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MONITORING WELL INSTALLATION REPORT <br /> Dates ' I CONSTRUCTION <br /> Premise Address: 166 W• Well NO. <br /> Inspector: j Total Depth <br /> k <br /> Screen Length o <br /> Filter Pack 5 - <br /> Bentonite Pellets -2 ; - sa fOd� <br /> Permit No. + Grout . 00 <br /> Consultant �, Completion-St ve.pi <br /> Geologist <br /> Auger O.D. 't <br /> Auger I.D. <br /> AAM <br /> Holding Tem nature add(-UPMethod , <br /> Screening Method ^ <br /> ABOVE-0ROUND CFWISTY�80X <br /> Tracking Sheet (y/n) COMPL.EI`" COMPLETION <br /> SPOILS i5 Omu dSurface <br /> `" gout <br /> Storage Method ,, . <br /> LAW- <br /> Contamination Noted - yes/no <br /> Storage Location 00-a. ._ ��$ fL. <br /> ¢x: r <br /> SPECIAL PEWIT INFO. <br /> Distance to sewer line ,= <br /> Domestic well on site - yes <br /> If yes, location & distance <br /> GROUTING <br /> WATERIALS !jSED: <br /> Depth to water '��� Casing type 2� <br /> Mix Ratios Blank_ ft. Screen ft. <br /> Installation Method Slot size-0-1 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/sized 9UU(Vd1(4,4WJ <br /> Total Billed Time Per Site 010 <br /> Date Permit Finalized <br />