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MCv wr'ORING WELL INSTALLATION REPORT S--� <br /> Date: ` –9 2 CONSTRUCTION <br /> Premise Address: f Total Depth, — <br /> Screen Length (from) O (to) 2_ 01 <br /> Well No.: Zo o Filter Pack (from) OC �(to) { <br /> Bentonite (from) t (to) lis <br /> Inspector. Grout (from)_ 1(0` (to)_ O` <br /> Drilling rig type <br /> Permit No. fl Auger O.D. ` I <br /> Completion - Stove pip a box (circle one) <br /> Drilling Company: �Q <br /> Driller• [ll f _ casing <br /> �y ,,J, height <br /> Consultant Il Y/.�ll.� -EWT <br /> Geologist <br /> ABOVE-GRCUNO CHFi M43OX <br /> COMPLETION COMPLE'TICN <br /> SPECIAL PERMIT INFO. Grwnd Urface <br /> Qrout <br /> Distance to sewer line SD �• - <br /> Domestic well on site - (y/6) <br /> If yes, location and distance - n- <br /> tt. <br /> SAMPLING slara� M <br /> aodcn x <br /> Holding Temperature <br /> Method •> � F <br /> ack <br /> Screening Method _ <br /> Tracking Sheet - (y/ n ) <br /> ft. tt <br /> SPOILS <br /> Storage Method MATE_nALS(QEVE1,OPMENT <br /> Contamination Noted - y n ) –ft0UMd I i <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> 0�b -9uQkeft bentonite 1111 <br /> Depth to water Bags sand/gravel R <br /> Mix Ratios -6 Filter Pack type/size <br /> Installation Method_ Surge Block: - (yi ) <br /> Quantity Installed 0 Discussed with geologist: - n) <br /> Type of method <br /> EH 29 29 <br />