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MONITORING WELL INSTALLATION REPORT <br /> Date:_ <br /> CONSTRUCTION <br /> Premise Address: i , Total Depth 7 <br /> Well No.:_ A Screen Length (from) SS (to) q �� <br /> Filter Pack (from)- 4-3 (to) Z< <br /> Inspector: tN'4 AA Ar- _ Bentonite (from) tp_(to) {; <br /> Grout (from) _(to) <br /> Permit No. ✓� $ 1 Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (cir— cle one) — <br /> ��� v' <br /> Driller:. <br /> � '" casing <br /> Consultant /-� (� height <br /> Geologist —WW-f <br /> �� <br /> U ABOVE-GROUND <br /> COWL.ETION CHRISTY48OX <br /> SPECIAL PERMIT INFO. --- - _- _- -COMPLEMOa- <br /> Oround Surface <br /> Distance to sewer line <br /> Domestic well on site - ( ) grout <br /> If yes, location and ce - yq 9. h <br /> 0 <br /> O <br /> SAMPLING - <br /> slotted — c <br /> Holding Tern eraturelM 1!^ wcdon = 8 <br /> Method <br /> Screening Method p tG <br /> :. <br /> Tracking Sheet -U n ) y <br /> SPOILS n <br /> Storage Method_ 6-1:]gp <br /> Contamination Noted - (y n ) MATERIALS/DEVELOPMENT <br /> Storage LocationCm si P �{ <br /> Casing type_ n <br /> Blank-- _it. Screen Z--C> ft. <br /> GROUTING Slot size_ , 07 C) <br /> Bags cement <br /> Depth to water N 60 Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed L� '�`� Surge Block: .❑ ) <br /> Discussed with geologist: - (y)Q) <br /> EH 29 29 Type of method <br />