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WTORING WELL INSTALLATION REPOT- <br /> Date: CONSTRUCTION <br /> Premise Address: -7 e)A U/ �4 Total Depth_ a?g,S <br /> Well No,:—. W - 7A Screen Length (from) .2�7� (to)_Z7� _ <br /> Filter Pack (from) /7 ' (to) /,-r <br /> Bentonite (from) /15-1_(to) / r <br /> Inspector. Grout (from)_ 13 , <br /> Permit No. <br /> Drilling rig type & - <br /> D� Se24 G 8 Auger O.D. 8-i phi I.D. <br /> Drilling Company: <br /> Completion - Stove pipe c iristie o circle one) <br /> � moi✓ c�li j��i�� <br /> Driller: l'(O-Yqa Ll casing <br /> (heft F}re »QS Aires lf/mz Gg rdn. � height <br /> Consultant [} fi e,4 D T_5 <br /> Geologist__ fro, lf7Bh�jj v�- AR�A�Ts 711 <br /> - w <br /> T7TGj/1-�J r7`0/�dn.��.vL�1o7 7- �-iPL1RDiS ABCVE•GACUND <br /> v LJ (iL <br /> COWLETCN <br /> SPECIAL PERMIT INFO �J ^ COMPLETICN <br /> �E/f?N /�y Cl amd Sa1xt <br /> Distance to sewer line_ /fin (' ai,f� ���� grout <br /> Domestic well on site - (y n /D-//.S 22,7 <br /> If yes, location and distanc /y ft. <br /> iq S 28,57 17 S n. <br /> r8 -i9.S -//S-S- m <br /> SAMPLING 20 -2/,S-3017S c <br /> 22 -23 - 3001 <br /> Holding Temperature__ AIA 5'L b8 +eeicn <br /> Method 41 -27,5 - 39d3 <br /> Screening Method__ V )� Z8-29,5• /86L ' _= <br /> Tracking Sheet - a/ n ) <br /> v O tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> OPMENT, <br /> Contamination Noted - y n <br /> Storage Location ,r�r.c f Casing type a - S U <br /> Blank ft. Screen, <br /> Slot size_ C. /9/ o i <br /> GROUTING Bags cement '75-/)- <br /> Depth <br /> /)- n <br /> Buckets bentonite /� <br /> Depth to water Bags sand/gravel <br /> Mix Ratios_ '7 5/# / }<� d Filter Pack type/size 7t ZL� <br /> Installation Method � - _ /r„ d, �„� Surge Block: - (y/ n <br /> Quantity Installed I f s s Discussed with geologist: - �✓ n ) <br /> vF QaJ4 Type of method <br /> EH 29 29 C�iZLitt O mw �0 <br /> O <br /> =35"61-F <br />