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MONITORING WELL INSTALLATION REPO <br /> Date: ! 9 �20 I _ CONSTRUCTION //II <br /> Premise Address: 1 �; Total Depth TS <br /> /� I Screen Length (from) (to) a L <br /> Well No.:_ � v W - '� _ ________ Filter Pack (from) -(to)---1,3 <br /> Bentonite (from) a 3 (to) I j' <br /> Inspector: Y Grout {from) 19__ __(to)_ sEtrface - <br /> Drilling rig type 6- <br /> Permit No. Sit j�j) G 2 Auger D.D. Y I.D. , Z s`; <br /> Completion - Stove pipe/christ2e box (circle one) <br /> Drilling Company: s � <br /> Driller: -T6 In/", t.7 L4C a$S casing <br /> i s b <br /> JQmes Ince--Yn��re� � height <br /> Consultant <br /> Geologist_ _ ]_l �py <br /> ABOVE-GROUND <br /> COWLETION CHRtM43OX <br /> COMPt.EMON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n g <br /> If yes, location and distance - B• <br /> � ft, <br /> � Sft. <br /> m <br /> a•= p <br /> Tn. d <br /> SAMPLING <br /> slottQd Y? � <br /> auction x�: —_ <br /> Holding Temperature -X725-Gy1„�� �-Cl( <br /> Method _ �- �� —_ 9M` Pack <br /> Screening Method ? " — <br /> Tracking Sheet - (y/ n) !V iT <br /> IFft. <br /> SPOILS <br /> Storage Method rdrI MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n <br /> Storage Location 'S' -e- Casing type._ i n !4/t%i <br /> Blank----_2y::- ft. Screen 2d ft. <br /> Slot size _ 0,a / ".d4"Z <br /> GROUTING Bags cement a -116 <br /> ,I <br /> ?_-Buckets. bentonite cnt sro_-w Psi f�x+a IO91 t-V and ens MA- cot" <br /> Depth to water 7. Bags sand/gravel G one-honlr,el •b�n,nd ck. X :I <br /> Mix Ratiosv F �S`�q//rte o�idq�Filter Pack type/size 2/ 1 L <br /> Installation Method i - �f Surge Block. - ( n ) <br /> Quantity Installed _ ! kb4JJ*�'.d� rn4d' i., 4llr,,— Discussed with geologist: - O/ n ) <br /> Type of method5 U <br /> EH 29 29 <br /> H�A ra+ed NS G b �oY►i e <br />