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:E _OFA_ <br /> MONITORING WELL INSTALLATION REPORT <br /> �o3Apt /f /p_ �� CONSTRUCTION <br /> Date: ry O ����/� I//f <br /> ���� l�/� �Y,Ep� Well No. � <br /> Premise Address: Total DepthJ� <br /> Inspector <br /> Screen Length 3�S <br /> Filter Pack ��-- <br /> Bentonite Pellets Z.5 <br /> Permit No. - 077-7-7 Grout -s <br /> Consultant Completion-Stove pipe/coiristie box <br /> Geologist <br /> y� ► t Auger O.D. �0 <br /> 2it <br /> o�_ �J = " Auger I.D. <br /> SAMPLING <br /> stick-up <br /> Holding Temperature �� <br /> Method RD 1 s.�R / <br /> T7 T <br /> Screening Method <br /> ABOVE-GROUND CHRISTY4= <br /> Tracking Sheet n) 0OMPLE7K)N COMPLETION <br /> I/v Ground Surface �-- <br /> SPOILS <br /> 5� grout <br /> Storage Method I s ' <br /> Contamination Noted - yes <br /> Storage Locations <br /> = '3 <br /> — m <br /> _= o <br /> SPECIAL PERMIT INFO. — <br /> 0 <br /> slotted — c <br /> Distance to sewer line 2 section "- <br /> Domestic well on site - yes gravel= P <br /> ack <br /> If yes, location & distance - <br /> I <br /> �ft. n <br /> GROUTING 35 ' `• <br /> MATERIALS USED: <br /> 2 � ll`` <br /> Depth to water 3 Casing type l 1, N 0- <br /> Mix <br /> Mix Ratios Blank ft. Screen :_�D _ft. <br /> Installation Method Slot size . O2 O <br /> Quantity Installed Bags cement <br /> Buckets bentonite 2 <br /> Bags sand/gravel =T <br /> Filter Pack type/size 5 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />