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a-, - s � - ... - Y-..ate.....� .. b wa..-e •--=,r 4 !. -.e u.. «. - �..r d. ,SY v , <br /> MONITORING WELL INSTALLATION REPUK'I <br /> p G/zzf/° <br /> ` s.N • _ _ ._ - _ T. �`zi�/o �'un�� �.�tbdvf b_s`F <br /> Date: p- - 2 6/U,__. .. ` . CONSTRUCTION <br /> COun+- riylt+-OT- 2tJ. /L�Qr Q i <br /> Premise Address: .2;Y3 SS' IOW a 99 AdWmfo . Total Depth- <br /> MM- Screen Length (from) !t (to) _ <br /> Well No.: )m W_- 1 ,0 Aft -S] e- Filter Pack (from)- S (to) 70 r <br /> Bentonite (from) S (to) <br /> Inspector: Grout... (from) 6 3 t. (to) xu r Az,,e-- <br /> Drilling rig type rh u I rAa <br /> Permit No.. eS }Z D D 579 1-/' $ _ .,Auger O.D. 7 i k r bid I.D. <br /> Completion- Stove pipe/ tstie box SOFele one) <br /> Drilling Company: <br /> Driller: / YY B A AJ <br /> ' Ja sort Ale Tr - casing <br /> 1{ A5,Y;sfanf - ,f'',',"J� I - Faus+o -S4q Ors height <br /> i - Consultant - F Y! VI <br /> r o n rn ems, 'a,� �1 2.5 0-� r/-_-�'o n'5 c, ....,r <br /> Geologist David - Dq n ; E'S -( 9 n, <br /> j l� <br /> ABOVE-GROUND <br /> IC.p IQS hNr1GAc0OWPE7Ch! <br /> VPC <br /> SPECIAL PERMIT INFO. Ground Surface <br /> • proof <br /> Distance to sewer line 1/r1kYLetu}, / 0ff .., <br /> a. Domestic well on site - (Vn ) <br /> If y6, location and distance - w 0 ft <br /> ,'J42Yo�j rY2 a'7//,, 1 I>, rev r` ..70 7S ft. 7 <br /> .. <br /> 1 = q <br /> SAMPLING •lotted - c <br /> ti <br /> racoon _ B <br /> r <br /> Holding TemperatureQr&V%4 pack <br /> aCi /IS <br /> ! Method_ j t- - i n is �n21 Prr _ •- . <br /> Screening Method r` _ <br /> Tracking Sheet -(yY-(yn ) <br /> y SPOILSt OW 7,07YJ <br /> r ` <br /> Storage Method jo i n -Ld i)l �e tErnaYr�r G%LS/!d` MATERIALS/DEVELOPMENT. / <br /> Contamination Noted - (y/ n ) . - m_. a_ !ri stn S[ �iEGU! <br /> Storage Location n¢a Y `I�t i S Casing type r/Ie a <br /> 3 - Blank IS ft. Screen c?O <br /> $.. _. . .• .._ _ Slot size 6 . D_D 1t t <br /> { - <br /> GROUTING Bags cement 13 417-1 s <br /> tq Buckets bentonite ¢ 1 7 1 / <br /> Depth to water ti X(Ia Bags sand/gravel - 4 l. <br /> + ; Mix Ratios �tis�¢ 2S-aQ!/a„J efw�t� 8 y7j� <br /> Filter Pack e .3 <br /> ! Installation Method G / S2/' < Surge Block: - �/ <br /> Quantity Installed 3 �2VP /�� <� Discussed with geologist 0/ n ) a <br /> Type of method -511 a r he <br /> ' EH 29 29 <br /> b v ,< <br /> F"' <br />