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JMTORING WELL INSTALLATION REPOT <br /> N <br /> N �q _ asvnnvl - � �ov7` Li��rPD� <br /> Date : VU_4 3� 2 Q / / p c CONSTRUCTION <br /> Premise Address : .?i1S'�f <br /> ✓ODD �aaSO`• Total Depth <br /> Well No. :_ M �- Screen Length (from) (to) f S <br /> Filter Pack (from) cc:�8 (to) Ayd) <br /> t�,� � " Bentonite (from) e) S (to) P8 <br /> Inspector: _ YlGl� i m Y�2Gu � nr��eFfir�.� Grout (from) I <br /> (tO)—�5— <br /> L, Y04kf/ Drilling rig type (LM < - �S ro T <br /> Permit No . .r7� 1� G 7G T S Auger O .D. I .D. <br /> Drilling Company: /�f <br /> n /t Completion Stove pipe/c ' stie box (circle one) <br /> yt/¢ /1 A'b�pdd"3'Ir1�0� <br /> Driller: IV 1) <br /> J(, Q�yQ � i �L JOSS casing <br /> </ 40t# J[4ATe(LJ height <br /> Consultant Itd yAw e4l GGrs �!i�(j'rrn n, s P <br /> Geologist �4n ; eJ Yt 1deizoyn e <br /> ABOVEGROUND <br /> COMPLETION CNAISTY-BOX <br /> SPECIAL PERMIT INFO . Ground Surface COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - ( y <br /> If yes, location and distance - <br /> �� ft. ft. <br /> SAMPLING <br /> slotted <br /> Holding Temperature Q I <br /> Method rho r CSO �. = 9 N P <br /> ack Screening Method (P /y = <br /> Tracking Sheet - UY <br /> n <br /> C _ft. _ ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) L <br /> Storage Location Casing type PUC - 5P14 yU <br /> Blank 01 C1 ft. Screen ft. <br /> Slot size_ <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water31! Bags sand/gravel — S $ 44a5 <br /> Mix Ratios 7,�1 / ��f Filter Pack type/size7 . - / Z <br /> Installation Method I REM I� Surge Block: - ( y / n ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> EH 29 29 Type of method <br />