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..MONITORING WELL INSTALLATION REPOt, . <br /> Date: Z' O CONSTRUCTION <br /> Premise Address: ZZ l t 12-2-tj X� UJL A Total Depth `✓/� <br /> Screen Length (from) $� —(to) <br /> Well No.: U� - "05 Filter Pack (from) 5 (to) 3 <br /> Bentonite (from) (to) 31 <br /> Inspector: Grout (from) '1)1- (to) 3 <br /> Drilling rig type -(o 2-m <br /> Permit No. J 7 0 Auger O.D. I.D. 47— <br /> ^ � Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: 6odlJ.t1 <br /> Driller: J4,cy"-- casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> CO MP LETO N to <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - ( y 7n 3 <br /> If yes, location and distance - ft. <br /> . n. ft. <br /> = m <br /> — o <br /> = m <br /> _ <br /> _ o <br /> SFNPLING $lotted _ c <br /> sac9on = <br /> Holding TemperaturegnYsl l <br /> ack <br /> �— <br /> Method <br /> Screening Method W`^ _ <br /> Tracking Sheet y/ n ) <br /> 5s n. <br /> SPOILS <br /> Storage Method 61&- t tae- t U/ l MATERIALS/DEVELOPMENT <br /> Contamination Noted - (D n ) Z�\ �V� <br /> Storage Location ��-� Casing type <br /> Blank ft. Screen ft. <br /> Slot size .02l� '� <br /> GROUTING Bags cement <br /> / JCjdu Buckets bentonite rn 30 <br /> Depth to water = 5 Z Bags sand/gravel 6500 <br /> Mix Ratios t Filter Pack type/size A <br /> Installation Metho N14—' Surge Block: - (y/ n <br /> Quantity Installed Discussed with geologist: - (y� <br /> Type of method <br /> EH 29 29 <br /> V ,1; ` �c <br />