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MONITORING WELL INSTALLATION REPOnT <br /> Date: CONSTRUCTION <br /> Premise Address: �Ty� /I/, Total Depth <br /> `/G l Screen Length (from) <br /> Well No.: 5 (to) 1.5 <br /> G GU W. <br /> Filter Pack (from) 50 (to) 1£ <br /> Inspector: Bentonite (from)_ 28 (to) 23 <br /> Grout (from) 2 3 (to) 3 <br /> �! (/ Drilling rig type C-16 t <br /> Permit No.__ 7 Auger O.D. $ I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: -f' casing <br /> � <br /> Consultant height <br /> Geologist <br /> ABOVE-GROUND <br /> COAdPLET10N JrL= <br /> X <br /> SPECIAL PERMIT INFO. N <br /> Ground Surisct <br /> Distance to sewer line <-56 grout <br /> Domestic well on site - ( y n <br /> If yes, location and distance - 23 ft. <br /> 2 41 <br /> .CD <br /> .3> = m <br /> SAMPLING — o <br /> ilatwd Y: _ <br /> tecton � u <br /> Holding Temperature ­4<40"IR <br /> Method — RaYW Pack <br /> Screening Method = <br /> Tracking Sheet <br /> SPOILS p <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted <br /> Storage Location Casing type Y <br /> Blank 072 ft. Screen 70ft. <br /> Slot size . <br /> GROUTING Bags cement 5 Y- 1o" I I <br /> �� Buckets bentonite2 50# <br /> Depth to water -'� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size ?° 12.- <br /> Installation Metho Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />