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M*ORING WELL, WSTALL471I0N REPORT• <br /> Date: s�3 < L�1 G CONSTRUCTION <br /> Premise Address: d YCJn AlTotal Depth . S <br /> Well No.: Z Steen Length (from) &8s (to) <br /> Filter Pac< (from) CpS. 5 (to) 43 . <br /> Bentonite (from) °� • (to) q �(-S <br /> Inspector: Grout (from) <br /> / 3 q Drilling rig type C 6 157 <br /> Permit No. / ODZ Auger O.D. 12Yz I.D. 7 y <br /> Drilling Company: � <br /> /_ ��� rs <br /> Completion - Stove pipe/chde box (circle one) <br /> -yKF <br /> Driller. casing <br /> height <br /> Consultant �r�UticO�lta.� � 4/'T <br /> ♦ j <br /> Geologist ` ::tw�& ABCVEGROUND <br /> COW��i ICN CNAIs-,Y-acx <br /> PL FTiCN <br /> SPECIAL. PEzL IIT INFO. Ground Su act r <br /> SJr� g(cut <br /> Distance to sewer Line <br /> Domestic well on site - ( y AO 'A•S ft, <br /> If yes, location and distance - 43 ft <br /> — e <br /> SAMPLING py �� eiottad _ m <br /> Holding Temp acute e O _ yraysl pack <br /> Method (� <br /> Screening Method rc = <br /> Tracking Sheet - y/ n ) <br /> 6g•S ft ► _ <br /> n. <br /> SPOILS �f <br /> Storage Method MA—i--RIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Locadon_ �t — Casing type <br /> Blank .5 fr. Screen 7A fL <br /> Slot size ,n7,0 <br /> TI <br /> GROUNG Bags cement 6 <br /> M1�6 Buckets bentonite 2 <br /> Depth [a water Bags sand/gravel 15 <br /> Mix Rados__tbo4 t 46%-a- } B6/o F17[er Pack type/size 3 <br /> Installation Method �o a Surge Block: - (y nn <br /> Quantify Installed /i!'H�C Discussed with geologist: -®/ n ) <br /> Type of method <br />