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&ONITORING WELL INSTALLATION REP& <br /> Date: E? '�a-9-4 CONSTRUCTION \ <br /> Premise Address: S ✓�� ' �t�l5 bU✓� Total Depth <br /> Screen Length (from) +C0 (to) <br /> Well No.: M W I C) 5 R Filter Pack (from) (to) <br /> Bentonite (from) 44 (to) AL-5 <br /> Inspector: Grout (from) Ro) <br /> Drilling rig type <br /> Permit No. Auger O.D. iD3'y" I.D. <br /> ��^ <br /> DrillingCompletion - Stove pipe/christie box (circle one) <br /> Company: l� r '�� � �r <<I�l�rl <br /> Driller: �le-v -` casing <br /> Qn o� height <br /> Consultant (��`� Lv`� ' LL�CP • I�C� IEWTI <br /> Geologist Lob Agpyg GRWND <br /> COMPLETION CMPLE ON <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfx° <br /> Distance to sewer line NIA RR <br /> grout <br /> Domestic well on site - (y P5 n, <br /> If yes, location and distance - ^ n, <br /> t n. <br /> = m <br /> e <br /> _ o <br /> SAMPLING y5�cel vzt s-Ie � Sc�wPI�S n'r-TOG slatted <br /> i+cJon z <br /> Melding-Tetr mature g �l 1 < a - gravel pack <br /> Medtatl = <br /> n <br /> SPOILS _ <br /> .� Ta <br /> Storage Method iPLV1s MATERIALS/DEVELOPMENT Shu(oss <br /> Contamination Noted - (y/ k <br /> Storage Location onsite .cad'SPox9 _� a-,A 1Hc'$p4 Casing type 4usch /}D PvC <br /> +yV1clUM� Lc(c 3�kon5 e - \ ULd- V-" Blank 4(o fr. Screen 3a fr. <br /> ct 5�4 ciZPP�C Q Slot size O CID <br /> GROUTING 40' 'tr'ewv&te_ ' P Bags cement Qt) qq Uo � i <br /> AI&^ . <br /> Buckets bentonite <br /> Depth to water -65' `p-,,� Bags sand/gravel <br /> x,,,4 Q 4-41 Filter Pack type/size 1C <br /> Installation Method Surge Block: - (� n ) <br /> Quantity Installed Discussed with geologist: - )/ n ) <br /> QVSe✓S W2�e �IUS u/ <br /> Type o�thIMID pe bc((�o <br /> EH 2929 �� � 1P✓ll2d <br /> CW,C,LvL 1o1ab� w4k� ✓�v� Ira well's <br /> -1� Qeaed "y'e, �a <br /> 'fie wc�4�^ used' <br /> W V'-- , 1 ti e Qa, , eco {v s� 441ey^t� <br /> -(645' kM4-c U �u A L�- -lei� s fug l l . tl.s cL�crs I�l�el� <br /> C1�-e- `1T� ftie4.�•Lw, �cv+d�5'lSot,Gww-d<-Ns� . <br />