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C�NITCIRING WELL INSTAL.L.ATION�REPOi <br /> Date: ' 4 r CON ISTRUCfION <br /> Premise Address: to 12 CJ _ m Lz:��_ %r Total Depth:1 <br /> ►'Y1i r4� I <br /> n Screen Length (from) S (to) <br /> Well No. /�7^ f M �� 3� Filterl pack II. (from) $•_S (to) 41 <br /> Bent6nite ';I (from) 4-1 (to) 3�! <br /> I Inspector. c5 CL4iJ mvb M _- Grout` (from) 36 •(to) .6- <br /> Drilling rigtype <br /> Permit No. j 2A921 Auger,O.D. 11 /6,2�Mu�istieox <br /> Completion =Stove pircle one) <br /> Drilling Company: 61 <br /> Driller- 'L�� �lvN(��L� .�, casing <br /> ' I TV <br /> he;ght <br /> Consultant l�la(1L 1 (fib 7i <br /> EWT <br /> Geologist 0j"n uf:�Gt9 r�Vi LPA , <br /> ABOVE-GFiLIlND CHRZN43OX i <br /> CCMPLEnON <br /># SPECIAL PERMIT INFO. II .IIS G=M Swfaca <br /> Distance to sewer line Sb h. !i Qraat { <br /> Domestic well on site - (y/ <br /> F If yes, location and distance ii i� ft. <br /> o <br /> SAMPLING I slara•! <br /> Ili a0C'icn <br /> HoIding Temperature G JC�1 <br /> �I �,rav91 pada <br /> Method cktte ;'cis (k <br /> Screening Method <br /> Tracking Sheet y n ) I qr <br /> rip ft. — 12. <br /> SPOILS I. ' <br /> Storage MethodA2f•5 Aij, > Cady. MATERIALS;MDEVELOPMENT <br /> Contamination Noted - (y/ I 'i rr <br /> Storage Location S Casing type 4 'LO 4o Alc f <br /> Blankll 4.3 ft. Screen 20 ft. <br /> Slot size II: o.vzo <br /> GROUTING Bags cement) <br /> Buckets bentonite 39idCy21ar5 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter.iPack type/size N R <br /> Installation Method SurgePlock:`- (V n ) <br /> Quantity Installed - Discussed with geologist: - (4D/ n ) <br /> Type of metliodM-ouuaW.), f313-11,ty2_._ <br /> i EH 29 29 ;iI ... <br /> �� I <br />