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WTORING WELL INSTALLATION REPOLS <br /> Date: <br /> I J S D 8 anQ /l e/l wtis s eoNSTRuerroN 7 a to l d eP �3C ;Feel <br /> ihcr/-78- s&AP- 38' <br /> Premise Address: a_ -50 /9 �/�/ ✓�ldTotal Depthf+y"dyc�i r e4rol. SP� Q} 2S <br /> / Screen Length (from) 38 ' (to) 33 , <br /> Well No.:-- /`!1 �]�j Filter Pack (from) 38 ' (to) 3/ <br /> ff,. ym�j -/ Bentonite (from) 31 (to) 28 <br /> Inspector. Yj ri'k , /,Le 1' c Grout (from) 28 (to) su _ <br /> Drilling rig type C m x -A. <br /> scS <br /> Permit No. o D — G S Auger o.D. <br /> Drilling Company: �. ZS in vlzeJ <br /> Completion - Stove pipe/ u-istie bos' (circle one) <br /> �< � P � r� �� ` z� <br /> Driller: hm .rr r r o v o casing <br /> +- t8 oS /}JSisf �lJJOYr L�IrJrrL �h *DYc ��� height <br /> Consultant_ is l7av' ✓n v '4 <br /> rz3-o8, <br /> Geologist T, o r Vii' r <br /> 1-r0-e8 �j/jt g,y1iABOVE-GACUND <br /> 19/ A1411 - �RDi J COWLEnoN ctRMY-BOX <br /> SPECIAL PERMIT INFO. Kreh b;e! /�R CFJ Dasj"ef- o Coe,PPLmCN <br /> 1 Ground Surface <br /> Distance to sewer line 0 _ 1,9' 3115 grout <br /> Domestic well on site - ( y/ ).;? ' 3472 <br /> If yes, location and distance - 14' '31,77 ft, <br /> /5' x70 1ft- <br /> l6 i R' — <br /> 2d ' , = <br /> m <br /> p <br /> c <br /> SAMPLING .22 ' t fd8 <br /> .23' /689 saran <br /> saricn <br /> Holding TemperatureZ <br /> Method <br /> Screening Method 49 lD <br /> C.: <br /> Tracking Sheet - rYY n ) <br /> r�zyOB 3G = 37,S' /62d wkJ � .ft. = 3 ft. <br /> SPOILS 3B -34.5' 187 <br /> Storage Method S 3a -11517 MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) v 22' 15-91 <br /> Storage Location Ols r )-c 3y 14g1 Casing type <br /> LrJ6JtG 6��afe +' Blank 33 h. Screen <br /> �✓ »� Gd/�i�rT�Qd/4/�`r, 35> Slot size 0,01d <br /> TI <br /> GROUN'6QJ � c!/rvn a, <br /> C� Bags cement_ 7 - <br /> 1 Buckets bentonite I j2vejwt Pel JeOi� <br /> Depth to water -2 h�, ) ' Bags sand/gravel SZ 0 4 >� r <br /> r <br /> Mix Rados 30 /mss �F�,ia�e�--1,. �i 1�1�Cem�.�Filter Pack type/size <br /> 3 <br /> Installation Method 7` Surge Block: • ( y/(�) <br /> Quantity Installed _-s X7-/,6 Discussed with geologist: - 0)/ n ) <br /> I �Z3 j0e we,4i tvaJtLot Type of method <br /> EH 29 29 7 <br /> Itil X r o - �t/l� o f w,rh 7- <br /> m�� '1 *b OaJe�l�}� <br /> -Tgp-L Z An <br /> Two Wan V44 <br />