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MONITORING WELL INSTALLATION REPORT <br /> Date: 3L.�3 I/w CONSTRUCTION <br /> Premise Address: Total Depth ( 7 <br /> Well No,: W�S (U W 1 Screen Length (from) /7 (to)7 <br /> Filter Pack (from) 7 (to) <br /> Bentonite (from) (to) k <br /> Inspector: C JS�,rcL� Grout (from) (to) <br /> Permit No. ��!�9 6d�"141 Drilling rig type <br /> Auger O.D. K I.D. 2 <br /> Completion - Stove pipe/christie bo (circle one) <br /> Drilling Company: �S�a^-- <br /> Driller: <br /> casing <br /> heigh <br /> Consul,ant- /5 <br /> Geologist / r�I b M P PL4 T <br /> ABOVE-GROUND <br /> OOF,PLE'rZN CFRIim-80X <br /> ON <br /> SPECIAL PERMIT INFO. Ground Skrfws <br /> Distance to sewer line kgrout <br /> Domestic well on site - }�/ n ) <br /> If yes, location and dist ce - ft. <br /> tt. tt' <br /> q <br /> SAMPLING 6 jA 6z o = 9 <br /> Slotted 8 <br /> Hold' g Temperature wcdon <br /> Me gravel pack <br /> Scr Hing Method <br /> Tr king Sheet - (y/n ) — <br /> __ <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y IN) <br /> Storage Location Casing type_ <br /> Blank '7 ft. Screen O ft. <br /> Slot size /7.010 <br /> GROUTING Bags cement Z -.C4c.C, <br /> v j0 g Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/(n_) <br /> Quantity Installed Discussed with geo ogist: - n ) <br /> EH 29 29 Type of method <br />