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MONITORING WELL INSTALLATION REPORT <br /> Date:_ 3-- /7 - 13 CONSTRUCTION <br /> z / <br /> Premise Address: 3d $� 6 �� 51'ck,. C CP4 ` Total Depth 5 (o <br /> Well No.: �)W Screen Length (from)' /A (to) 3 T <br /> I� \ / Filtet Pack (from) I (to)� <br /> Inspector: D nwv. / 7 a �C uyt� GroutBento (from) <br /> (from) 9' (to) <br /> (from) / (to) <br /> Drilling rig e i/M <br /> Permit No. Auger O.D. �. Z r' LD. <br /> 1 1 ^ Completion- Stove pipe/ • stie box (circJQ o e) <br /> Drilling Company:. hlt �/ /� ch <br /> Driller:_,/ ugV�- pi%Soc Ctf 'Ci casing <br /> /� J / height <br /> Consultant"�/'"�`✓tercto) �'y6�lyiWnvh,,,/7�+ <br /> Geologist .IJAA )'c1/ . &✓11/{,(/C` _ <br /> ABOVE-GROUND <br /> cowLETION CHRZTY-BOX <br /> C PLETION <br /> SPECIAL PERMIT INFO. Ground Suixa <br /> Distance to sewer line <br /> Domestic well on site . (y6TA1 QS <br /> If yes, location and distance - -� <br /> _I'D ft. = 5 <br /> sA, m <br /> O <br /> C <br /> SAMPLING = <br /> �btted — 'c <br /> Holding Temperature L = vavo packMethod _/CL G/n uS _ <br /> Screening Method = <br /> Tracking Sheet - n) <br /> aft. = tt. <br /> SPOILS <br /> Storage Method Say 4,11, MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type S c 1 L/U P U C- <br /> Blank 0 - 1 0 ft. Screen_-_/G-�ft. <br /> Slot size 0 • o t o - <br /> GROUTING Bags cement <br /> _ . Buckets bentonite ` -L <br /> Depth to water Bags sand/gravel _0 9`/ bS <br /> Mix Ratios Filter Pack type/size �2 <br /> Installation Method _.- Surge_Block:_,_(.y- -d; <br /> Quantity Installed Discussed with geologist: -C%' n ) <br /> Type of method A11 <br /> EH 29 29 <br />