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MOt6OWNG WELL INSTALLATION REPORT <br /> Date: 7'd `lPU CONSTRUCTION c <br /> Premise Address: 919'1 Total Depth 3/ <br /> Screen Length (from).. <br /> Well No.: 7 eW 1A,19 Filter Pack (from)„ —(to) g` <br /> Bentonite (from)- Ss ' (to) 7 <br /> Inspector: l dL Grout (from)_ —(to)!S � <br /> Drilling rig type 2 �^ ' <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: caszng <br /> he, <br /> Consultant F '� <br /> Geologist -' <br /> ABcvE-GaCUND cry -aox <br /> oCl�t�R>oN C0&LPt.mCN <br /> SPECIAL PERMIT INFO. Ground$Lxfws _+ ""'—"'""'"° <br /> Distance to sewer line a grout <br /> Domestic well on site - ( y/ n <br /> If yes, location and distance - <br /> ft. <br /> - � w <br /> a <br /> SAMPLING dot•ni <br /> soden <br /> Holding Temperature r� I('�t, i�nu ti � r vet <br /> Pz F� <br /> Method �i✓uys sl 5 ��� _ <br /> Screenin;Method <br /> Tracking Shcet - (may n ) <br /> ft- M <br /> SPOILS <br /> Storage Method MATEPJALS/DEVELOPMENT <br /> Contamination Note - ((Y)/ n ) <br /> Storage Location �� _-_ Casing type_ D✓C- a _ <br /> Wank___422ft� Screen o f[. <br /> Slot size_ _ O/D <br /> GROUTING Bags cement C-a&;r \ <br /> Buckets bentonite -k 1 <br /> Depth to water '" Bzgs sand/gravel_ 3 _ -- (, - 7 _ <br /> Mix Ratios Filter Pack type/size z. <br /> Installation Method Surge Blocks - (V n ) <br /> Quantity Installed _� ♦s_-���_�_ Discussed with geologist: - (y/ n ) <br /> Type of method_ h/u,,"o, 4 - <br /> EH 29 29 � � <br />