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MONITORING INFU INSTAI.LATION RF-P/^ I <br /> Date:J J ) NOUe(� 2 005 CONSTRUCTION <br /> Premise Address: S ' " �G"C` l�r�`u- Total Depth �5 <br /> Screen Length (from) 61 V (to) <br /> Well No.: !v t 5 � _ Filter Pack (from)O I "3 7 (to) 55 <br /> Bentonite (froth) (to) 07 <br /> --�— <br /> Inspector:^ ///� Grout (from) 1 (to) 3 <br /> ` Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/chxistie box (circle one) <br /> Drill Ig Company: <br /> Drilled: 7c casing <br /> height <br /> Consultant O <� �,e►` <br /> ABOVE-GROUND <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Grkxmd Surf act <br /> Dist ice to sewer line gfout <br /> Domestic well on site - { y/ n) - - ��ft. <br /> If yes,I�location and distance -. <br /> SAMPLING <br /> n <br /> Holdul�9 Temperature <br /> graval pack <br /> Method <br /> Scree nng Method — <br /> Trackuig Sheet • (y/n ) <br /> j <br /> SPOILS 36-fes �{rewc cs���zed, <br /> Storag Method Z�S MATERIALSEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type <br /> Blank ft. Screen 15, ft. <br /> L&(`eej Slot size MI 'X25 rf d <br /> GROiJTING r Bags cement 5_9±t-l l r-R;_ <br /> Buckets bentonite <br /> Depth':to water J Bags sand/gravel -.n.,F oHS�%✓� <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/ i) <br /> Quantity InstalledDiscussed with geologist: - ( y/0 <br /> I� pics� � sa-t*% J Type of method <br /> EH 29 29r�l ler [rMs� /J y� <br /> o�atn ���" tC-. ;�Cr(3c /[o�d.:Sa�� • R��1`�r/ "'z�lft•r+.JKJ' <br /> 04;� ,AtW I <br /> Uc�'�l �e�t��� � d vc.Ju¢c3 E-f a�'�' �1cs••f! u ���'G!<CGf t,;>:��er Z�i-cc a.luve <br /> ..� <br /> i •n� G� lit. Q�J v[r v�:4( 2 Dine. posy, 1r Sk+ffrGlx e��kwtJOY! CCu�jH`'� :'rsc J <br /> ci L <br /> 15` ys <br />