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04 <br /> .ONITORING WELL INSTALLATION REPO. _ _ P / Z 2. <br /> �vt* S - S0na) <br /> J Urr L �, ZO , r _ t ef+ o .4/r <br /> Date : Maiq a % 20( tAf?e ,2) Za / S"II CONSTRUCTION ;? wd s �te 1819A wr <br /> S :ie4,IF- // 136o <br /> Premise Address : Hunfe , S . pYpe )fiIK nO--rNA e Total Depth $ 0 ' <br /> &Y, +hi - 5a Li 4t.,_ s1 a of Hun+j: ,e 5'T Screen Length (from) 80 ' (to) 75 <br /> Well No . : h IV - / S Filter Pack (from) 90 (to) 3 <br /> Bentonite_ (from) 13 (to) <br /> Inspector: (to) <br /> K1 zK8 <br /> r . <br /> r$ Drilling rig t To /1yr v <br /> Permit No . 0 O 17 4;2- 1 8 8 V, Auger O .D. _ ft <br /> Complet on - Stove pipe christie bo , (circle one) <br /> Drilling Company: ri �nal141 ( rJ If , ) ), ne{ <br /> 5�29 /� ✓ <br /> e I i Grvana4 <br /> Driller: A, l Y:2 AD S L r C2a casing <br /> ��Z�/tAs3✓t ( ✓fi xlMnDPGd� J�.eQIR°�aR�`Sv height <br /> it4 <br /> Consultant )Y/[lne .v rp GJYroYe 4rn �rv��stj e rION Geologist L ' t ISG AgpyE,.GR�1ND ILvol % GV4 COWLET{ONCOMPL <br /> &N <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> proof <br /> Domestic well on site - ( y / n zt)_ ft <br /> If yes , location and distance - <br /> ft. <br /> SAMPLING ® o ed = c <br /> ex5on _ B <br /> Holding Temperature 5 -29—/r g'i —c5dy d6 �t � _ Pack <br /> Method (' an bf�� L 14 A ` ems- `0 4+ u = <br /> Screening Method P 1 <br /> Tracking Sheet - y /A _ <br /> SPOILS <br /> Storage MethodJS S7lfl�r 1NaatJ MATERIALS/DEVELOPMENT <br /> Contamination Noted - � �n/ 'fkl—oX f <br /> Storage Location J)"'i T�.c Casing type .�2 1k. _- SAdie4&4f �!7 <br /> Blank 7,S7' ft. Screen S ft. <br /> Slot size 0 ,920 a <br /> GROUTING Bags cement ?✓ 7 b f 1 ; ) <br /> Buckets bentonite t — 1 4�Ita/! / <br /> Depth to water Bags sand/gravel eRSp <br /> Mix Ratioscal <br /> IJ Filter Pack type/size 3 <br /> Installation Method % eb�/7rSurge Block: - ( y an <br /> Quantity Installed Discussed with geo ogisc - , n ) <br /> Type <br /> EH 29 29 <br />