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:MONITORING WELL INSTALLATION REPORT <br /> '04-r - sUrcnj / aboot 1'2'r <br /> Date: Mdr6h -2011 CONSTRUCTION <br /> Premise Address: 42E LAA, Total Depth 211) r <br /> Screen Length (from) 20` (to) 5 ' <br /> Well No.: MW - 28 Filter Pack (from) 20' (to) 4 <br /> Bentonite (from) 4 ' (to) 3 ' <br /> Inspector: V Grout (from) 3 , (to) <br /> Drilling rig type e e--.0 <br /> rT <br /> Permit No. .51t * OG6 -aJ03 Auger O.D. S In eh ej I.D. q,Zs- i Gle r,1 <br /> Completion - Stove pipe/ stie (circle one) <br /> Drilling Company: e ri �, <br /> JPSSG a'�isvn '! <br /> Driller: V&t o p W/�� casing <br /> ,n ,1 Y height <br /> A <br /> Consultant m'' , Ad,,,, ; u 4-ise• (/�-/}.+d4) <br /> Geologist 1I tkA"G Q W 64-) <br /> ABOVE-GROUND , <br /> COMPLETION COMP ON <br /> SPECIAL PERMIT INFO. n f Ground Suriac0 <br /> Distance to sewer line cW TGG grout <br /> Domestic well on site - (y 10 1 3 h <br /> If yes, location and distance - <br /> ft. <br /> n. <br /> F <br /> 9 <br /> SAMPLING IVU S0l•l 154/Aa0/Gd c4-1/Z4jC-1 gloUd <br /> taction <br /> Holding Temperature vaVE4 pack <br /> Method Wit <br /> Screening Method /V14 ri <br /> Tracking Sheet - (y/ n ) AIA <br /> SPOILS <br /> Storage Method Jr� 44—�/ 4YUrrzJ MATERIALS/DEVELOPMENT <br /> Contamination Noted • (y�tiy1 <br /> Storage Lore-4 Casing type -Z 'i�h64, <br /> Blank .57 ft. Screen <br /> Slot size 0,U <br /> GROUTING Bags cement 3 of A 41-Ibhha 8ata1-h SF-TC �� <br /> Baekets bentonite' %s of aSd-Ib baa CEreo PUrc6olai-JA*,�r <br /> Depth to water N0�( w6A'%S.1'r Ql Bags sand/gravel r i <br /> Mix Ratios S aalle„ buwk- w,4it ^ 2. al cpuYfl^ Filter Pack type/size 2116 ° <br /> Installation Method •Gr a bo6kP1 -h 314 of w Surge Block: - ( y/0 <br /> Quantity Installed rm e bAl-1.1 ��1LV Discussed with geologist: - ( y 0 <br /> Type of method <br /> EH 29 29 <br /> .Fiv. �glln�c�rurws ( x.c kalf ;VY/� da 3/¢ �vl� /�l�i /e pi�S23 LRr� <br /> :A- <br /> r) <br />