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Av,wMTORING WELL INSTALLATION REPORT <br /> Date: -' 3--017 CONSTRUCTION mw 2 1 3� m ) Aw eb^� <br /> Premise Address:-222 e Total Depth �5� �� <br /> Screen Length (from) `z(to) `7 lz <br /> Well No.: (1M,c 7 IVl(tet» 1�1) tc3 Filter Pack (from) �3/zEto) <br /> -22 <br /> Bentonite (from Z (to)071 <br /> Inspector: Grout (from) (to) a <br /> Drilling rig type <br /> Permit No. � 0 Z— Auger O.D. /o" " <br /> Completion - Stove pip christie box ircle one) <br /> Drilling Company <br /> Driller: casing <br /> height <br /> Consultant A�I <br /> Geologist �i°Vwti►`S �'�R.� .- <br /> ABOVE-GROUND CHRISN43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface + --�� <br /> Grout <br /> Distance to sewer line <br /> Domestic well on site - (y"n <br /> If yes, location and distance - ft. <br /> ft. <br /> 0 <br /> SAMPLING aloft" <br /> sackn '- <br /> Holding TemperaturegMV1W -14K <br /> Method CL-A a-� "' _ P <br /> Screening Method <br /> Tracking Sheet - LY.)/ n ) <br /> ft. <br /> SPOILS / <br /> Storage Method l.Y J f l`11 1.�iY1�S `Alle I2J MATERIALS/DEVELOPMENT L 3 <br /> Contamination Noted • /n ) y �I chi n�� „- Z,. <br /> Storage Location Blank <br /> a ti' ft. Screen 757 ft. <br /> Slot size }o <br /> GROUTING y�,l,�2y�3 Bags cement <br /> Buckets bentonite <br /> Depth to water �"' Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y//1171 — <br /> Quantity <br /> nQuantity Installed Discussed with geologist: - (y/® <br /> Type of method <br /> EH 29 29 <br />