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-7,71TORING WELL INSTALLATION�. .ORT <br /> 4 <br /> CONSoN <br /> Date: <br /> Total Depth <br /> ; <br /> Premise Address: Screen Length <br /> Filter Pack Cfrom)�—Cto) /� <br /> well No.: ��—�9 Bentonite Cfrom) Z. (to)=S3 - <br /> Gr6ut Cfrom)�Cto) <br /> J <br /> Inspector: U DrMingrigtyPe GNEs � <br /> S Qt7(>G$ 4 So Auger O.D. I D.�— <br /> Permit No.- Completion tove pip Christie box (circle one) <br /> Drilling Company: <br /> I casing <br /> Driilel: `V d height <br /> Consultant7� r <br /> i. <br /> Geologist—21 MG ABOVEGROUND CHRMTY-BOX 1 <br /> cow EnoN COMPLETION s, <br /> 6rWrd S�.rixv � . <br /> SPECIAL PERMIT INFO. proof i <br /> Distance to sewer line 2.Y ft- t <br /> • / 3,5 ft. I <br /> If yes, location and distance- S ft { <br /> — c <br /> SAMPLING L,c4on <br /> • w:• = pravd Pack <br /> Holding Temperature _ ..' <br /> Method `e <br /> Screening Method <br /> Tracking Sheet - (y/n) IS ft <br /> SPOILS <br /> ,Rd carer c/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted- C y/n) Casing type SGK YO Pgc- <br /> Storage Location Bl � ( ft Screen ft. <br /> Slot size <br /> Bags cement 0 f' <br /> GROUTINGBuckets bentonite <br /> Bags sand gravel <br /> Depth to water Filter Pack type/sim <br /> Mix Ratios <br /> Installation Method Discussed with geologist: - C / n ) <br /> Quantiiy Installed Type of method <br /> EH 29 29 <br /> y <br />