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M� <br /> 410NITORING WELL INSTALLATION REPORC <br /> ,Day- cloudy - a-6oit 40` � o'k? ly <br /> Date: N o Jembe-f- n�3`/ 2,011 CONSTRUCTION <br /> Premise Address: 5-08 CA4 fYY Wa N Total Depth 44. <br /> Screen Length (from) /G (to) <br /> Well No.: !r- I Filter Pack (from) /L (to)�_ <br /> Bentonite (from) cl (to) <br /> Inspector: PM Grout <br /> Drilling rig type <br /> Permit No. S R 0 0 4 3 7 SO Auger O.D.-- jift jw A <br /> I Completion- Stove pipe/c 'sti circle one) <br /> Drilling Company: WDG �xD Jn Yl�7"Y�_�1�fe l l s <br /> Driller: Y WcasLng <br /> Ui z 't de_ F'cbP.r+s height <br /> Consultant $}y �-Geologist LQr�vbir'onks .�rray�t✓G}QPiY"�JcJ ABOVE-GROUND ta BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground SuA'c° <br /> Distance to sewer line Grout <br /> Domestic well on site - (y AD (ft, <br /> If yes, location and distance - <br /> .fin. <br /> q <br /> � C <br /> SAMPLING 5 abtted <br /> l L PjtY� w` �D I = 'c <br /> 8 <br /> T� Pi j) Q4t+talis rertoadon 'x <br /> Holding Temperature S 7.S��o,,t _ gravel pxk <br /> Method 3.a .,— <br /> Screening Method P I E"f <br /> Tracking Sheet - n ) ISr t 7-f <br /> SPOILS <br /> Storage Method d1 n� MATERIALS/DEVELOPMENT <br /> Contamination Noted -0 I <br /> '/ <br /> Storage Location rw r,`7 t Casing type 'Y <br /> Blank !/ ft. Screen �5- ft. <br /> Slot size 441 <br /> GROUTING Bags cement 19 - re -` bJjS <br /> bV BaelcembentoniteAwa aE p cg�/ <br /> Depth to water �✓ r ba Bags sand/gravel is b <br /> Mix Ratios4 b6VA ('17-# .;;1 r� �J1—OA411�yrf{zD Filter Pack type/size <br /> Installation Method !/.,t drv� Surge Block: - (y n <br /> Quantity Installed bkfA r Discussed with geologist: - "n ) <br /> U Type of method <br /> EH 29 29 <br />