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l MONITORING WELL INSTALLATION REPORt <br /> 1 <br /> t Date: /(/ 3 CONSTRUCTION <br /> I _ <br /> Premise Address : •4 .2 S LQY� ��. 1 YtieGr Total Depth M W <br /> Screen Length (from) (to) tial 3a ' <br /> Well No. : _ l� ill/ / Filter Pack (from) (to) ZS ' <br /> ` , A i r4Bentoniteclupb(from) .78 ' (to) ZnJ <br /> Inspector. 1 i*dl � YVI _ L _7iuw Grout (from) .74 ' (to) gr rade <br /> Drilling rig type C Sr/ <br /> Permit No. 6634344 Auger O.D. LD. <br /> FU <br /> Completion - Stove pipe/dtristie box (circle one) <br /> Drilling Company: Wee k3 pr ; 11 ; na it ( Ump 606 - 5e, ba? smo pe 1 , eA <br /> Driller: Don CAnnisfracl and Wad ogbvrn FMI <br /> � aaeing <br /> height <br /> Consultant dames jazm ; n and lklytnl 3lgk¢ly <br /> �B14 ly En IPonmen.-zzA rnud.ct;yd'3% oas <br /> G:eelagist�� ct tp✓ ABOVE-GROUND <br /> COhf'LETION <br /> &=nc <br /> SPECIAL PERMIT INFO. ac01rd Sact MIMI <br /> Distance to sewer line [grout <br /> Domestic well on site - ( y / n AO ft, <br /> If yes, location and distance - 3V ao ' -28 h- <br /> tt. <br /> SAMPLING = B <br /> sacicn <br /> Holding Temperature Sea VIVS4 Pack <br /> Method <br /> Screening Method P t D S <br /> Tracking Sheet - ( y / n ) _- <br /> "1 ,,Li <br /> ft. = ft. <br /> SPOILS So ;l SaMfjet Oji S ` 1' n fgorV41 S . <br /> Sart 540WiI04 44tA01y zcX44t44 socJ44c4 z4vLr <br /> Storage Method MATERIALS/DEVELOPMENT 0Y4 6 <br /> J <br /> Contamination Noted - ( y / n ) pY� C/� <br /> Storage Location Casing type <br /> Blank 3 ft. Screen 3 6 SSU ft. <br /> Slot size c7 r 02� 0 <br /> GROUTING Bags cement <br /> Buckets bentonite 1 /llda _!l/125 <br /> Depth to water ^' 1 / Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method.4nordd 4•Yn .M zwkia laarrt/ Surge Block: - ( y /6) <br /> Quantity Installed 64411 rx we}ir / ba Discussed with geologist: - ( y / Q <br /> �,JParJoJZ- Type of method <br /> EH 29 29 <br />