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-MONITORING WELL INSTALLATION REPO' <br /> Date:_6/L CONSTRUCTION <br /> Premise Address:-17-7- N' �'" "' Total Depth 1361) <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to)�.�..�_ <br /> Inspector: _ 12 Grout (from) (to) cam/ <br /> Drilling rig type <br /> Permit Nod]] -o-n Auger O.D. 7-?1v I.D. <br /> - Stove pipe/cluistie box (circle one) <br /> Drilling Company: VCompletion <br /> Driller: casing <br /> height <br /> Consultant T-rA <br /> Geologist_ �� <br /> ABOVE-GRCUND <br /> COMPLETION CHMM-BOX <br /> SPECIAL PERMIT INFO. u�. Ground Surtacy CCMPLEnPL ON <br /> Distance to sewer line 3 '(Y(��bAs S grout <br /> Domestic well on site - (y <br /> If yes, location and distance <br /> ft. <br /> SAMPLING <br /> &#don <br /> Holding Te erature <br /> " <br /> Method 9I <br /> Pack <br /> Screening Method <br /> Tracking Sheet y/ ) 111 <br /> o AL—ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (, Ln <br /> n <br /> Storage Location 6M-r �� Casing type �A- <br /> Blank ft Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> '' // Buckets bentonite <br /> Depth to water 4�' Bags sand/gravel <br /> Mix Ratios � � ,s �"Os�a P Filter Pack type/si e <br /> Installation Method , �— Surge Block: - ( / n ) <br /> Quantity Installed %z c ,J; Discussed with eologist: - (y/ n) <br /> Type of metho <br /> EH 29 29 <br />