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MONITORING WELL INSTALLATION REPORT <br /> Date: ' ^ CONSTRUCTION <br /> Premise Address: 1 G 71 Total Depth- <br /> y <br /> Well No.: `^�-(S 13 Screen Length (from)' 1 -70 (to) Z C,o <br /> Filter Pack (from) Z,-2S- (to) / L27 <br /> l l'Z l ti' Be�toni a (from) i C 7 _(to)__LLL L <br /> Inspector: `� ' ��'���/� -5A Grout (from) ( E`1 (to) S- <br /> Drilling rig type 1-'",4,) /'n T41-1t-1, <br /> Permit No. Auger O.D. 10 ? I.D. <br /> Drilling Comp �� <br /> Completion- Stove pipe/chnstie box (circle one) <br /> any: sl�i�k ✓qv< r <br /> Driller: S Lle Z t 5 C 14 <br /> casing <br /> height <br /> Consultant � ��i>/ S <br /> Geologist <br /> ABO VE-GROUND <br /> COwLETION CNAISTY 80X <br /> SPECIAL PERMIT INFO. GroundSuriacs COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - <br /> 7o ft. ft. <br /> C <br /> SAMPLING <br /> s to rted <br /> Holding Temperature <br /> Method _— g"'1W Pack <br /> Screening Method = <br /> Tracking Sheet - (y/n) <br /> Z njo <br /> SPOILS <br /> Storage Method r4 <br /> MATERIAWDEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type f T�liyLEss -.5 <br /> Blank 17-2 ft. Screen �'n ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel .— <br /> Mix Ratios_ I I3P .-ALiz A.4" Filter Pack type/size 7- <br /> Installation Method_ -tRE,11 , pk,Fc.� _ _-- --- _Surge Block:.-_ /-n-)---- <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />