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MONITORING WELL INSTALLATION T <br /> r - _ <br /> � a r9 al n, l /iBaw�:Zc <br /> 'N1c Ca,� per Lu k- L < a 5'ga Ales ;Pio=o_3' Q�p -o <br /> .. 0-IS <br /> do FP"f <br /> Date: -59 + CONSTRUCTION Premise Address: /SYOG T icr /S/val. Total Depth as' ri <br /> Screen Length (from) a5'—a%K• (to) t 's- <br /> Well <br /> sWell No.: M k/ / a j ( a d , L ); a Filter Pack (from) As" — (to)AJ z. <br /> u Bentonite _ (from) ::3.Y (to) <br /> Inspector. (2 m/ oy Grout (from) (to) "rye <br /> Drilling rig type Aie� <br /> Permit No. * x t Auger O.D.- Z I.D. <br /> Completion - Stove pipe/chrtstie box (circle one) <br /> Drilling Company:_ M ;4¢ :X c <br /> Driller: 1U,4-, eff sing w <br /> _ r eight r .. <br /> Consultant v y - ACE <br /> t. 1 <br /> Geologist 7-0 �t • f <br /> VEd9ROUN Ct4i75TY 80X <br /> COA�LETION <br /> SPECIAL PERMIT INFO. Ground SLcf 1 <br /> Distance to sewer line VA grout <br /> Domestic well on site - T/n <br /> If yes, location and distance - <br /> 4 <br /> SAMPLING <br /> slored d <br /> axicn 52 _ <br /> Holding Temperature e/ <br /> Method A r_W ,o 4,.,Zca <br /> Screening Method_ _ _ P/D <br /> Tracking Sheet - (®/ n ) <br /> .. - -. a. rm. a5 ft. ,• � 0.b :fie <br /> SPOILS <br /> Storage Method Contamination Noted tff� _ rig+ -o� MATERIALS/DEVEI.OPMENT <br /> Contain <br /> Storage Location g, , .9� Casing type <br /> a /' O✓� <br /> Blank ft. Screen ft. <br /> Slot size o <br /> GROUTING Bags cement <br /> Buckets bentonitt 07&S 4flL a <br /> Depth to water 7. �; e V Bags'sand/gravel `/ WU& jpvtdj 4--k 6kgj <br /> Mix Ratios Filter'Pack type/size <br /> Installation Metho Surge Block: - (y/ n ) <br /> Quantity Installe4 4 �,. Discussed with geologist: - (&/ n ) <br /> Type'of method [� j PiQ S ,,� ,; 6a <br /> EH 29 29. - _ _, - � .,-- ,:... ' c, <br /> //Q sew /;-,.� � , ,. <br /> oCtRaP.P.)Lt..ICS A,,A/E'.,I/V bo'.�2s�+.. <br />