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MONITORING WELL INSTALLATION REPORT <br /> Date:_)/ 12- y 0 <br /> CONSTRUCTION <br /> Premise Addres 62_ A-J_ dt'14- • Well No. i-3 <br /> Inspector: 1 Total Depth SS' <br /> Screen Length 15 <br /> Filter Pack <br /> 6- <br /> Bentonite Peilets <br /> Permit No. _ Grout <br /> Consultant ' <br /> Geologist) i Completion-Stove P e/christie box <br /> �<� p` <br /> Auger <br /> SAMPLING Auger I.D. l! <br /> HoldingL,Temperature [� •tk*-up <br /> Method),-1,-i_:�7 <br /> Screening Method fi'(b <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n).v COMPLETION COMPLETION <br /> SPOILS Ground Surlwe + <br /> grout <br /> Storage Method. CT')- a-<-k{ 4 3� <br /> Contamination Noted - es/no ft. <br /> Storage Location a^A "S <br /> SPECIAL PERMIT INFO. — 0 <br /> c <br /> 0 <br /> Distance to sewer line UA,)e- sloned <br /> $ <br /> Nrdon <br /> Domestic well on site - yes/no..) _ <br /> If yes, location & distance tm;WPack <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water `t Casing type JUG <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size <br /> Quantity Installed AA Bags cement— <br /> Buckets bentonit S -e <br /> Bags sand/gravel -( 6d <br /> Filter Pack type/size -W/2- <br /> L t <br />