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MOORING WELL INSTALLATION REPORT . <br /> Date: /f'' 3 , , _ . CONSTRUCTION-, <br /> �� ew Totpl•Depth oL� <br /> Premise Address: c'�a�-� — <br /> s -T Screen Length,(from) 8' (to) <br /> �--- <br /> Well No.: "51 4.!E i� 3 Filter Pack ., (from) -(1a) •s <br /> Bentonite (from) S <br /> r. .. �� _ Grout (froru) , <br /> Inspecto <br /> Drilling rig type�f <br /> Permit No. ytd , ' <br /> Auger O D, 402 I D: <br /> • Completion>$toKe•pipe/chrtstie box (ctrde one <br /> Drilling Compa i§.e <br /> Driller: Tom height <br /> Consultant Zer.,�p 6 <br /> Ott c% 10, <br /> Geologist !�G n s=v3 �,e.,, Ivri VE-GACUND C{fs -BOX <br /> fJi s &PLETCN COMPI°r`71CN <br /> SPECIAL PERMIT INFO. Grcurd 8urtxe —� <br /> .S" BGrGI� grout <br /> G 2 <br /> Distance to sewer line <br /> Domestic well on site - (y/(P <br /> If yes, location and distance - n' <br /> n. <br /> O <br /> O <br /> SAMPLING �� �(-o% c� Gw S VE <br /> Su .s � ' / sacicn - � <br /> Holding Temperature A) <br /> Method - <br /> Screening Method — <br /> Tracking Sheet • (y/ n ) <br /> SPOILS <br /> Storage Method �� �N a� MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) Al PVL <br /> Storage Location Casing type <br /> Blank jr ft. Screen Ly — <br /> fr• <br /> Slot size /00 <br /> GROUTING Bags cement ' °L <br /> Buckets bentonite / <br /> Depth to water A.41A Bags sand/gravel <br /> / u <br /> Mix Ratios Filter Pack type/size bei <br /> Installation Method . ©) <br /> .��P Surge Block: - ( y/ <br /> Quantity Installed —T Discussed with geologist: - ( y/ n) <br /> Type of method <br /> EH 29 29 <br />