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"%wONITORING WELL INSTALLATION REPO"opw <br /> Date: l0/Z-7 Id CONSTRUCTION <br /> Premise Address: 216 6 2 A)� /�� Total Depth 25 <br /> Screen Length (from) 2 (to) i <br /> Well No.: 1/15;w' Z Filter Pack (from)_ (to) 13 <br /> Bentonite (from) —(to) <br /> Inspector: Grout (from) (to) <br /> ��ii �✓/ q Drilling rig type <br /> Permit No. a!� %J Y Auger O.D. l)_ I.D. <br /> /f Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: �t d t casing <br /> ` height <br /> Consultant � �� T7 f <br /> Geologist C4 <br /> ABOVE-GROUND CHRLT Y-80X <br /> COMPLETION COMPLETIO <br /> SPECIAL PERMIT INFO. Ground Surface <br /> 7 . <br /> Distance to sewer line grout <br /> Domestic well on site - (y� ft- <br /> If yes, location and distance - <br /> ft. <br /> SAMPLING slottad <br /> socron = <br /> Holding Temperature gravW <br /> ack <br /> Method a` _ P <br /> Screening Method <br /> Tracking Sheet - (y/n ) x'2- <br /> SPOILS <br /> SPOILS <br /> Storage Method SS YA..-10— MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) 11" U <br /> T <br /> Storage Location Casing type T U <br /> Blank (S ft. Screen '1 Q ft• . <br /> Slot size <br /> GROUTING Bags cement —� -4 <br /> Buckets bentonite <br /> Depth to water = 5� Bags sand/gravel <br /> Mix Ratios 30 f- 34fo 0, lwiht Filter Pack type/size <br /> Installation Method Surge Block: - (yJG3 <br /> Quantity Installed 'ZO—ZS< Discussed with geologist: - (y� <br /> Type of method <br /> EH 29 29 <br /> /o z��a � . <br />