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's MONITORING WELL INSTALLATIt6 REPORT <br /> Date:_ CONSTRUCTION <br /> Premise Address:] S • I5, Wtl Total Depth <br /> Well No.: y w 3 Screen Length (fro I)�(to) S <br /> Filter Pack (from) (to) <br /> o Bentonite (from)Inspector: �+1w:N► 0 U l� y� Grout (from) (to) <br /> (to) <br /> Permit No. Drilling rig type L%d-v%M-0ia.. 16 <br /> Auger O.D. to <br /> Drilling CCompany:_. 8:1-0)K <br /> ` Completion - Stove pipe stie bo (circle one <br /> Driller: �l l)C�.,ti C¢:1 th - <br /> casing <br /> Consultant_ <br /> A,�''CG height <br /> Geologist vc. , a <br /> ABCVE-GROUND ; <br /> COMPLETION CHRLSTY-BOX <br /> SPECIAL PERMIT INFO rcurxiC PLEn1ON <br /> 6Su-fxe <br /> Distance to sewer line �5 r Drool <br /> Domestic well on site - (y/ <br /> If yes, location and distance - <br /> R _ <br /> e - <br /> SAMPLING . <br /> 0 <br /> . abttad <br /> Holding Temperature_ 3 12 aoc5on <br /> Method gnvW packScreening M!,!thod <br /> :r _ .... <br /> Tracking Sheet - y n) <br /> J <br /> SPOILS <br /> Storage Method VV1� MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n) <br /> Storage Location_ \osy�, Casing type Q� L <br /> Blank <br /> ___.a_ft' <br /> Screen_ \O ft. <br /> GROUTING Slot size_ t) ,o'Lc, <br /> Bags cement �– <br /> Depth to water 3 S Buckets bentonite <br /> Mix Ratios Bags sand/gravel Z> <br /> Installation Method Filter Pack type/size <br /> _ ._Surge_B1ock:= (_y_- r <br /> Quantity installed Vcl. S Discussed with geologist: - n) <br /> EH 29 29 Type of method <br />