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—rQITORING WELL INSTALLATION REPOT' <br /> Date: CONSTRUCTION CONSTRUCTION <br /> Premise Address: D C f�M tM- Total Depth <br /> .-/�� Screen Length (from) (to) <br /> Well No.: ylX . r 0{ :551 Filter Pack (from)—(t0- <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Perm [it No. 1 "t6 b7 3{ Auger O.D. I.D.- <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:nA"Ar-V P'tu <br /> Driller: casing <br /> � height <br /> Consultant k`(� �� <br /> l -VV' <br /> Geologist:& K 411JX�.� <br /> A80VE-GACUND CHpZ'tygCX <br /> CCMFLETICN COMPLETION <br /> SPECIAL PERMIT INFO. Ground S rlact <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) V 7 ft, <br /> If yes, location and distance - S /� — ft. <br /> c <br /> / 0 <br /> SAMPLING <br /> to on — <br /> HoldinTe perature ti�A = gavel Fao" <br /> Methog <br /> d �AAft'h ✓ C9�rS = <br /> Screening Method A1,4 r` <br /> Tracking Sheet n ) <br /> '0 ft. �. — fto <br /> SPOILS 1.$ <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) I & <br /> Storage Location Casing type <br /> Blank ft. creen ft. <br /> Slot size <br /> GROUTING Bags cemenr <br /> Buckets bentonite <br /> Depth to water ~ �� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />