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MONITORING WELL INSTALLATION REPORT <br /> Date: 731-1–?.oPL CONSTRUCTION <br /> Premise Address: 30lS h13W �YNe t ek��" Total Depth { <br /> Screen Length (from) o (to) Ss <br /> Well No.: "�C>�T Zg Filter Pack (from) 2:� (to) 35 <br /> Bentonite (from) :;L.s (to) 2$. <br /> Inspector: -Te21 alio x vVs Grout (from) O 5 <br /> (to) 2 <br /> Drilling rig type Ctit� <br /> Permit No. O0('052-z( Auger O.D. &a" I.D. 'q- <br /> Completion <br /> Completion - Stove pipe hristie box (circle one) <br /> Drilling Company: �' LS Ga,.r ,(w.�twx , ��• <br /> Driller: ane SAIA .7:3r casing <br /> height y <br /> Consultant &v\'4r+bV\moy�ect <br /> n <br /> Geologist 1"L Lv' Noll W- T <br /> r <br /> ABOVE-GROUND C7-ff115TY-80X <br /> COh'PLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Staface <br /> Distance to sewer line VW ki— Of O1 t <br /> Domestic well on site - (y�on ft <br /> If yes, location and distance- <br /> 31) <br /> _ m <br /> . = m <br /> SAMPLING ilcnad <br /> ;s =_ <br /> w'tion <br /> Holding g Temperature` 4$c, <br /> Method C T4., NekyJ( ��enr• Vt4 load I v <br /> Screening Method�—� <br /> Tracking Sheet - y n) _— <br /> �v5 <br /> SPOILS <br /> Storage Method ®Vt4k V-01 -o4 6v` MATERIALS/DEVELOPMENT <br /> Contamination Noted - 02)y n) ` n , <br /> Storage LocationyW A'.% gibs a4 yz- Casing type 2" �cana.�.�.r. 4co t– <br /> Blank 3a ft. Screen 3S ft. <br /> Slot size O.OLb–tiv.c <br /> GROUTING Bags cement 9 41 . <br /> Buckets bentonite I To t6 <br /> Depth to water Bags sand/gravel fo Sv b _ <br /> Mix Ratios4r-k6s Filter Pack type/size i�ko tz- <br /> Installation Method �A Surge Block: - 0/ n) <br /> Quantity Installed '55 c Discussed with geologist: - ((,b/ n) <br /> Type of method <br /> EH 29 29 p� <br />