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WITORING WELL INSTALLATION REPO* <br /> Date: 161?1 y CONSTRUCTION <br /> b FF�xxi� S�. Sty ' <br /> Premise Address: Total De <br /> / pth <br /> Screen Length (from) 33'S'I (to) Z 3-t <br /> Well No.: W y �J Filter Pack (from) 1";.S' (to) Z0' <br /> /� <br /> Bentonite (from) Z-1 ' (to) Ig f' <br /> Inspector: Gkkjod'I 60A&AI Gy Grout (from) 55" AV (to) IF.s ' <br /> Drilling rig type BBT <br /> Permit No. 7"VO Auger O.D. QI.D. q,Z .S' <br /> Completion - ipe uistie box (circle one) <br /> Drilling Company: W"Wcrd <br /> Driller: 5 W'-e ttj 14 /Z hel'ghct-� <br /> Consultant <br /> �(L S <br /> Geologist —es�i�C <br /> ABCVE-GR MND CNAISTY-80X <br /> CCNFLETCN COMPL.ETICN <br /> SPECIAL PERMIT INFO. Ground Susfacs <br /> Distance to sewer line �( <br /> Domestic well on site - (y/ n ) 4'r fL <br /> If yes, location and distance - 2 ft. <br /> C <br /> SAMPLING <br /> 0 <br /> Holding Temperature <br /> Method ►Y,40— <br /> Screening Method c` _ <br /> Tracking Sheet ( y/ n ) <br /> fL <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) ti PVG <br /> Storage Location Casing type <br /> Blank V t3 $ Screen 112 ft. <br /> Slot size "'Cl-N <br /> GROUTING Bags cement_ )7 b'` S 171 . Ea• 5hwetf 3 <br /> Buckets bentonite l— .TO !� <br /> Depth to water C, Bags sand/gravel -7 -b"-f <br /> Mix Ratios _ Filter Pack type/size-a3 <br /> Installation Methodkn�( Surge Block: - ( y/[9) <br /> Quantity Installed 1 Discussed with geologist: (®/ —,�, • <br /> Type of method <br /> EH 29 29 <br />