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, SAW]UMIN <br /> Environmental Health Department <br /> I .. COUNTY— <br /> `-`r;yFor''3' Greatness grows hcrn:. <br /> I <br /> sty Monitoring Well/Soil Boring Inspection Report <br /> q Date: \ SV.� � LTiiaNeCtor: S� CONSTRUCTION <br /> Facility Address: VID - <br /> Well Address: ( %K P M k/• Qi•W Total Depth: \T0 <br /> WP#\j')R-A _Well#: MJ3 �13> Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: �/QC�oI JpcOr(v <br /> Driller Onsite: Screen Length From: \O14 To: �1_ <br /> Consultant: Filter Pack From:. To: \IA::) <br /> Geologist: ( P.Q'EjFjlJ <br /> Bentonite From: Q, To: <br /> Grout From: SUl o: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe UJChristie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> COMPLE-BOX <br /> Holding Temperature: CowLEriON cohtatt-rioN <br /> Method: °ra;n°sutao. �__St1ILF <br /> Screening Method: arart 96 <br /> Verified Chain of Custody: ❑ Yes ❑No \�� Q ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: ; = s <br /> abttad <br /> Covered: ❑ Yes ❑No a�°� '° = <br /> VAM Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth% <br /> Depth to Water: ,�` W0' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: QUL <br /> f well Installation ❑Well Destruction Blank II Feet Screen ?biS Feet <br /> Slot Size: D. 0'L. <br /> ❑Boring Installation ❑Boring.Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity f�JTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags _ Bentonite/Cement Mix 3% MiX 5%MiX <br /> 2.5 5 1 s 10 1 Bentonite per 47lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.8214.7 <br /> 7.5 15 3 15 30 3 -, <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 35 70 7 <br /> 20 40 80 8 <br /> 10/16/2017 <br /> 4.1. 1 nC•AC 1 T /A/ AC° 7AnA 1 C nn(1 A A A nO 1 ------_:__LA __� <br />