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MONITORING WELL INSTALLATION REPORT <br /> Date:__. 3/ /d CONSTRUCTION <br /> Premise Address: ¢767 1bLt-1eWL5,- well No. <br /> Inspector: Total Depth152.I' <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets — 4,�; 6�- 4-6, <br /> Permit No. "' 3b Grout_ -&- --I,- — `5 <br /> Consultant j� Completia Stove p�i,pa chriBtie box <br /> Geologist Vl� /Z . 7 CC fid , <br /> Auger O.D. <br /> Auger I.D. 4 <br /> SAMPLING -- - <br /> Holding Temperature <br /> o atk*-up <br /> Method _. (ek <br /> Screening Method OI/H T <br /> I1sovE-GROUND CHRISTYWX <br /> Tracking Sheet y n) COMPLMON <br /> COMPLETION <br /> SPOILS Ground Suriace <br /> grout <br /> Storage Method 00A(1711&fL, Z 81A ft• <br /> Contamination Noted - yes nn ft• <br /> Storage Location <br /> _ r <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> Distance to sewer line <br /> on <br /> Domestic well on site - yes = Pack <br /> If yes, location & distance - => <br /> _....._it. — ft. <br /> GROUTING <br /> MATERIALS USED: <br /> 1 �! <br /> Depth to water Casing type 56,440 Air, <br /> _ Blank 6J 3f ft. Scree -T " f <br /> Mix Ratios _ _ 1 1°'� n � f� ft. <br /> Installation Method _22UM16 Slot size 010/0 <br /> Quantity Installed Bags cement /L <br /> Buckets bentonite �,�137 <br /> Bags sand/gravel Z, saciC <br /> Filter Pack type/size----- _ !� tsnAjl� <br />