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`w ONITORING WELL INSTALLATION REP6,W <br /> Date: 3-10— O /, / CONSTRUCTION <br /> Premise Address: 1/6 N• f7A�T,(i� Total Depth �. <br /> �/5— /7 Screen Length (from) (to) <br /> Well No.: Filter Pack (from)_ <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Permit No. tr4 &6 Drilling rig type 71' <br /> Auger O.D. I.D. <br /> Drilling Company: <br /> �s J Completion - Stove pipe/christie boa (circle one) <br /> Driller: Z casing <br /> � .tf,Q V height <br /> Consultant_ //�� <br /> Geologist d"06— <br /> ABOVE-GROUND <br /> COMPLETIONCNALM43OX <br /> SPECIAL PERMIT INFO. Ground g � <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - 8 ft. <br /> — o <br /> SAMPLING <br /> slatted c <br /> section — <br /> Holding Temperature <br /> Method �s D <br /> Screening Method <br /> Tracking Sheet - (y/n) °= <br /> SPOILS 5O"� <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) Zrt C, Pyc <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot siz <br /> TIe 7A <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water L Bags sand/gravel 700 <br /> Mix Ratios "AA4% * S Filter Pack type�/ iyze {t- 7 <br /> Installation Method Surge Block: - W n ) <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />