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r, iTORING WELL INSTALLATION REPORT <br /> Date: 5 La:�t CONSTRUCTION <br /> -7--7Premise Address: T(�`T jZ fi'� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) 7.5 (to) �{ p <br /> Bentonite (from) '41r:> (to) 3 8" <br /> Inspector: Grout (from 8 (to) <br /> f Drilling rig type 15-5-7 <br /> Permit No. I Auger O.D. 01 75A –LD—�L14 <br /> �, s.� Completion - Stove pip stieox bcircle one) <br /> Consultant <br /> Geologist <)a w T sock-up <br /> SPECIAL PERMIT INFO. AE;0VE-GACUNO <br /> 00WFLETCN �� Ct-1A15fY-$OX <br /> Distance to sewer line Grou5� CCiNPLSTION <br /> Domestic well on site ( y n ) �Six• <br /> If yes, location and distance - ptout <br /> po <br /> 38 n. <br /> �t v n. <br /> y5 n. <br /> M O <br /> SAMPLING <br /> C <br /> Molding Temperature slottwd = � <br /> Method sac�on _ <br /> Screening Method — gi V1 Pack <br /> Tracking Sheet y n} —_ <br /> SPOILS <br /> _-7� p••-pct. <br /> Storage Method �s � MATERIALS/DEVELOPMENT <br /> Contamination Notes - ( yam ) 2 P J C c 1 <br /> Storage Location Dir. Casing type <br /> Blank Lj 5 ft. Screen 30 ft. <br /> Slot size 0 2 <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> l Bags sand/gravel a0p <br /> Depth to water Jr8 Filter Pack type/size t Z <br /> Mix Ratios Surge Block: - ( y/ nn <br /> Installation Method Discussed with geologist: n ) <br /> Quantity Installed Type of method <br /> N'6)1- <br /> 4 �� <br />