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t; <br /> MONITORING WELL INSTALLATION REPORT <br /> si <br /> Date: CONSTRUCTION <br /> Premise Address: Well No. W' <br /> Inspector: ;i Total Depth <br /> Screen Length <br /> Filter Pack Z� <br /> Bentonite Pel�ets <br /> Permit No. Grout <br /> Consultant completion-Stove pipe/c ristie box. <br /> Geologist L- <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING _. <br /> Holding Temperature atkk-up <br /> Method <br /> Screening h <br /> ABOVE-GROUND CHRl57Y-BOX <br /> Tracking Sheet (y/n) " COMPLETION COMPLETION <br /> SPOILS Gtviw Surfer <br /> i xL <br /> Storage Method yam/ i <br /> Contamination Noted - yes/no a; ��T�N• <br /> Storage Location ft. <br /> ✓ O n <br /> SPECIAL PERMIT INFO. <br /> / Wottod <br /> Distance to sewer line_ ; sottlon {` r <br /> Domestic well on site - yes/no <br /> If yes, location & distance - z.. = gr&vWpa <br /> it <br /> ........�_it. ft. <br /> GROUTING <br /> i <br /> MATERIALS USED- <br /> Depth to water Casing type <br /> Mix Ratios it Blank ft. Sc een . ft. <br /> Installation Method ' Slot size OrL42 i <br /> Quantity Installed i Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />