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HLT0NGE0SCIEPiCE 16- v52-. 92 H P R 9 2 10 .:'5 Ilo . 005 P , 03 <br /> MONITORING WELL INSTALLATION REPORT <br /> d <br /> o � <br /> Date: 26, f q f7' CONS UCTxON <br /> l 6 o y ro +t% B S-r <br /> Premise Address: 1ro­z70"J well No. <br /> inspector:_!; charm. f Co/1_N1 Total Depth -7 If <br /> Screen Length 61-- 7e- <br /> Filter Pack 17' <br /> Bentonite Pellets 31 <br /> Permit No. _ Grout 5$' _ <br /> Garsultant. /W7-6 ,V Gco�c• 'tKc� Completion-Stora pipe/ ristie ha <br /> Geologist <br /> Auger O.D. <br /> Auger I.D.__ <br /> Holding Temperature___ � •tk*i'F <br /> Method <br /> SPreeni.ng Method <br /> _ AE30VE-GROUND clot M430X <br /> Tracking sheet {y/n) 0OWPLET1ON COMPLETION <br /> SPOYLS 13nauns!Sulaics ...�.•+.�... <br /> aPG�Jt <br /> Storage Method S Tot�p,'/r.l e,/ P/Ajr,4 CaveerX <br /> Contamination Noted - yes/noft• <br /> Storage Location �, 1 • <br /> 0 <br /> w <br /> SPECIAL PERMIT INFO. w <br /> siott�d — <br /> Distance to sewer line "CnloPq <br /> Domestic well on site - yes/nom . <br /> if yes, location & distance <br /> ?$ �• — n, <br /> 4R_a��YNa <br /> =Eg;ALs USED: <br /> Depth to water n., Caainq t Yl� Sc�./v/� 46 Pvc <br /> Mix Ratiog Blanker_ ft. Screen /S ft. <br /> Installation Method Slot Size D. OA ;rc� <br /> Quantity Installed Bag® cement 2 2 <br /> Buckets bentonite -2 <br /> Bags sand/gravel -F <br /> - <br /> Filter_ Pack type/size N4••-¢ /�?•�7i..7 s ,� <br />