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&NITORING WELL INSTALLATION REPO <br /> Date: o l z n_��'; 2-017- <br /> -017- CONSTRUCTION / <br /> Premise Address:_ )40/) cLU r j i 4e!r, ert Rol. Total Depth .ZJ <br /> Screen Length (from) (to) 2 Z.$-" <br /> Well No.: As ^z. Filter Pack (from) '7:z /0 (to) an a <br /> Bentonite (from) 20. o (to) /7, 0 <br /> Inspector. L f Grout (from) 17.0 (to) sv�y <br /> Drilling rig type - c <br /> Permit No. Auger O.D. J ,� <br /> Drilling Company: V <br /> /4E (/�/ �f•j Completion - Stove pill-a/christie (circle one) <br /> Driller: } B� 'fit casing <br /> / me/o -47 height <br /> Consultant 0 % d t yJ,'/ f -T)? <br /> GeologistKQ b laa o tom/ 4-ndfgKJ,D0 r <br /> � i ABOVE-GROUND <br /> CO&PLETION CNAISTY-80X <br /> COMP <br /> SPECIAL PERMIT INFO. Ground g <br /> Distance to sewer line �c_u n knot✓k <br /> Domestic well on site - ( n ) o ry <br /> If yes, location and distance - 2d- 0 h, <br /> ISS /,S30�rh - <br /> SAMPLING a0tlotwd <br /> 83,sP� <br /> .ZS ?( aac5on <br /> Holding Temperature _ vavO- <br /> Method id 2 i» l a a �P� _ P <br /> ack <br /> Screening Method <br /> Tracking Sheet - n) <br /> .7� tt• E — N <br /> SPOILS <br /> Storage Method G <br /> � 4&2 dryrytJ MATERIALS/DEVELOPMENT <br /> Contamination Noted -(U/ n ) T� <br /> Storage Location DY1J.fr Casing type l-i rt Snlz�a ee S/D <br /> Blank o?2,S- ft. Screen 2.5- ft. <br /> Slot size O,d L O i o <br /> GROUTING 6.C&Lf. Bags cement ,S 4/# QUi l r- � -tx„rz.c2-IT <br /> r 5d# -Buckets bentor /,�,burJfofr L rL <br /> Depth to water /.S.Bagssand/gravel Jeo#b4V CErr�c7t Lqe;rtortrc <br /> Mix Ratios tit % S Filter Pack type/size 2 <br /> Installation Method t - ✓r 4,1- Surge Block: - (y n) <br /> Quantity Installed l b a-Ax 4�� Discussed with geologist: -6P/ n ) <br /> Type of method <br /> EH 29 29 <br />