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MO' (RING WF.LI.INSTALLATION R. °ORT <br /> CONSTRUCTION113 <br /> DE. I )( � Total Depth a 119 6oion.ai Ca.aa2 <br /> Premise Address: Steen Length Cfrom) 1103 (to) 63 <br /> Well No.: l Filter ?ack (from) <br /> Benronite (from) /4�U (to) 13F <br /> . Grout (from (3 g (to) <br /> InspectorD <br /> Drilling rig type . -e 16 <br /> Permit No. Q3 ' 1652 Auger O.D. 2a" I.D. I <br /> Com 1 e i e/christie box (circle one) <br /> Drilling Company. Cz rrta".c'ce K° �6 <br /> C s�casi ng <br /> Driller �/A�^= - 177 <br /> height <br /> Consultant f A <br /> GeologisL /rw w _ _ ABCVpWND CNRSY-3cX <br /> t--=3 -'v��„pLitC Z•O� C^.MW�CN <br /> / - rd Stn! <br /> SPcCI?! ?ERyfIT INFO. ptou <br /> n/ /3P <br /> Dis;ante to sewer line 14 ft. a V/ <br /> Domestic well on site - y n) d fL <br /> If yes, location and distance . 153 ft. _ <br /> `. <br /> a AA <br /> .lame <br /> S?�iP� iNG section _ _ pG�, <br /> r N� JR <br /> .�Holding Temperature MethoScree.mrigMethodTraccingSheer - (y/ n ) 113 ft. <br /> G"Pie sPOlts NStorage Method °" Mp CAIS r <br /> Contamination Noted - ( y/ n) (0" ��I C Sd S O <br /> Storage Location Casing type <br /> Blank �/SS fr. Screen l0 fr. <br /> Slot size o <br /> GROU?ING Bags cement Q (Avera. <br /> Bucker bentonite 3 6aRo (Son Ea iiR14 <br /> Depth to water UAj11 Bags sand/gravel 6 <br /> Mix Ratios 2-5 leu-...1Filter Pack rype/size <br /> Insrallacon Meth s U Surge Block: - C y/ n <br /> Quantity Installed 15.6 at- Discussed with geologist: • ( y/ n <br /> Type of method <br />