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MONITORING WELL INSTALLATION REPORT <br /> Date: t V CONSTRUCTION <br /> Premise Address:,_.V,7-0 O r) . ��S Total Depth ? <br /> Well No.: MW 1 ) �' <br /> Screen Length (from) g " (to)—?A= <br /> Z <br /> Filter Pack (from) (to)-,gD — <br /> Bentonite (from) (to)— <br /> Inspector: 11u u ctc ._ Grout (from) (to)— <br /> Drilling rig type <br /> Permit No. <I S- 3 L_ _ Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> w. <br /> Driller: cas Ing <br /> height <br /> Consultant <br /> Geologist _ V <br /> ABOVE-GROUND 1T <br /> C}{A15TY-8QX <br /> ����N COMPtEf10lV <br /> SPECIAL PERMIT INFO. Ground Sudws <br /> Distance to sewer line grout <br /> Domestic well on site - <br /> lf yes, location an tance - ft• <br /> SAMPLING <br /> won" Jr <br /> taction a' <br /> Holding Temperature `y <br /> Method a° —_ V'vW Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> �9"�...tt. <br /> SPOILS <br /> Storage Method rg _ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n } <br /> Storage Location Casing type <br /> Blank 2,f 5 ft. Screen <br /> SIot size .0 iy - <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 1* 5v%*of <br /> Installation Method Surge Block: - (y iCri) �cv1..-Cww/ <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />