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MONITORING WELL,INSTALLATION REPORT <br /> Date:_ to CONSTRUCTION <br /> Premise Address:_ `�3 �� <br /> 1---114.d Total Depth 40 <br /> Well N°" VV <br /> V_ S G , <br /> Screen Length (from) c > (to)_ s O <br /> Filter Pack (from) 5; (to) <br /> 6P <br /> T✓wn..srkic, (from) fL <br /> Inspector: 1 ��ao (to) <br /> Grout (from) — <br /> � ( )�_ <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company:. Gr�l�.c bo <br /> ,..t Completion - Stove pipe/christie x�(circle one) <br /> '!wll�, <br /> Driller: ' �� / <br /> casing <br /> Consultant height <br /> �4 <br /> Geologist_ J XUWM 6,t,1)19'n <br /> ABOVE-GFCUND <br /> C01.FLETION CNAtSTI'-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> (around Surface <br /> Distance to sewer line groutDomestic well on site - (y <br /> If yes, location and ce - S ? . ry, <br /> _eft ft. <br /> q <br /> - 0 <br /> SAMPLING = o <br /> tla ltad — 'c <br /> aectlon = <br /> Holding Tempera — <br /> Method = gavel pacts <br /> Scree Method — <br /> gSheet - (y/ n ) _ <br /> SPOILS <br /> StorageMethod MATERIALS/DEVELOPMENT <br /> Contamination Noted n ) Pte. <br /> Storage Location r Casingh(ym�e_ ••�•,ZS/� <br /> Blank SS I ft. Screen fi <br /> Slot size_ 01010 <br /> GROUTING Bags cement y <br /> Depth to water B*ekets'bertttmite / , o ^^ <br /> Bags sand/gravel <br /> Mix Ratios q, I f Filter Pack type/size ..G <br /> Installation M od /�. � Surge Block: - (y/ <br /> Quantity Installed TDiscussed with geologist: - ( y (y ) <br /> EH 29 29 <br /> Type of method <br />