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rv10NITORING WELL INSTALLATION REPOn <br /> Date: `I/�/ /P CONSTRUCTION <br /> Premise Address: Total Depth l!S <br /> g� Screen Length (from) Z (to) S <br /> Well No.: Filter Pack (from) (to)�_ <br /> Bentonite (from) (to) --r6Inspector: Grout (from) (to) <br /> Drilling rig type 5J— <br /> Permit No. Auger O.D. Fl I.D. <br /> .e-- � Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: //'_ <br /> Driller: / r d�E casing <br /> Consultant <br /> N� IffT <br /> height <br /> Geologist <br /> ABOVE-GROUND <br /> CONN ETION iCHRZ-rY430 <br /> SPECIAL PERMIT INFO. Ground Surf <br /> Distance to sewer line C5� grout <br /> Domestic well on site - ( y A(D <br /> If yes, location and distance - <br /> �ft ft. <br /> O <br /> 0 <br /> C <br /> SAMPLING <br /> slotted = 1' <br /> section '- <br /> Holding Temperature r elk CGLP Z S—(os <br /> VAYS4 Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - y n ) <br /> SPOILS <br /> Storage Method OL IF Lc eK MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y n n <br /> Storage Location Casing type Z se <br /> Blank ft. Screen _ <br /> Slot size 'U!0 4' <br /> GROUTING Bags cement d !'- 7 P's"f <br /> r Buckets bentonite <br /> Depth to water Bags sand/gravel a—t*" <br /> Mix Ratios Filter Pack type/size 2•� <br /> Installation Method ro Surge Block: - (y <br /> Quantity Installed 7--10 Discussed with geologist: - (y/D <br /> Type of method <br /> EH 29 29 /fes <br /> /l/M Pb " �5 <br /> / � 3Z <br />