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U <br /> MONITORING WELL INSTALLATION REPORT <br /> i <br /> -d! —`7a <br /> Date' .� " ,_ CONSTRUCTION <br /> Premise d re Well No. V W <br /> Inspector: Total Depth <br /> Screen Length - 13 --:> 7 <br /> Filter Pack -20 7 Bentonite Pellets <br /> Permit No. 90 Grout - 4_0 - 'Z <br /> Consultant S Completion=Stove pipe/christie box <br /> Geologist !� <br /> Auger O.D. .Z5 <br /> Auger I.D. (a •Z <br /> SAMPLING <br /> 0� <br /> Bolding Temperature <br /> Method 1 G� <br /> --•• - � �dckup <br /> Screening MethodLib U4 <br /> Tracking Sheet AbOVE-GROUND ` <br /> �L�� wbw�EraH crw�m�,ax <br /> SPOILS OfVA'd 5 <br /> piwl <br /> Storage Method <br /> Contamination Noted - yesno n. <br /> Storage Location n' - <br /> l 9 <br /> D <br /> doled — � <br /> SPECIAL PERMIT INFO. <br /> r wbvw PA* <br /> Distance to sewer line 'SSU-o t` <br /> Domestic well on site - yes/ - <br /> If yes, location & distance <br /> GROUTING MATERIALS USED: <br /> Depth to water Casing type 4-'0 +'v C- <br /> Mix Ratios Blank '7 - ft. Screen D ft. <br /> Installation Method slot size D•0�-f3 <br /> Quantity Lnstalled Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />