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'%�ONITORING WELL INSTALLATION REP(,,,1 <br /> Date: 2 ' 6 CONSTRUCTION <br /> Premise Address: 20?) S• U vAGyl h Total Depth <br /> Screen Length (from) 13:5 (to) <br /> 'I�' <br /> Well No.: ,�1,W I Filter Pack (from) 35 (to) 1:5 <br /> Bentonite (from) l3 (to) I <br /> Inspector: Il�/�w"1� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> DrillingCompany: <br /> �` �l D►^L l`L Completion -�S �christie box (circle one) <br /> Driller: ��"� — w� �� casing <br /> 17Theight <br /> Consultant �?3Y>�L <br /> _qvTGeologist (Oy"_ L-L)�G.✓� ._ 19 <br /> 3S— Z ABOVE-GROUND CHSZTY43OX <br /> COMPLETION <br /> COMPLETION <br /> SPgGi I, PHP"rdT-fN v. Ground SuAxt <br /> Distance to sewer line Ofout <br /> Domestic well on site - y n ) <br /> If yes, location and distance <br /> � ft. <br /> too N1 <br /> b <br /> C <br /> SAMPLINGs ,, <br /> lotted � <br /> Is section = <br /> Holding Temperature aCLegcr-4-e- <br /> Method LLt cl, ¢StCr')51'PI ° � _ wsvel Pack <br /> Screening Method Pi P <br /> Tracking Sheet - (6y n) IDcn--,vc c l__ 6�cr t1xl'o 'J, _ �J <br /> o��e 35 n. = n. <br /> dveyvl, <br /> SPOILS (t( <br /> Storage Method LA__ �S C W/J,t,S MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ 2- 11 <br /> PUG <br /> Storage Location ( - go�i'ti•� Casing type <br /> Blank 1 ft. Screen ft. <br /> Slot size D <br /> GROUTING Bags cement <br /> Buckets bentonite , <br /> Depth to water Bags sand/gravel 3 — <br /> Mix Ratios Filter Pack type/ ' ;e Zr 12 <br /> Installation MethodONrP_ Q Surge Block: - lY/i n ) <br /> Quantity Installed Discussed with geologist: - a n ) <br /> Type of method � tx_L <br /> EH 29 29 -D/-4- vw Fly _4- NW LZ29 <br /> CZV� +n L-(-(-- t7le--oe4ca 4� <br /> 1+ w&-j o���� tb �� <br />