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.ONITORING WELL INSTALLATION REPOr _ - <br /> Date : Z7 CONSTRUCTION <br /> kr '/ r r <br /> Premise Address : : J , Total Depth <br /> G47S-1- b -] / q40 J r V by ra�d- a J t Screen Length (from) (to) 305� ' <br /> Well No . : ow w ` jig Filter Pack (from) sp ' (to) 13 ' <br /> Bentonite (from) 33 ' (to) 34!_, _. <br /> Inspector: Grout (from)— (to) CS �- <br /> Drilling rig type in d ' Clr�L a.vaog 2swo rTq <br /> Permit No . 6L CC� a 18 8 Auger O.D. $ LD. , 2S <br /> mod <br /> �/ / Completion - Stove pipe/christie box (circle one) <br /> Drilling Com an YVnn /II l 14nd= �rvl ti <br /> g P Y �!! <br /> Driller: �niz` d 16? a5 `1QG � r�03 "�- IC2Q casing <br /> A& m eg air 4n 0 height <br /> i4C <br /> Consultant & �jAvr`� GqPO <br /> Geologist C�(kyJl � I � ny �J� <br /> ABOVE-GRO(JND CNAISTl'-80X <br /> COWPLETION COMPLETION <br /> SPECIAL PERMIT INFO . } mrd Sa�e <br /> Nov J procrt <br /> Distance to sewer line � <br /> Domestic well on site - ( y AD <br /> If yes, location and distance - <br /> ft. <br /> h. <br /> _ M <br /> SAMPLING dotted & <br /> �1 641e �� wcJon � <br /> Holding Temperature o Sai orrWa+�+ vs1 <br /> Method 94 ` /� _ <br /> Screening Method ffA <br /> Tracking Sheet - ( y / n ) — /l/ <br /> su So n. <br /> SPOILS <br /> Storage Method s ° ae ffr" { rums ' Qv1Sr4-B MATERIALS/DEVELOPMENT <br /> ' Contamination Noted - ( y / u') 51 7Yf a dee <br /> Storage Location Sq� Casing type_ <br /> Blank 3S ft. Screen / S" ft. <br /> Slot size OZd <br /> GROUTING Bags cement <br /> Buckets bentonite_ jIPTS <br /> Depth to water / i G' Bags sand/gravel d ` <br /> Mix Ratios - ;-�# Filter Pack type/size / 3 <br /> Installation Method 39' 'I"u 4bYllrns Surge Block: - ( y /©) <br /> Quantity Installed o3o of Wy}o� Discussed with geologist : - n ) <br /> j Type of method Ah+ <br /> FH 29 29 Gn A W65 mAd 4 <br />