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&wNITORING WELL INSTALLATION REPOR'' <br /> Date: �n!�P U� � z CONSTRUCTION <br /> ( �/`f e f Jin_ Total Depth `f0 <br /> Premise Address:_3 2�0 N Screen Length (from) '7G ` (to) (_D ' <br /> �( ,.. '-1✓ra 1v11�1"S Filter Pack (from) '70 <br /> Well No.: n W �OG�' �� 5 - Bentonite (from) 57. <br /> Inspector. r 4' Grout (from) 5 3' l0 (to)_ U r d c e <br /> - - Drilling rig type eML '7,'>- <br /> permit <br /> 7SPermit No. C7 0 4` 0 `7 Auger O.D. P-i n&6 I.D. 4,2Z7 <br /> Completion - Stove pipe/qWistie b3. (circle one) <br /> Drilling Company-. ela S 61A/de- J7 r1, <br /> casing <br /> Driller: height <br /> a55i5+0n,+s; Ca los Bens) Dw;qht Mt15es, Avon ,q, �� <br /> Consultant A TE <br /> Geologist Anna B e-A r�n S <br /> ABOVE-GRCUND <br /> OCkVL.ET{ON CNRS5LE <br /> COMP N <br /> SPECIAL PERMIT INFO. Ground Sucfacs ��� <br /> groutDistance to sewer line U 4 rl n t.)n <br /> Domestic well on site - (y AD <br /> If yes, location and distance - 57. ft. <br /> -- a <br /> O <br /> SAMPLING C <br /> 5Qm/oAe-5 avP.r�Ca/(� .�1 o(vr; �nSfA Ad; secjcn _ <br /> Holding Temperature tJ A of Mitt-S, = gavel pack <br /> Method _ <br /> Screening Method <br /> Tracking Sheet - (y/ n) _ <br /> �70 _ <br /> it. <br /> SPOILS <br /> Storage Method SS- r ,--PS 0 s,+t MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/D 1 <br /> Storage Location oil—5 tz Casing type S le,4�16 40 2 a;arn <br /> Blank C_/7 ft- Screen 10 ft. <br /> Slot size 0 . coo I n UL,f <br /> GROUTING Bags cement <br /> Buckets bentonite Use-d Z - 5o 16,bags A,,e&-Idmed cl;f <br /> Depth to coater .52 S _ Bags sand/gravel a - iapl s Lu s hr 5G-)b. b¢gs <br /> Mix Ratios 8 e S /ham safe— Filter Pack type/size --3 <br /> Installation Method' G-rov} Surge Block: - ( y n <br /> Quantity Installed .2 T! Discussed with geologist: - n ) <br /> Type of method <br /> EH 29 29 Crr6 L) U.S 'B4jai <br /> 1+c pa r4 ja / <br /> _JJ f-1-X_7T_ • Z/7 1b. b��s. <br />