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MONITORING WELL INSTALLATION REPORT <br /> Date: I2 -fZ 1 CONSTRUCTION tj <br /> Premise Address: 4!:-,-2c2G�u//ter Well No. vU ' A VS- <br /> Inspector: Total Depth O <br /> Screen Length Zh <br /> Filter Pack j,/O $ <br /> c Bentonite Pellets_L - <br /> Permit No.—2�� Z / -!;--1 Grout_ <br /> Consultant 7"A Completion-Stove pip chr'stie b <br /> Geologist K�6nn/i <br /> Auger O.D. / D <br /> Auger I.D. y <br /> SAMPLING <br /> Holding Temperature �- stick-up <br /> Method C(? j i1rW <br /> Screening Method Y- Al u <br /> Tracking Sheet �n) COMPLET ONC CHRISTY-BOX <br /> COMPLETION <br /> SPOILS Ground <br /> Surface <br /> proof <br /> Storage Method ?X-- ��. <br /> Contamination Noted -(�O/no <br /> Storage Location ���, n• <br /> •s <br /> SPECIAL PERMIT INFO. <br /> _ a <br /> s1otiod <br /> Distance to sewer line ( section <br /> Domestic well on site yes/nog' <br /> If yes, location & distance - -- gmP <br /> ack <br /> L.Jft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Z7 Casing type J l/�G S"c p <br /> Mix Ratios Blank 20 ft. Screen L cD ft. <br /> Installation Method Slot size 0 ' (07-0"' <br /> Quantity Installed Bags cement 9 <br /> Buckets bentonite ! Q <br /> Bags sand/gravel x <br /> Filter Pack type/size t!L <br />