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MONITORING WELL INSTALLATION REPO, <br /> D� - 5vvtn.� , fru 1- 8d " f= <br /> Date: CONSTRUCTION <br /> Premise Address :_ r�r,orn F Total Depth S <br /> S _ Screen Length (from) 42S (to) 23 <br /> Well No . : A Filter Pack (from) 23- (to) 21 <br /> Vick ; <br /> I Bentonite (from) 02 1 (to) / 8 <br /> Inspector; _ � 1 ck MCiarril mil Grout (from) ! 8 (to) t5ur�ac , <br /> / T Drilling rig type 75 <br /> Permit No. S (2 4- yc Q 6 $ Auger O.D. R " I .D._ ice ' <br /> I Completion - Stove pip c sue ox circle one) <br /> Drilling Company:_ Alt INe-il �� n /�PInri1P� <br /> Driller. JA S ¢.- ( P /+ <br /> TT casing <br /> G height <br /> Consultant <br /> Geologist .14n ' el — f} GE <br /> ABOVE-GAOUND <br /> COMPLETION VCOMP <br /> SPECIAL PERMIT INFO. Ground Surlacs <br /> Distance to sewer line " �ST22f grout <br /> Domestic well on site - ( y n <br /> If yes, location and distance - <br /> Z ft. <br /> SAMPLING ibtted = 3 <br /> taclon = <br /> Holding Temperature — /(le sa ; Hi n/ s wer4 Ci <br /> Method N /} _ Vaw Pack <br /> Screening Method_ �/f} <br /> Tracking Sheet - ( y / n ) &A <br /> eft. _ I F <br /> SPOILS <br /> Storage Method SS - 4 ) 1 ErL drVma — erta ,¢e, MATERIALS/DEVELOPMENT <br /> Contamination Noted <br /> Storage Location_ n nS '"I'a- Casing type - 1k2 Zej7i jAf 40 <br /> Blank Z3 ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 2 Cev„ e�_LLAe , .rt� .6v* <br /> Mix Ratios 3 - /b ^- }S �i+� y� Filter Pack type/size #_3n <br /> Installation Method_�y e QO��p Yh �u Qu py.- Surge Block: - y n ) <br /> Quantity Installed / (�gj� O Discussed with ologist: - & n ) <br /> EH 29 29 Type of method <br /> Q � /b6 alevq�a TS� rxt d �v �x � � 9�1b �, -Ti ta - <br />