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CONS I RUCTION <br />Total Depth 6C <br />Screen Length (from) <br />MONITORING-WELL INSTALLATION REPORT <br />Date: it. q-u I <br />Premise Address: 30 7 z_ <br />Geologist <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site 7 ( y <br />If yes, location and distance - <br />ScreeninØitethod <br />Trac Sheet - ( y/ n ) • <br />SPOILS <br />Storage Method Method )1t( <br />Contamination Noted - <br />Storage Location 5 6 TA.2 kaA <br />(-) <br />GROUTING <br />Depth to Water <br />Mik Ratios /1"--124---( Ca-14-4-0L-S <br />i,nstallation Method <br />Quantity Installed <br />Efi 29 29- • <br /> <br />(Co) Yr-- <br />Filter Pack (from) c s--- (to) 74_ <br />(from) Y (to) <br />(from)pr 1 <br />.. Drilling rig type L.41 _5 <br />Auger O.D./0/ I.D. •>? X . (.• .i... <br />Completion - Stove pipe/christie box (circle one) <br />CCM' rd Suixt <br />K t, <br />zior.d <br />s c-cicn <br />ft <br />-rb <br />gra.; <br />ft. <br />I NV casing <br />height <br />ABC/ VE-G R CON D <br />CO MP LETPO N CI-ISTY-BOX • <br />COMPLETION <br />ft. <br />Filter Pack type ze <br />Surge Block: -• / n ) <br />Discussed with geologist: - iD / n) <br />Type of method e-01b-C i-' NA <br />Bentonite <br />Grout <br />MATERIALS/DEVELOPMENT <br />Casing type CLgo <br />Blank Lic) ft. <br />Slot size • n 2_0 <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />SAMPLING <br />Holding Tempptature <br />Method <br />Well No.: <br />Inspector: <br />Permit No. <br />Drilling Cowan): (_21e4-e(e <br />Consultan(.7 <br />t <br />Screen 2-o