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MONITORING WELL INSTALLATION REPORT <br /> Date: 3/1 0 r 5— CONSTRUCTION <br /> Premise Address:_ 1 W- \���7 �(�� (^��(�. Total Depth <br /> Screen Length (from) 7 (to) Is- <br /> Well No.: /44 w — 3 Filter Pack (from) 5 (to) 1!5,- <br /> Bentonite <br /> 5'Bentonite (from) 3 (to) Is <br /> Inspector: Grout (from) O (to) 3' <br /> Drilling rig type L�.itls' 176- <br /> Permit <br /> TSPermit No. Auger O.D. " I.D. <br /> . ���� Completion ove pipe istie box (circle one) <br /> Drilling Company: <br /> Driller: �(� �Y / casing <br /> eight <br /> Consultant <br /> 14-D7 T3- <br /> Geologist RYAA) C-RAW�RX-;;- 71 <br /> ABOVE-GROUND <br /> COMPLEMN CHRZTY-$OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface (� <br /> Distance to sewer line to grout 3 <br /> Domestic well on site - (y/ <br /> If yes, location and distance - aZ 3 <br /> y. <br /> b <br /> _ � r <br /> SAMPLING r stoned <br /> Bacton <br /> Holding Temperature <br /> Method = t'V'W Pack <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) —' <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) n <br /> Storage Location Casing type�� C-(,/� r VC , <br /> Blank � ft. Screen $ ft. <br /> Slot size O.d o" <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 7 <br /> Mix Ratios Filter Pack type/size 4k 3: <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />