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MONITORING WELL INSTALLATION REPORT <br /> Date• / ///0 CONSTRUCTION l <br /> Premise Address: G /�� � Well No. N4 �� � ° ��y/ <br /> Inspector• Total Depth U <br /> Screen Length /O 0S0 27 /,cone <br /> Filter Pack rBAgSffAcv <br /> Permit NO; 2�/ Bentonite Pellets <br /> Grout A"_4 <br /> Consultant Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. /- <br /> Auger I.D. 9 9- <br /> SAMPLZN6 2 i 5 , fl, - .�-�, / �� <br /> Holding Temperature `+-•'�El"`^✓'/y v•�_� <br /> Method <br /> Screening Method <br /> Tracking Sheet (y/n) <br /> ABOVE-GROUND <br /> COMPLETION Cr jm WX <br /> COMPLETION <br /> SPOILS Orourd Sl+lac� <br /> 1 <br /> Storage Method ��'�� �k"�/"� �- y � / <br /> Contamination Noted - yes/no <br /> y <br /> Storage Location e7h_ 44X.2, <br /> n <br /> YOIwA = <br /> SPECIAL PERMIT INFO. «tion <br /> p uw peat <br /> Distance to sewer line A//'4 <br /> Domestic well on site - yes/no =_ <br /> If yes, location & distance - 160 �—n• _ _n. <br /> 511�,1wn-�I , J I ba <br /> I <br /> GROUTING MATERIALS USED: <br /> i <br /> Depth to water ZO -Z' y Casing type51 <br /> L <br /> Mix Ratios •e -< < Su.�� <br /> Installation Method Blank � <br /> ft. Screen /0 <br /> � Slot size010 <br /> Quantity Installed Bags cement at/v i <br /> Buckets bentonite .Q <br /> Bags sand/gravel 1 SgcKS' <br /> Filter Pack type/size itt/ X/�) <br />