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Ovl�)AONITORING WELL INSTALLATION REF ~ T <br /> Date: 7b 7/©S CONSTRUCTION <br /> Premise Address:- ' I , yy � Total Depth <br /> Well No.: J ' b IQ !U L Corrne�cf 5), 4( Screen Length (from) 30 - (to) �6 <br /> Filter Pack (from) � Z> ' (to) 0 <br /> Inspector: Iy� / 1: uS" C k0entonite (from) 2. (to) � I <br /> fl,lzf r—Grout (from) (to) <br /> Permit No. / I no 323 9 Dulling rig type C� — <br /> � Auger O.D. 0 4 LD. <br /> DrlllingjCompany:_ <br /> �/� Completion - Stove pipe/christie box (circle one) <br /> �IpeGTrvr.n <br /> Driller:, <br /> Q ,y/� casing <br /> Consultant (f �_ ��^- ) �+D ��fS1C height <br /> Geologist VrJ iSSti L 37 <br /> ABOVE-GROUND QW <br /> COMPLETION CNAI157Y-BOX <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Sw1xe <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) I <br /> If yes, location and distance - ♦ h. <br /> h. <br /> ft. <br /> _ n <br /> SAMPLING 1/6 <br /> slotted <br /> Holding Temperature met soc5on <br /> Method Pack <br /> Screening Method r{� <br /> Tracking Sheet - ( y / n ) <br /> SPOILS ��77 <br /> Storage Method uanlLG' Cf MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n I <br /> Storage Location NE for au e• Casing type pV C Z <br /> Blank 30 ft. Screen Za ft. <br /> Slot size e2 <br /> GROUTING Bags cement_ 5 .V4�!( t <br /> 35 Buckets bentonite / <br /> Depth to water A" Bags sand/gravel <br /> Mix Ratios u l Filter Pack type/size 7 3 si <br /> InstallationMethod 7vk ! .tlu � r Surge Block: - ( y <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> EH 29 29 Type of method <br />