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ONITORING WELL INSTALLATION REPO <br /> Date:_ --3' 1j <br /> CI .' '.o 57 CONSTRUCTION <br /> Premise Address: (� I�TMa Total Depth tto t <br /> C N•S.oCa k Screen Length (from) 3 <br /> Well No.: S-3 S -Z Filter Pack (from) 3 (to)_ y01 <br /> Bentonite (from) (to) <br /> Inspector._ Grout (from) •-A-- <br /> (to).- <br /> Drilling rig type 1��...�1.� o�•�s <br /> Permit No. Auger O.D. g', I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company. <br /> Driller:_ �)avm•e5 casing <br /> FM] he_ght <br /> Consultant 5 CGo 2 '� + <br /> 7qGeologist IZtt�os, � �eCLel� �. <br /> • ABOVE-GRCUND <br /> COMPLEffON G ASiY aoX ' <br /> SPECIAL PERMIT INFO. G=rd CCM1?LETICN g�(yy <br /> Distance to sewer line drat <br /> Domestic well on site - (y/n 3 C) ft. <br /> If yes, location and distan - <br /> ft 3 <br /> T• <br /> r <br /> SAMPLING <br /> ilonud — c <br /> soc*cn <br /> Holding Tem = ; <br /> Method -l:, = ., <br /> Scr ' ethod r = <br /> Trac; g Shcet - (y/ n) <br /> 0 ft. r = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y ADCr✓tawwr <br /> Storage Location m, 5az eG 4rA4n5p&- �(93L) Casing type f5L-9 <br /> Cy¢Mf �- Blank_ 44•5 ft Screen S-� h• <br /> Slot size_ nnu <br /> GROUTING Bags cement <br /> Buckets bentonite Av A ( -,6 n.URZ!6_ <br /> Depth to water ^��' Bags sand/gravcl <br /> Mik Ratios Filter Pack type/size <br /> dltstallation Method Surge Block: - (y/@)) <br /> ) <br /> Quantity installed iv lc�oADiscussed vrith geologist. - (yQnA <br /> Type of method <br /> EH 29 29 <br /> 3lq�oti S 3 S- Z <br />