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:t <br /> MONITORING WELL INSTALLATION REPORT <br /> 6 . <br /> �1 1, <br /> Date: �� �j ;i CONSTRUCTION <br /> EI <br /> Premise Address: ! 0A41J4./ �'�' Well No. �(o <br /> ,q <br /> Inspector:-- LV6 Total Depth 40 <br /> - <br /> ! Screen Length -4_0 <br /> i <br /> E, Filter Pack —4L1 '3.- 7--Z- <br /> Bentonite <br /> ,`ZBentonite Pellets <br /> Permit No. 28 Zwl 3 Grout-- /f _+% S' <br /> Consultant _ Completion-Stove pipe Christie box> <br /> Geologist_ MAL 4PW5,Qj � ! - <br /> ! Auger O.D. CO•-7 s <br /> 1 <br /> Auger T.D. <br /> SAMPLING <br /> Holding Temperature 4°G <br /> Method_. 434-u.fr <br /> j atldo-up <br /> Screening Method__ <br /> Tracking Sheet On) AeavE cRou►rp <br /> COMPLETION CHAl57Y•&ox <br /> COMPLETION <br /> SPOILS oumS Z-•-' <br /> f <br /> proof <br /> Storage Method ON 611L- _ <br /> Contamination Noted - yes/no n <br /> Storage Location� �pL1 5. - <br /> SPECIAL PERMIT INFO. E: a _ <br /> It �°'- prarWpadt <br /> Distance to sewer line <br /> Domestic well on site - yes/ — <br /> If yes, location & distance An — fi• <br /> GROUTING r MATERIALS USED: <br /> Depth to water '30 ' Casing type 4'V - ;SGN i 41) <br /> Mix Ratios q SAUe- r4d, S Blank 25 ft. Screen /S ft. <br /> Installation Method sr C/ (i Slot size 0.0 f <br /> Quantity Installed ' a Bags cement nArd <br /> Buckets bentonite / 13 <br /> ! Bags sand/gravel <br /> Filter Pack type/size s L 1U(_,-SI"ATI_ <br /> ,1 <br /> f <br /> • � l� I <br />