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JNITORING WELL INSTALLATION REPL <br /> Date: 2( " CONSTRUCTION <br /> Premise Address: 132-b v� eV-)-e l Total Depth -55 <br /> l ,` Screen Length (from) 05 (to) ZU <br /> Well No,: I"I V V Filter Pack (from) 33 (to) <br /> Bentonite (from) ZO (to)_M�7- <br /> Inspector. Grout (from) / 5 (to) <br /> q� f 2� Drilling rig type � to/ <br /> Permit No. Auger O.D. 5 -7 £s I.D. <br /> �('o �� �( r�(� Completion - Stove pipe/ iristie box)(circle one) <br /> Drilling Company: L v �" / `� <br /> Driller: e,L1SSe�� )C)n-0 casing <br /> height <br /> Consultant w �'1 r N IFI <br /> vJ� <br /> —QW, <br /> Geologist r •- <br /> ,� (Wu ABOVE-GROUND CHStSN-8OX <br /> iZ COhPLETCN COhAPL.RiCN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line N Dbn gfout <br /> Domestic well on site - (y/ n ) �r.ft. <br /> If yes, location and distance - 14 <br /> ZD <br /> ft. <br /> : <br /> SAMPLING <br /> 161-f ?jC <br /> p soden — <br /> Holding Temperature <br /> Method 10T) I —T _ gmvw Pack <br /> Screening Method C <br /> Tracking Sheet Ky n ) <br /> ft. <br /> SPOILS <br /> Storage Method �� Jm MATERIALS/DEVELOPMENT <br /> Contamination Note - ( / n <br /> Storage Locational f Casing type 2�/ <br /> 'aroma ! ��a r„ Blank 2 U ft. Screen /5 ft. <br /> I/ W Slot size 2U <br /> GROUTING Bags cement _ <br /> Buckets bcrnit b <br /> Depth to water � Bags sand/gravel <br /> G <br /> Mix Ratios Filter Pack type/size _3 Sr <br /> Installation Method Surge Block: - (y �1 ) <br /> Quantity Installed Discussed with geologist: -�/ n ) <br /> Type of method <br /> EH 29 29 <br />