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M i-CRING WELL.INSTALLATION REPORT <br /> I <br /> Date: 5'`f`L 3 CONSTRUCTION <br /> I <br /> Premise Address: S S ; Total Depth �5 <br /> I ; Screen Length (from) SS (to) 3 S <br /> Well No.: /tel/�� /lit/1I6 i Filter Pack (from) 5 (to) 33 <br /> Bentonite (from) 3 S (to) 3 <br /> Inspector: Grout (from) (to) Co <br /> Drilling rig type S <br /> Permit No. Auger O.D. 1D Z I.D. 7 <br /> 11 ' Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ,. <br /> casing <br /> DrlIer. T_ height <br /> COCISUItanCG� <br /> Geologist1� t �1 ABOVE-GROUND r ! <br /> COW ZN <br /> C^MP«=i ICN <br /> sulacs <br /> SPECI?L PERDrIIT INFO. <br /> groutDistance to sewer Iine 3� , <br /> Domestic well on site Ir (y 4tp <br /> tL <br /> , r� - 33 ft• <br /> If yes, location and distance - <br /> A y '3 <br /> m 1 <br /> s+ e <br /> a ., .��- z. -Y ,;�«' �.•,-,::,�-_-�•.-s`r,:.'. - -.•-�-`�%"y =-€LIOCL6d •: � 'c"' t,..r��"'. �=�:-- _ -n:;:,r- <br /> �, ti g <br /> SAYPLING saclon <br /> Holding Tem eracur �'� '�`e 'n 15; _ _�'+�,"- .y, <br /> . _ <br /> Method <br /> Screening Method �.., <br /> Tracking Sheet — <br /> �5 ft. <br /> • M , <br /> SPOILS <br /> Storage Method � _� — �`� � MA i cRIALSIDE_VELOPMENT <br /> Contamination Noted (y/ n ) <br /> Storage Location _a ZR Casing type 4 scA 40 - <br /> f <br /> Blank^ 35 ft. Screen Za fL F <br /> Slot size _02- <br /> GROUTING <br /> 02GROUTING ' Bags cement <br /> Buckets bentonite 7— <br /> Depth <br /> Dept,`t to water -5 , a� Bags sand/gravel i <br /> Na Ratios 0 " $ f Filter Pack type/size 41-3 <br /> L.5 { <br /> Installation Metho(Y PLaik-,_e Surge Block: -M n ) i <br /> Quantity Installed 739- Discussed with eologist: - CY, n ) <br /> ,. .Type of method 'L g <br /> 3 ` _ <br />