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Y Y <br /> kL6RING WELL INSTALLATION REPORT <br /> Date: �'Z� —91- _ CONSTRUCTION <br /> Premise Address: Total Depth 55 <br /> Screen Length (from)�S5 (to) _ <br /> Well No.: Filter Pack (from) 4a0 (to) 5:5 _ <br /> Bentonite (from) 3 3 (to) <br /> Inspector: : Grout (from)_3, (to) <br /> .Drilling rig type <br /> Permit No. 11 - 0 -5111 Auger O.D. I.D. <br /> Completion - Stove pip sue bo (circle one} <br /> Drilling Company: 1 <br /> Driller: casing <br /> height <br /> Consultant LokAJ _ <br /> Geologis 1oJtYv PMA4A -- <br /> ABOVE-GROUND CHRW Y43OX <br /> OONFLETION <br /> C'k�k 4 - <br /> MI <br /> SP CT COWLEnON <br /> PERT T O. G=nd Says <br /> Distance to sewer line oraut <br /> Domestic well on site - (y/ n] (t. <br /> If yes, location and distance - It- <br /> Y — m <br /> a <br /> SAMPLING INA IR49t A-LW sloro.9 <br /> socicn <br /> Holding Temperature <br /> Method : _ :i t1 <br /> A.Y = <br /> Screening Method <br /> Tracking Sheet - {y/ n <br /> Spoils <br /> Storage Method MATERIALS/DEVEI,OPMENT <br /> Contamination Noted - ( y On ,,rr <br /> Storage Location Casing type_JYL 2'I <br /> Blank ft. Screen t2p ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios p Filter Pack type/size <br /> Installation Method Surge BIock: - (y/ n ) <br /> Quantity Installed_�_�:i(_ Discussed with geologist: - (y/ n ] <br /> Type of method <br /> EH 29 29 <br /> I <br />