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MONITORING WELL INSTALLATION REPORT <br /> Date: y CONSTRUCTION <br /> Premise Address: <br /> Jj. 1-)114d)q ( Well No. 1 � - �.C.i-! l <br /> Inspector: Total Depth <br /> $(,khJ9 )US:� Screen Length <br /> Filter Pack <br /> Bentonite G,Pl is r �J <br /> Permit No. 170 • 2-59(. Grout I= ----p - <br /> Consultant &,S. 'ISG Completion-Stove pip christie box <br /> Geologist ./tft1ln 4M•rO'!�' <br /> Auger O.D. •L.5 <br /> Auger I.D. <br /> SAMPLING -- <br /> d &**-up <br /> Holding Temperature <br /> Method I(-/-, I T_ <br /> Screening Method <br /> �/ ABOVE-GROUND <br /> Tracking Sheet (y ) COMPLETION CMPL f BOX <br /> COMPLETION <br /> Ground Surface __+ + <br /> SPOILS <br /> PRO grout <br /> Storage Method <br /> Contamination Noted - ye no <br /> Storage LocationCD <br /> h' <br /> _ -CD <br /> 46 <br /> SPECIAL PERMIT INFO. 44 — <br /> Wtu, <br /> 0 <br /> Scsf Fan G -� dotted <br /> Distance to sewer line section <br /> Domestic well on site - yes OnvWpack <br /> If yes, location & distance - <br /> ft. <br /> GROUTING <br /> MATERIALS USED: <br /> i <br /> Depth to water �� Casing type 4D rV(-- 4 <br /> Mix Ratios j— Blank--T2- ft. Screen 3u ft. <br /> Installation Method '7 A4Mg-_r Slot size 6. 010 <br /> Quantity Installed Bags cement 9 -- <br /> Buckets bentonite Z <br /> Bags sand/gravel <br /> Filter Pack type/size Z` <br />