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b Y <br /> MONITORING WELL!INSTALLATION REP.OR� <br /> Date: .J tJ 2 a0) o CONSTRUCTION ' <br /> Premise Address:- 730 4 x� n PJ­ S+r e-Q,; Total Depth S1/4 an d SVC -T b 5. 3 ' <br /> Screen Length (from) <br /> Well No.: 60 I'l V r ,S : S Y-,4,1'S and 5 V-C Filter Pack __Sr 3' (to) 3' <br /> 6 , <br /> Bentonite ""' om) 4, 3' (to) <br /> Inspector: )� r"1` 13tnfc�+;}� s_I v r r_ (r off) 3. 3 '(to) " Ia I ew su*fd <br /> n1 tLtj'C f r��g g type <br /> ` Permit No. S ¢ Auger O.D. i n I.D. <br /> Completion - Stove pipe/ e box ' cle one)- <br /> Drilling Company: F-Lt r} ��G rtv j o Qi eS <br /> isti <br /> cQ] <br /> Driller:_ _ 1311_ t4-b o k - h4 t7� cas ing _ r <br /> 1 0 height <br /> Consultant._ CAU d ON- <br /> Geologist <br /> YGeologist <br /> ABOVE-GROUND <br /> COMPLETION -� <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> P, cl aw JV+ a ct <br /> Distance to sewer line ))y1 a bGnto n rf� <br /> Domestic well on site - (y/n <br /> If yes, location and distance - �•9 V.Ies <br /> �, renle <br /> mss.S�ft. <br /> — m I <br /> SAMPLING - Y20 S't1rlej U/�''� — <br /> G�U r: slotted C , <br /> Holding Temperaturegraw Pack <br /> AI <br /> Method ` _ <br /> .. — <br /> Screening Method ;: _ <br /> Tracking Street - {y/ n ) <br /> _5,3 ft. tt <br /> SPOILS <br /> Storage Method a A MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location _ i�d _ Casing type _ 4s:n t S' a �•�rr l+Jb„� <br /> Blank N ft. creep fij.A G(5- ft. <br /> Slot size 5'F f X35 Sjrn i c rr-e- i <br /> GROUTING Bag&-�rt N A <br /> B udeets bentoniten I,u )has <br /> Depth to water u r2 }Lrt o w' _ T Bags sand/gravel , I S_L6.5. _ M r- <br /> Mix Ratios N 14 Filter Pack type/size --e_j <br /> Installation Method Surge Block: - ( y/ n ) N p� <br /> Quantity Installed T Discussed with geologist: - (y/ n) <br /> Type of method, N <br /> EH 29 29 �'• � I <br /> �otat cE-7C o --JE S 5re,n v 1,es a� <br /> fmr 3 was - N S^PU VISAS <br />