depth <br /> Screezi Length (froth) 940 (to) s <br /> Well No.: �������� Filter Pack (faros) � (to)� � <br /> Bentonite (&oaf (to)1 <br /> Inspector: Grout (from) (ta) <br /> Drilling rig type Gly.5� <br /> P1errnit:No. 0 R11215Auger O.D.. _ � -o ii). 5-7T <br /> Completion-Stove pipelchristie box (circle ohe) <br /> Drilling tqmpany- "S <br /> Drill er.. -' t *,, casing <br /> � � height <br /> Consultant <br /> Geologist - AYE-GROUND <br /> SPECIAL PEIRMT`INFO. Gall— <br /> d5txtaet <br /> Distance to sewer Iine <-56 gm't <br /> Domestic well on site - (y AD <br /> If yes,location and distance • <br /> a <br /> S I:MPLING ata;ad `c <br /> u =1 gravgt pac+c <br /> . aia132g Temperature <br /> S. ening Method ►3 tA...Q <br /> Trackm Sheet , n - <br /> SPO"Ls <br /> forage.Merhpd 07U-f A MATERJALSlDEVELOPNMNT <br /> COntarnination Alotea.:r €ie <br /> Storage Location p <br /> �' _ Casizrg;type � ��., 1 t <br /> Blank ft. Screen 20 <br /> Slot size C37 <br /> CRtit7TlNG Bags cement <br /> �, Buckers henron te: <br /> Depth to water .Bags san<i/gravel <br /> MIX Ratios 0 .�Q Filter Pack <br /> typelsize <br /> Installation:1rTethod Surge Bock: - <br /> _ <br /> Quantity Installed Discussed �rritt gec�iogis • n <br /> Type of methodeAOt <br /> �7 <br /> (6t. <br />