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MONITORING WELL INSTALLATION REPORT <br /> Date: ( �O /l Z CONSTRUCTION <br /> Premise Address: 34L IZ i Total Depth els <br /> q Screen Length (from) 1815' (to) 115 <br /> Well No.: µ'^J71°ic-� � �0 FiltetPack ' (from) 1 $-1 (to) 1"Lt-5 <br /> G ✓� Bentonite (from)_tlo`1 (to) IIsY <br /> Inspector: _ _ nti. Grout (from) 16'; (to) 5 � <br /> Drilling rig type_ r^rbi1� r 11 U BV <br /> Permit No. z)izoal, V r9S N Auger O.D. <br /> LD- <br /> Completici - Stove pipe/costie box Xcircle one) <br /> Drilling Company: 6rec,G �r M. <br /> Drillet: �r�9 ' ' �' r --77-- casing <br /> height , <br /> Consultant -�•• <br /> Geologist <br /> T <br /> ABOVEGROUND <br /> COWLEiION CHRO Y-BOX <br /> COMPLETION <br /> W <br /> SPECIAL PERMIT INFO, _ Ground Surlace 7— <br /> Distance to sewer line "Out <br /> Domestic well on site - (y/n ) ( S <br /> If yes, location and distance - ILq ft <br /> 1 <br /> = m <br /> — c <br /> SAMPLING = <br /> ■lotted _ 8 <br /> sac�on <br /> Holding Temperature <br /> Method 2%'�Pack <br /> Screening Method <br /> Tracking Sheet - (y/n ) y' <br /> ft. <br /> SPOILS p� <br /> Storage Method I�o�l VOf IJu iPs�IPS MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) U �U <br /> Storage Location Tr1 RK(VG HU* Casing type <br /> Blank 1 l S ft. Screen--j d5 ft. <br /> Slot size O ,O 1 o 1---k <br /> GROUTING Bags cement <br /> Buckets bentonite Z <br /> Depth to water �y 4 Bags sand/gravel I S <br /> Mix Ratios 4 U)6� 5 Filter Pack type/size <br /> Installation Method Puwm Surge Block: - y)n ) —r <br /> Quantity Installed N k�) Discussed with eologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />