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- <br /> MONPLORING WELL INSTALLATION REF .KT <br /> fCONSTRUCTION , <br /> Date: 3 1 <br /> Total Depth -------- <br /> Premise Address: 11 Steen Length (from) <br /> z (t°) <br /> Filter Pack (from)�Ct°) 11 <br /> 1 1 <br /> Well No.: Bentonite (from) (to) <br /> �e_ C� V_�-- Grout (from) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Com lesion- Stove pipe/ tie box (circle one) <br /> Drilling Company: I r� <br /> D— <br /> ca <br /> Lag <br /> he <br /> Driller. nn If height <br /> 7 � <br /> Consultant r <br /> Geologist AgCVEv^ACUND p-ffi45T`!-30X <br /> CCW!ETION DDMpL CN <br /> d ed Sutaac* <br /> SPECIAL PERMIT INFO. (Vr&-•tcr 1--4,.. <br /> rout ('o4 <br /> Distance to sewer line i ft. 16 <br /> Domestic well on site - ( y/ n ) IL <br /> If yes, location and distance - 6�P I �O tt r — A f <br /> �u t (V% <br /> o <br /> 2 f t aattaa = `a <br /> SAMPLING S wccn <br /> Holding Temperature <br /> Method <br /> Screening Method t V S fi 71 <br /> Tracking Sheet C Y/ n ) — IL <br /> I R ..= — <br /> SPOILSC•b!N <br /> MAr1/)u�� �j�id5 ,n r bo�C51'1'� MATERIALS/DEVELOPMENT <br /> -(iv✓af <br /> Storage Method b � n <br /> Contamination Noted - C Y/ n) Casing type <br /> Storage Location —�Q��uCDr Bl ft S¢eea�— <br /> C pt,S Z lot size <br /> ags cement <br /> GROUTING Buckets bentonite <br /> Bags s Pack <br /> zypvel <br /> Depth to water r � yn, ��Filter Pack typesize <br /> Mix Ratios �'�i Surge Block: - C Y/ n ) <br /> Installation Method <br /> Drscussed with geologist - C Y/ a) <br /> Quantity Installed D Type of method <br /> EH 29 29 m � x • r r �Y r <br />