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MONITORING WELL INSTALLATION REPORT <br /> Date: ///F//7! CONSTRUCTION <br /> Premise Address: /1/ 77F F. l-Yp ..-�. A"b '` <br /> Well No �&- <br /> Inspector:�:c. 7P_ �- �p`t7 <br /> 5 <br /> Total Depth <br /> Screen Length/7 <br /> Filter Pack�G--..�� <br /> Permit No. ( !- 3c� <br /> /� 2- BentonitelPellets -Z <br /> Grout <.�t <br /> Consultant Completion-Stove pipe/dhristiebox <br /> / <br /> Geologist ca36 „�... 1 7 <br /> L•r-v�/c- c/'4nw�b s Zl S y S!6��'� Auger O.D. `t <br /> /-N�A. <br /> SAMPLIAuger I.D.NG <br /> Holding Teperature AJ/A stick-up <br /> Method_ ? -Iffl <br /> —EWTScreening Method .1 <br /> ABOVEGROUND <br /> Tracking Sheet (y/n) !A COMPLETION CHRISTY-BOX <br /> COMPLETION <br /> SPOILS Ground Surlsos <br /> Storage Method !S'^ti grout <br /> _ <br /> Contamination Noted - yeer) <br /> Storage Locations <br /> Yi r. }i. <br /> — m <br /> - r <br /> SPECIAL PERMIT INFO. = r <br /> — c <br /> Distance to sewer lined,�✓L- sacuon slottad <br /> — <br /> Domestic well on site - yes/no =_ <br /> If yes, location & distance - Ws�pa& <br /> n. Ll Z­ n. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water ( S Casing typetD✓C� r/ <br /> Mix Ratios --X _ Blank ( Z ft. Screen /5-- ft. <br /> Installation Method Slot 'size -OX <br /> Quantity Installed _ 122y,f, Bags cement ! rr--:- <br /> Buckets bentonite 2�r`- <br /> Bags sand/gravel ,l !i S,o-<.Lam✓ <br /> Filter Pack type/size=- - <br /> i <br />