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MONITORING WELL INSTALLATION REPORT <br /> Date: Z n CONSTRUCTION <br /> Premise Address: 113 5}ocL6 S+a,-- - Total Depth 50 <br /> Screen Length (from) 10' (to) 30 <br /> Well No.: VA W Filter Pack (from) I` (to) 30' <br /> Bentonite (from) 3 (to)--9 <br /> Inspector: Grout (from) (to) R <br /> Drilling rig type <br /> Permit No. Sgo3 zj Auger O.D. In <br /> Completion - Stove pipeist e box (circle one) <br /> Drilling Company: {Z S <br /> Driller: --zz�� casing <br /> height <br /> Consultant <br /> — 'A — � Ant,L, •- <br /> ABOVE-GROUND CHRISTY-BOX <br /> COkFLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground S uixe <br /> Distance to sewer line <br /> Domestic well on site - / n ) <br /> If yes, location ai fLdi Lance - ft, <br /> �_ft. <br /> = m <br /> q <br /> 0 <br /> - C <br /> O <br /> SAMPLING slotted = 8 <br /> soc9on — <br /> Holding Temperaturee,-%Aj = V3V'1 P'ck <br /> Method c n�C.{ d�-f <br /> Screening Method P t Q = <br /> Tracking Sheet -0/ n ) <br /> _'eft. — h. <br /> SPOILS <br /> Storage Method li `J Ok(,y{ 0(w_ MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( / n) t% <br /> Storage Location ire..... ,(�y Casing type Py G <br /> Blank I p ft. Screen g,o ft. <br /> Slot size -L o <br /> GROUTING Bags cement -Y T t& 6 <br /> Buckets bentonite <br /> Depth to water 1v IC 6t;' ax- n �.Q"� Bags sand/gravel <br /> Mix Ratios Filter Pack type/ I <br /> Installation Method . A Surge Block: - (y n ) <br /> Xn <br /> Quantity Installed � Zc c� ( fir.- Discussed with geo ogist: - (y <br /> Type of method <br /> EH 29 29 <br />