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Iv' "TORING WELL INSTALLATION REPORT <br /> Date: 3' CONSTRUCTION <br /> Premise Address: 16 Total Depth 3F <br /> Screen Length (from) 3g (to) /8 <br /> Well No.: �� l Z 13 Filter Pack (from) 3? (to) / 7 <br /> Bentonite (from) /7 (to) )-s <br /> Inspector: Grout (from) 15 (to) QS <br /> - ��� / Drilling rig type .• E -76S <br /> 9� <br /> Permit No. ) Auger O.D. /0/2-" I.D. ��y <br /> Complerion Stove pipe chrstie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: height <br /> z so <br /> Consultant -« <br /> Geologist ABOVE-GROUND CHR;SY-8CX <br /> COWFL_Fr CN COMPLET;CN <br /> Ground Suiacs <br /> SPECIAL PE LMIT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - ( y/D 17n- <br /> If yes, location and distance - <br /> = o <br /> o <br /> slotted = 'c <br /> SAiM?L ING aacdon = <br /> Holding Temperature JAA-44- <br /> M e tho d_ <br /> Screening Merhod <br /> Tracking Sheet n ) ,�. ♦ — 3F ft. <br /> SPOILS <br /> Storage Method Ox GI.�tGr°u �� .S�`e.c MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/(r�) �l` ,s �l� P✓�, [/Jlc� e <br /> Storage Location �_ Casing type <br /> Blank 19, ft. Screen Z rj ft- <br /> Slot size / <br /> GROUTING Bags cement -� � <br /> Buckets bentonite /77 TAA 3"f <br /> Depth to water Bags sand/gravel f Y't <br /> Mix Ratios &A Z2 -�.�.P I U Filter Pack type/size s_ #I� I <br /> Installation Method -t5% Z6 -Y Surge Block: - C& n ) <br /> Quantity Installed / SS Discussed with geologist: - d/ n ) <br /> Type of method �-&ck -`-.&Ec. or ca� dcR � <br />