Exhibit A5 - well-completion.pdf

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MW-D1 Replacement
Solicitation number
ISD-366011-RO
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The document is an Illinois Environmental Protection Agency Well Completion Report form, which provides comprehensive technical details for a well construction project. The form captures critical specifications including site information, drilling details, and well construction materials. Key technical details include a 6-inch borehole diameter, screen slot size (not specified), and materials such as stainless steel (SS304, SS316) or PVC for various well components. The well was constructed using a concrete surface seal, bentonite slurry annular sealant installed via tremie pipe, and a 20-sieve size sand pack. Elevation and depth measurements are recorded, with the bottom of the well at 40.25 feet and bottom of borehole at 40.5 feet, referenced to a National Geodetic Datum. The report documents installation methods, setting times, and specific construction parameters for each well component.

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Illinois Environmental Protection Agency Well Completion Report

Site Na State Plane C

Well #: _____________

Borehole #: __________

Surve

Drilli

Cons

Drilli

Logg

Repo Comp

AN

WELL CO

Protective C Riser Pipe A Riser Pipe B Screen

Well Comple Site Number: __________________________ County: __________________ me: ___________________________________________________________ o ' " o ' " oordinate: X _____ Y _____ (or) Latitude: ____ ____ ____ Longitude: ____ ____ ____ yed by: ______________________________________ ng Contractor: _________________________________ ulting Firm: ___________________________________ ng Method: ___________________________________ ed By: _______________________________________ rt Form leted By: _____________________________________

IL Registration #: _______________________________

Driller: ________________________________________

Geologist: ______________________________________

Drilling Fluid (Type): _____________________________

Date Started: ____________ Date Finished: ___________

Date: _____________________

NULAR SPACE DETAILS Elevations Depths (.01ft.)

(MSL)* (BGS)

______ _______ Top of Protective Casing

______ _______ Top of Riser Pipe

______ _______ Ground Surface

______ _______ Top of Annular Sealant

Static Water Level ______ _______ (After Completion)

______ _______ Top of Seal

______ _______ Top of Sand Pack

______ _______ Top of Screen

______ _______ Bottom of Screen

______ _______ Bottom of Well

______ _______ Bottom of Borehole

* Referenced to a National Geodetic Datum

CASING MEASURMENTS

Diameter of Borehole (inches) Type of Surface Seal: __________________

Type of Annular Sealant: _______________

Installation Method: _________________

Setting Time: ______________________

Type of Bentonite Seal - - Granular, Pellet, Slurry (Choose One)

Installation Method: _________________

Setting Time: ______________________

Type of Sand Pack: ____________________

Grain Size: _______ (Sieve Size)

Installation Method: ________________

Type of Backfill Material: ______________ (if applicable)

Installation Method: _________________ ID of Riser Pipe (inches) Protective Casing Length (feet) Riser Pipe Length (feet) Bottom of Screen to End Cap (feet) Screen Length (1st slot to last slot) (feet) Total Length of Casing (feet) Screen Slot Size ** **Hand-Slotted Well Screens are Unacceptable

NSTRUCTION MATERIAL

(Choose one type of material for each area) asing SS304, SS316, PTFE, PVC, or Other bove W.T. SS304, SS316, PTFE, PVC, or Other elow W.T. SS304, SS316, PTFE, PVC, or Other

SS304, SS316, PTFE, PVC, or Other tion Form (revised 02/06/02)

casing: 4
riser-above: 4
riser-below: 4
screen: 4
Site-Number:
County:
Well-No:
Site-Name:
Borehole-No:
X-Coord:
Y-Coord:
Lat-Deg:
Lat-Min:
Lat-Sec:
Long-Deg:
Long-Min:
Long-Sec:
Surveyor:
Drill-Coord:
Consult-Firm:
Drill-Method:
Logged-by:
Completed-By:
IL-Registration:
Driller:
Geologist:
Drill-Fluid:
Date-Start:
Date-Finished:
Date:
Type-Seal: Concrete
Annular-Sealant: Bentonite Slurry
Install-Method: Tremie Pipe
Set-time: 24 Hours
Install-Method2: Poured or Tremie Pipe
Set-Time: 1 hour
Sand-Type:
Grain-Size: 20
Install-Method3: Poured or Tremie Pipe
Backfill: N/A
Install-Method-Backfill: N/A
field1:
field2: -3.50
field3:
field4: -3
field5:
field6: 0
field7:
field8: 1
field9:
field10: TBD
field11:
field12: 31.0
field13:
field14: 33.0
field15:
field16: 35.0
field17:
field18: 40.0
field19:
field20: 40.25
field21:
field22: 40.5
Bore-Diam: 6+
Riser-Pipe: 2
Casing: 4.0
Pipe-Length: 38.0
Bottom: 0.25
screen-length: 5.0
total: 40.0
screen-slot: 0.010
seal: pellet

File details come from the government source that posted it. Updated .