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I <br /> -ONITORING WELL INSTALLATION REPOr. . <br /> N <br /> Co <br /> L{ OI� <br /> Date: Ifn ✓em 6e zcl1 201 / CONSTRUCTION `J �� (JSa F <br /> Premise Address: d3 / 47 S El Dr A/o S�, Total Depth 0 <br /> Well No. : D P E - Z Screen Length (from) j (to) / 0 <br /> Filter Pack (from) 0 (to) Q <br /> Inspector: Ji Gly McCk ren BentoGrout (from) <br /> (from) $ (to) 6 <br /> (from) (r (to) SUr Y [,Z <br /> / Drilling rig type e! 1 L <br /> Permit No, DOL 3 R 2 Auger O.D. 10 d $ " v � I.D. � d- 4 <br /> Completion - Stove pi e/Christie box (circle one) <br /> Drill ng Company: 11 <br /> Driller:- M nU�J CP L� d VOLS-e rP� a casing <br /> - height <br /> Consultant gL�Uditpe a� oEltl/ r` ronrn o�j1he, <br /> Geologist " Ude vol . <br /> ABOVE-GROUND CNA STY BO <br /> N <br /> SPECIAL PERMIT INFO. COMPLETION <br /> � � { ( Ground Surface <br /> Distance to sewer line - izeeA-Jfl C grout <br /> Domestic well on site - ( y n ) O <br /> If yes, location and distance - S 0 -i 8 h• <br /> Ph /0 o /o n. n. <br /> ! V <br /> 20, 5 - L1,D 2. 3 = <br /> SAMPLING — <br /> aOF. 0 -2./, S 3. 0 slotted = 8c <br /> 2S Wes, sec4on — <br /> Holding Temperature 40(ri = <br /> Method ICP �j ' L /Ane) 1& 30 $ 7S = gravel Pack <br /> Screening Method P I I 3S — 1 tV D7 <br /> Tracking Sheet - y n ) <br /> 40 ft <br /> SPOILS <br /> storage Method 4$_ < /Xrmalru..27 70) MATERIALS/DEVELOPMENT <br /> Contamination Noted - J <br /> Storage Location 0 1 &' -c Casing type S 'vlZY use X�/ ✓G <br /> Blank- 117 ft. Screen 36 ft. <br /> size Slot 0 , 0 2t) " <br /> GROUTING Bags cement I—VAJS j—1k r / c T <br /> Buckets bentonite o "- G" o (gr one Sad Xf < <br /> Depth to water Bags sand/gravel /Su /0- 64%S <br /> Mix Ratios o2hao ' 1 $ Q01k)x5 r 1a6'e -{0 � bjS (gµ 0l Filter Pack type/�s}'ze #�3 <br /> Installation Method op , rsn� Grm + LY SS-4a(/6�J Olru *+ Surge Block: - { yf/ n ) <br /> Quantity Installed. �� bnf Discussed with geologist: -(g/ n ) <br /> Type of method <br /> EH 29 29 <br />