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"TvIONITORING WELL INSTALLATION REP61`,, <br /> Date: IUdY1� Zp /l CONSTRUCTION <br /> Premise Address:_ .z Z;_' �Z /Yl� o _��y' Total Depth_ o2 7 <br /> Screen Length (from) _-2 7 <br /> Well No.: (to) 2-y- , <br /> Q Z - 2 Filter Pack (from) 2-7 (to) 2 y <br /> Bentonite (from) (to) <br /> Inspector: vi GlGe_ r Grout (from) (to) <br /> Drilling rig type <br /> Permit No. D O �d? '7 /Z Auger O.D. I 2S I.D. <br /> Completion - Stove pi christie bo (circle one-)-)Drilling Company: �S� r. <br /> Driller: S I� r i IV D rynj nj)Ctl��c casing <br /> Cir/o S n10 6, u� ES�-r //q height <br /> Consultant n It:,-jf , <br /> Geologist :D4 Vi C!yt U e-Va <br /> ABCVE-GROUND <br /> COMPLETION CHRZ Y-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Gd S <br /> Distance to sewer line —_2O 5 ' grout <br /> Domestic well on site - ( / n7 p p <br /> If yes, location and distance - 4 ft. <br /> -7X ft. <br /> ;2v o -eLs:-ft. <br /> 27 _7 <br /> - 10 <br /> SAMPLING o <br /> slotted _r � <br /> sacton <br /> Holding Temperature_ <br /> Method <br /> I Utz Xa, = Sr^tavel Pack <br /> Screening Method /D _— <br /> :C: <br /> Tracking Sheet -,-�/ n ) _ <br /> 7 ft. ft. <br /> SPOILS <br /> Storage Method - i-u MATERIALS/DEVELOPMENT <br /> Contamination Noted ) <br /> Storage Location ex-f Casing type _ PuC SG�tLr <br /> Blank ZE 2S ft. Screen 2- <br /> ft. <br /> Slot size ` <br /> GROUTING Bags cement #� <br /> Buckets bentonite BaG y <br /> Depth to water w- �f-���� s sand/ <br /> Bags gravel_ � S -!� L4.�;�,(.��fi_ <br /> Mix Ratios fdr f7 471b b, ' Filter Pack type/size <br /> Installation Method S Vee"? Surge Block: - ( y/0 <br /> Quantity Installed /0 6 Qo ry Discussed with geologist: - (q/ n ) <br /> �'�'���t+� i n l-i�C v►aye o Type of method <br /> EH 29 29 <br /> of6�(�r'a <br /> !0}'&0 0 o�sA/L/YYC.f <br />