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MONITORING WELL INSTALLATION REPORT <br /> Date: [2. I I I l 0 CONSTRUCTION <br /> Premise Address: YD 5� 6[.l of i ,� Total Depth__ } <br /> Screen Length (from) }z•-s (to) -S <br /> Well No.: l LU 'ki Filter Pack (from) ;r7 (to) -T:?--5- <br /> Bentonite (from) A 1: (to)� <br /> Inspector: orn Grout (from) )2:� (to)_ 97 <br /> Drilling rig type <br /> Permit No. S cls Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: e�pi�1 <br /> Driller: 4 casing <br /> Consultant <br /> A"iCheight <br /> Geologist [A A y / 't —QW7:F <br /> _ <br /> U ABOVE-GROUND <br /> COMPLETION CHAIS7Y-BOX <br /> SPECIAL PERMIT INFO. Ground Surface -COMPLETION <br /> Distance to sewer line proal <br /> Domestic well on site - (y/ <br /> If yes, location and dis ce - LAS_n. <br /> ?Z.Sn. n. <br /> o <br /> SAMPLING <br /> dotted = c <br /> iec5on :a - � <br /> Holding Temperature <br /> Method �` —_ gra P� <br /> Screening Method <br /> Tracking Shee - Cy/n) ' <br /> SPOILS <br /> Storage Method Sa �^^ MATERlALS/DEVELOPMENT <br /> Contamination Noted - /n ) <br /> Storage Location Casing type 3 $rte � JPVL- <br /> BlanktZ-C ft. Screen <br /> Slot size o ZO <br /> GROUTING Bags cement <br /> ` Buckets bentonite <br /> Depth to water 6o Bags sand/gravel 'Z/_3 <br /> Mix Ratios - L Filter Pack type/size 3 Ink,s-/rn. <br /> Installation Method �� Surge Block: - y n ) <br /> Quantity Installed iv 1 So Discussed with geologist: - (y <br /> EH 29 29 Type of method <br />