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1*41 '11� <br /> MONITORING WELL INSTALLATION REPORT <br /> Date•.2- 2.7 A J CONSTRUCTION <br /> Premise Addre'sss:yo6- AA a Well No. U 1 <br /> Inspector: ky__A- Total Depth / I <br /> Screen Length2'_17 ' <br /> Filter Pack .�. <br /> ,?/-O(//Z- Bentonite Bentonite Pellets % S- <br /> Permit No. Grout "e4_A_;b _�-' <br /> Consultant Completion-Stove pipe(Christie Ox <br /> G e o 1 o g i 9 t_/Z A-4,-,t IYA'01777__- <br /> Auger 0.D. <br /> Auger 1.D. 3 '' <br /> SAMPLING <br /> Holding Temperature stick-up <br /> Method qtr+ r <br /> Screening Method 7,1 <br /> ABOVE-GROUND CHRISTY43OX <br /> Tracking Sheet (y ) COMPLETION COMPLETION <br /> Ground Sudws <br /> SPOILS <br /> 9roul <br /> Storage Method <br /> Contamination Noted - yes n• <br /> Storage Location/11-SAZ4 17tt. <br /> -2—ft. <br /> •re <br /> SPECIAL PERMIT INFO. : <br /> � Monod <br /> Distance to sewer line Ltiz- soc�on — <br /> Domestic well on site - yes/no _ qmvWP <br /> ack <br /> If yes, location & distance - ' <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to waterf_` <br /> Casing type <br /> Mix Ratios, f rl�" Blank_ ft. Screen / ft. <br /> Installation Method C Slot size .G)2�6 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel Z-// i4 � <br /> Filter Pack type/size 'D Z6) �,� Q <br />