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MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address:(CT77 tz_. �' Rr{ o Total Depth Z <br /> Well No.: 10l4V3e2– Z 3Q Screen Length (from)' Zz- (to) 2 1"p <br /> Filter Pack (from) Z 1 g (to) 2 <br /> Inspector• Bentonite' (from) Z ! 2- (to) 2t 8' <br /> Grout (from) O (to) Z l Z <br /> Drilling rig type �'►�D Ro A <br /> Permit No. Auger O.D. 8 I.D. <br /> Drilling Company:_ L_/orvP — <br /> Completion- r5iZ p christie box (circle one) <br /> y • .PR/LL <br /> Driller:_ rrztS "VVz,4, <br /> casing <br /> height <br /> Consultant 0I1'e <br /> Geologist �S�UI•t/ � V�l.Lt/j'j ._ <br /> ABOVE-GROUND <br /> COWFLET1ON C*iA1M_BOX <br /> SPECIAL PERMT INFO. COMPLETION <br /> Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) /Z <br /> If yes, location and distance - ft. <br /> • Z2d ft i r� ft. <br /> SAMPLING -- o <br /> soon <br /> Holding Temperature = <br /> Method — v2vs?pack <br /> Screening Method = <br /> Tracking Sheet (y/n) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type SC 4 9',0 Z <br /> Blank Z zo ft. Screen ZD ft. <br /> Slot size O 2-0 <br /> GROUTING Bags cement <br /> Buckets bentonite 2 <br /> Depth to water Bags sand/gravel /S'- <br /> Mix Ratios Filter Pack type/size �tF 3 S4.vd <br /> Installation Method_ _ -__ -_ Surge Block: - (-y-/ <br /> ge <br /> Quantity Installed Discussed with ologist: - (y/ n) <br /> EH 29 29 Type of method <br />