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01TORING WELL INSTALLATION REPOT. <br /> Date: H31 07 CONSTRUCTION <br /> Premise Address: il2A✓ Ae, I�' Sde�i rz. p� Total Depth �✓ °J; � �� <br /> Screen Length (from) 9, / (to) <br /> Well No.: Filter Pack (from) (to) -2� ' <br /> - / Bentonite (from) ..7 1 (to) <br /> Inspector: ��elk rn r Grout (from) L - (to) J'r 4 __ <br /> C?i1q, Drilling rig type S & 7 <br /> Permit No. 5 dy / O-r- 7 Auger O.D. ,� I.D. OU <br /> /n1 C/r Completion - Stove pip lr stie bos circle one) <br /> Drilling Company- <br /> Driller: <br /> ompany Driller• 7kj)-a !7 a-f-S Chcasing <br /> h NQ _ e►-n � /� iGgYQ`C 7_ he, ,--- <br /> Consultant 1?4h7/Y�z <br /> st 0 <br /> K;Ye✓4/r"2 T <br /> Geolo <br /> Si <br /> /IBOYE-GAGUND X <br /> Z�12� j75 <br /> COM?L,FT10N COMPLETION <br /> SPECIAL PERMIT INFO. Gourd Surface <br /> Distance to sewer line U rl grout <br /> Domestic well on site - (y'ff) . ft. <br /> If yes, location and distance - 9 ft- <br /> SAMPLING cS?) oaf <br /> a/ secticn = -� <br /> Holding Temperature gavel pack <br /> Method 37 J <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS SVS �`� 1G� bs� •sof c z41a <br /> OW` Zg_ 1-j i✓ <br /> Storage Method AJ �" 7p S 1�-�- <br /> MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 321 -S4" 3 7f-ed, <br /> Storage Location G1/� 1� Casing type Glig�OTGr <br /> Blank ft. Screen / 0 h• <br /> /� / Slot size0, 0)01" <br /> � <br /> GROUTING p�r�r�A Bags cement g � - _ <br /> � � "��30-Buckets bentonite <br /> Depth to water J a Bags sand/gravel <br /> Mix Ratios z0 / -o 1 Filter Pack type/size _A_2- L <br /> Installation Method Surge Block: - (y 61j) <br /> Quantity Installed 0-1-k e ��fUh - o-�_�# -� Discussed with geologist: - n ) <br /> "yEH 29 29 ZZ-YI Type of method -1d /" <br /> s <br />