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MONITORING WELL INSTALLATION REPORT <br /> Date: 11 ' l2� `6 CONSTRUCTION <br /> Premise Address: (o I f7 U /U- Total Depth Q Ste' S <br /> T� Screen Length (from) <br /> Well No.: 1V�W -'�12 Filter Pack (from) L H• 5. 5 (to) 3 <br /> Bentonite (from) �(to) <br /> Inspector. Grout (from) -3 (to) z. <br /> DnMmg ng type <br /> Perrair No. SS Z Auger O.D. I D. <br /> . 1 ^ Completion-Stave pip chrisrie oz dreie one) <br /> Dulling Company: W 6TL�[A 'fin' 6c"1 <br /> Duller cag <br /> it <br /> / r � � heght <br /> Consultant .�Ir / 5-�y 4-tcA <br /> IVI <br /> Geologist L" :52CzA <br /> W' V-FFF%%%///��A � <br /> A_WV5vaCUND Ct6ilS7Y-acx <br /> =hPLl=i-AN <br /> C.^MP_=7CN <br /> SPECIAL PER-W;INFO. Ground SLea= A <br /> Distance to sewer line � <br /> I <br /> Domestic well on site - y/ n ) � {�Jl,5 <br /> If yes, location ce - 6N.S� L <br /> _ c <br /> SAMPLING slacsd _ ' <br /> Holding Temperature VZV= ,l iack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> S.S g ♦ tL <br /> SPOILS <br /> Storage Method S' � MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n ) <br /> Storage Location cam- s Casing type rA PVC <br /> Blank 6 S,S fs. Screen Zo ft <br /> Slot size • Ozo <br /> GROUTING Bags cement t q Y�-U <br /> Bucketsbentonite ni 1 m.., CA'-mss. <br /> Depth to water ^�3S^ifC�/! Bags sand/gravel. -s- <br /> Mix Rarios N 19 [ 14zc 'F SQP Filter Pack type/size 3 <br /> Installation Method I/\: Surge Blodc - (y')/ n) <br /> Quantity Installed �✓[j o Q<d I" Discussed with geologist: - <br /> U Type of method <br /> EH 29 29 <br />