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r,40MITORING WELL INSTALLATION REPOnf <br /> CONSTRt1CTION <br /> Date: <br /> Total Depth <br /> Premise Address: Screen Length (from) O_� -.-•,---Cto)— _�- <br /> Filter Pack (from) I R_.�--(to) 2 <br /> Well No.: t J Bentonite (from4k-._--.--Cto)j <br /> 1 Grout (from)=1 --- "-- — <br /> inspector: ..-.' `" Drilling rig type J5 , <br /> /LQ Auger O.D. <br /> Permit No. `7T o --- ---- h fFmstte"Do (circle one) <br /> Completion- Stove pip <br /> Drilling Company: OcK f, <br /> casing <br /> height <br /> Driller: ! <br /> consultantt- t��f'4 —EWT} <br /> Geologist , ', � I/ ABOVE-GROUND CHR*J -8OX <br /> coWLEVON COWLERON <br /> G=nd Stclacr . <br /> SPECIAL PERMIT INFO. #o S£Ol-i&, proof <br /> 1 ? � �' .9&0 tiit£.j <br /> Distance to sewer line_,NAC'-4.,.... 14 <br /> �—�-- � <br /> Domestic well on site - ( ft <br /> If yes, location and distan e - <br /> tH- — <br /> 0 <br /> ' slotted = <br /> SAMPLING N,,WE saC$on <br /> Holding Temperature — <br /> Method <br /> Screen <br /> Tracking Sheet - (y/ n ) K. = Z J tL <br /> SPOILS n <br /> n\ MATERIALS/52EVEL�_, OPNIENT <br /> Storage Method q , s I 7 L <br /> Contamination Noted- y n) Casing type <br /> n C 'rY r Screen,,,_. F7 <br /> Storage Location h Blank 2� a .._- <br /> Slot size_ o"L 0 <!+ <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand gravel ".` 71i/'t� t�i-f t — <br /> Depth to water 3 r i rF ?,LY-h 11.,� <br /> Filter Pack type/size Al <br /> Mix Ratios 4 6txr"'" Surge Block: - C y/(K/) <br /> Installation Methodf u t Discussed with geol gist: - (tyj n) <br /> Quantity Installed u Type of method <br /> EH 29 29 <br />