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E e_ Zaf� Z <br /> -L�t a'P I e.e - ? <br /> .ONITORINGWELL INSTALLATION REPO. - - ar'r ' v "« ,sJc d : 'f34n-L <br /> l0 : O6 <br /> Date : jtrrl L 3, Zol S CONSTRUCTION <br /> 1 i <br /> Premise Address : /iB1r£i' zo!�: �St —'s OW OW Total Depth c� <br /> -+IieG nor+h side, — hor+'. or- ri4A Sf , Screen Length (from) <br /> Well No. : M N/ / 4 Filter Pack (from) (to) 9. 700 <br /> Bentonite (from) 73 ` (to) <br /> Inspector: V1 w Grout (from) Td (to)� <br /> Drilling rig type 14 ;1 <br /> Permit No . 5 ,R 60 2Z 19 R Auger <br /> '' Completion - Stove pipe c 'stie bo (circle one) <br /> Drill ng Company: �IVOagIItt/d r� r, ri )�i�_ Zj%� <br /> ��II <br /> Driller: J�( 4 C 40 .0 )L CPF� �� �OeC'A casing <br /> height <br /> Consultant &OLIA12aCL de. t7lVkOn 4 xjj-*lIc <br /> Geologist :Paa; ef -V %� �(a /'/tJe?c/Q <br /> ABCVE�GFOUND X <br /> COWLEf IO N COMPLETION <br /> SPECIAL PERMIT INFO. Ground Somata <br /> Distance to sewer line / (`7 grout <br /> Domestic well on site - ( y /0) 70 <br /> If yes, location and distance - E' <br /> SAMPLING - <br /> 9r J /I eecaon = . <br /> Holding Temperature SOI ( Ji0414.rnun4o( r/dfi&�d ' 40g�m Pack <br /> nj <br /> Method IG2 1n � l — <br /> /� o�/vim — <br /> Screening Method IP LD <br /> Tracking Sheet - y n ) = <br /> SPOILS <br /> Storage Method �S- q� /� / Jrn- � MATERIALS/DEVELOPMENT <br /> Contaminat <br /> Storage Location QY1 Sif`L l9d / �J ,�prg4 Casing type r� ` i>' C�J!'f�6 7d <br /> Blank ft. Screen ft. <br /> Slot size ffi 6 d ZG <br /> GROUTING Bags cement <br /> � � — ce <br /> Buckets bentonite <br /> xonf <br /> a�JVR YJ l �i <br /> Depth to water N 3d �P1 �'+ � Bags sand/gravel IJ 5� <br /> Mix Ratios J3 - $' ni -.500,411"9 Fiher Pack type/size <br /> Installation Method etw" u ge Block: - ( y /� <br /> Quantity Installed + w Discussed with geologist: - / n ) <br /> GfoJtWR3 r44de V4 Q V4)� En4t .s uaL Type of method /yp <br /> EH 29 29 t�SQin/YT( 0 f'P J V <br /> - a <br /> d -h QSw <br />