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.jNITORING WELL INSTALLATION REPOI, <br /> i?e yo l rn ' well - 1 oe' }O-w ti J 0 4'M4 <br /> SOd+-h <br /> Date: L Iq 107CONSTRUCTION <br /> Premise Address: 491 ,J-,e ),)PJli r1 rLt �c Total Depth 4.0 e.e J <br /> r'�Jh+-e -Cv�` on Ca lc Rd, Jd-- Te nR <br /> t . Screen Length (from) to) <br /> Well No.: K M Ltl Ys ^ R Filter Pack (from) to) O <br /> Bentonite (from) S' (to) 2-' ziAe A_ <br /> Inspector. - V i e k , Grout (from)S (to) .2S-,S fay � <br /> Drilling rig type c <br /> IS- <br /> Permit No. 49 .7.2�' Auger O.D. I.D. .ed <br /> Drilling Company: FS'I"A rY1eir,`ccE Completion - Stove pipe iristie bo (circle one) <br /> Driller: - z casing <br /> a rLSA e- Aagd r-Gcv Ya V � height <br /> Consultant ane S i S V <br /> Geologist John d4a 1Pe­r- _ 4nim-- T <br /> ABOVE-GRCUND �� <br /> CO WLEMN cOMPLmON <br /> SPECIAL PERMIT INFO. around Suriacs — <br /> Distance to sewer line o grout <br /> 1 <br /> Domestic well on site - (y/ ) ft. <br /> If yes, location and dista e - ,? ,5 ft, <br /> eft. <br /> _ a <br /> SAMPLING slottad _ <br /> aoincn <br /> Holding Temperature - ,,'i Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet y/ n ) _ <br /> 4 tZ.fi. `� = ft. <br /> SPOILS <br /> Storage Method mss-AQ 6l dl'y2P MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location 9 w Casing type .2 t *,,� S62 44 t o r <br /> 0 <br /> (-0` Blank 30 ft. Screen <br /> U Slot size <br /> GROUTING Bags cement <br /> t 's Buckets bentonite - <br /> Depth to water 0PL%'J9+"9.1-Bags sand/gravel <br /> Mix Ratios —.2 S b ,b SCagra; filter Pack type/size 2 / ) <br /> Installation Method qz-W Surge Block: - ( y/rnlh <br /> Quantity Installed /,j soli Discussed with geol'o'gist: - n) <br /> --V7 Type of method <br /> EH 29 29 <br />