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vIONITORING WELL INSTALLATION REP. <br /> N <br /> i <br /> 1 <br /> I' Date : - fio 10 CONSTRUCTION <br /> n / <br /> Premise Address: Total Depth Sby <br /> Screen Length (from) (to)_�O _ <br /> Well No. : Filter Pack (from) CS (to) Vs <br /> Bentonite (from)_r �(to)�3l0 <br /> Inspector: Grout (from) (to) �— <br /> � Qp� Drilling rig type <br /> Permit No. / 0 Auger O.D. I.D. <br /> Completion - St ve pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: 14� t casing <br /> height <br /> Consultant //� T <br /> Geologist /' / *�1 /` L _ - J r <br /> 136 <br /> ABOVE-GROUNI 4l5 cHR�sn e0% <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. nd Surf <br /> Distance to sewer line ,> /Ud SffE proof <br /> Domestic well on site - ( y (D v 8�,gr 35 ' -56 n. <br /> If yes, location and distance - 507i ft. <br /> ME <br /> SAMPLING@ &lotted <br /> &action <br /> Holding Tempe ature l` <br /> grxvo pack <br /> Method = <br /> Screening Method 0 <br /> Tracking Sheet y n ) <br /> ft <br /> ft. <br /> SPOILS <br /> Storage Method ✓� " MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n Zil <br /> Storage Location Casing e ( V �J <br /> Bl; 0 ft. , Screen 10 ft. <br /> Slot size AA . OW <br /> GROUTING Bags cement I& Zh _! 111 Aw� Id (J <br /> Buckets bentonite I' i TOE ecl <br /> Depth to water �5 Bags sand/gravel_ 4 as <br /> Mix Ratios S, t !eUr Filter Pack type/size Z <br /> Installation Metlad u.r Surge Block: - ( y n � <br /> Quantity Installed Discussed with geo ogi t: - ( y ' l:J <br /> Type of method N �i4 <br /> EH 29 29 <br /> 1046eff /JA9 �c �° <br />