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MONTTORING WELL INSTALLATION REPORT <br /> l <br /> yy <br /> Date: t 13 D <br /> CONSTRUCT70N <br /> Premise Address:_ <br /> Total Depth_ 5 <br /> Well No.:— 1V —Zj Screen Length (from) « (to) <br /> Filter Pack (from) yq'�tom' (to) <br /> inspector•. Bentonite (from) —�' (to) J <br /> Grout <br /> (from) (to) <br /> Permit No, Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company. Completion - Stave pipe/ciu istie box (circle e) <br /> Driller, <br /> T� casing <br /> Consultant F height <br /> d <br /> Geologistt� � <br /> ABCVE-GRCt1ND WT <br /> SPECIAL PERMIT INFO. CONFL DON CHR�M•BOX <br /> COMPL_RIcN <br /> Ground SuAacs <br /> Distance to sewer line. <br /> Domestic well on site - / n) grout <br /> If yes, location and ' tance - <br /> S= _ <br /> c <br /> Holdingp <br /> Temperature zacic� f e-o socicn — 3 <br /> Method <br /> Screenin pry <br /> Tracking = pavvly�dc <br /> Meth <br /> G od_ <br /> Shcet - (y n ) <br /> SPOILS �'} tt• — <br /> tt. <br /> Storage Method <br /> Contamination Noted - ( //{l MATERJALS/DEwi.opmENT <br /> Storage Location Crt15 .0) <br /> Casing type_ Z ` �V(+ <br /> Blank U ft Screen <br /> GROUTING Slot size nz <br /> Bags cement <br /> Depth to wateryvS S r( _ Buckets benro i <br /> Mix Ratios I O _ / p Bags sand/ 1 <br /> Installation Me od Filter Pack type/size F <br /> Quantity Installed 1� ��V Surge Block: - (y n �— <br /> Discussed with geo ogist: - (y <br /> FH �9 29 Type of method <br />