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MONITORING WELL INSTALLATION REPORT <br /> Date:_ _U4 CONSTRUCTION <br /> Premise Address: 7(p y7 �/�/�/L J9►/�• >�L� Total Depth <br /> Screen Length (from) 6b (to) <br /> Well No.: �j ^ Filter Pack (from) -70 (to) ��3V <br /> Bentonite (from) (to)-J <br /> Inspector: y GboAJ6r Grout (from) b (to) <br /> Drilling rig type <br /> Permit No. "';7L (p Auger O.D. ~" /� I.D. <br /> ,2 EI i-- Completion - Stove pipe/chnstie box (circle one) <br /> Drilling Company: /�7.j6— <br /> Driller: �Z �- 5• casing <br /> height <br /> Consultant3MOAJ0 alt ?/17LLIPS &(a <br /> Geologist �� S�:u.,.•�11.•k } '' ,���� ,_ <br /> _qV <br /> ABOVE-GROUND <br /> CO w LETZ N C,1iR ZTY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line_ Z Z / Grp <br /> Domestic well on site - (y 'q 0 <br /> If yes, location and distance - ,J ft <br /> X' <br /> SAMPLING /ti1 i/A'L� a _ <br /> Holding Temper tore72 V= P <br /> Method _— <br /> Screening Method J =_ <br /> Tracking Sheet - (y/n ) - <br /> -w: <br /> tt. — tt. <br /> SPOILS <br /> Storage Method SS UTICA, ))A,cj"< MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> 4ECV,2�YD Blank ft. Screen - f. <br /> AT Slot size <br /> GROUTING Bj�/L/ Bags cement V Y7 <br /> Jt- <br /> Buckets bentonite K - <br /> Depth to water_ z __71A PIT Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 3 <br /> Installation Method t _ __S.urge Block:=(.y_/n_)_ <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 <br /> Type of method <br /> > �I x <br /> .X <br /> y7 X 2) .9 7 <br />