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Lr)MTORING WELL INST ;;4w'REP011�I� <br /> Date: CONSTRUCTION <br /> Premise Address: ;939 0 O F Total Depth'—' ��N►M <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: (,� Grout (from) (to) <br /> JO& <br /> /JDrilling rig type <br /> PermiAuger O.D. LD. <br /> Drilling Company: <br /> - D �,. �/� Completion - Stove pipe/christie box (circle one) <br /> t��T!"�-d'S � y�K-� <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist . OV . <br /> Ai;VE-GROUND <br /> COMSS'LETION C 4R1STY-SOX <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line grout <br /> Dorriestic well on site (y/ n ) <br /> 1f yes, location and distance - ft• <br /> ft. ft. <br /> a <br /> IV <br /> = m <br /> A <br /> i to ttad C <br /> Holdin , <br /> g Te�,pw ature <br /> Method�S = ons Pack <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) _ <br /> ft, — I Fft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) VolavW3 <br /> Storage LocationCasing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> / yx I Buckets bentonite <br /> Depth to water hVV Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />