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ONITORING WELL INSTALLATION REPO* <br /> Date: 11- z B o G CONSTRUCTION <br /> Premise Address:_ 14, 0 1 Tu rn vi k Total Depth <br /> Screen Length (from) <br /> Well No.: MW - 4 Filter Pack (from) (to) /3 ' <br /> Bentonite (from) / 3 (to) <br /> Inspector. V' ek e ed rimaf4 Grout (from) // (to) r --C- <br /> Drilling <br /> Drilling rig type ` <br /> Permit No. 0 0 4 8 84 7 Auger O.D. D i re r-t-� I.D.— Al. Z S <br /> Completion . Stove pipe/christie box (circle one) <br /> Drilling Company <br /> Driller: cS 1 Z4r - ri o Qir ��-T casing <br /> height <br /> Z; "Yd CI- 4 a, �h o n..o-t - <br /> Consultant A +� - T <br /> T <br /> Geologist Allye 16 J '+A ABovE-GRCUND <br /> CCNFLETION CN <br /> SPECIAL PERMIT INFO. �� Surtx� <br /> grout <br /> Distance to sewer line t n k-n o L.1nir <br /> Domestic well on site - (y'� lt, <br /> If yes, location and distance - 3 tt. <br /> = a <br /> — o <br /> = o <br /> — o <br /> SAMPLING doral <br /> tac5on —_ <br /> Holding Temperature 4 �(� = gravel pale <br /> Method I <br /> Screening Method = <br /> Tracking Sheet - y n) <br /> P4 : S '� to' S' 20' LS' 30, 3S ' - PID read-, tj _ �S tt. _ = n. <br /> 4,6 n.o-,a ♦- <br /> SPOILS / <br /> Storage Methodr7s- g4//, z LDr11�lL✓ MATERIALS/`DEVELOPMENT <br /> Contamination Noted - (y/ nQ e Z 2 0 <br /> Storage Loof �(catioq b'Ya-C, f� Casing type �„ seti.e�L��,--J=— <br /> Blank ft. Screen 2 0 h• <br /> Slot size ()- <br /> GROUTING Bags cement l0 7 i rn� <br /> Buckets bentonite 5-h* "rhr <br /> Depth to water <br /> Bags sand/gravel 12 �f 1'— <br /> Mix Ratios A� Filter Pack type/size 3V o;J Lu <br /> Installation Method Surge Block: - ( y/ n <br /> Quantity Installed Discussed with geologist: - ( y <br /> Type of method <br /> EH 29 29 <br />