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MONITORING WELL INSTALLATION REPORT <br /> Date: 2 Z) CONSTRUCTION tI/Q, <br /> Premise Adds: )oo Well No. <br /> Inspector: __K Total Depth a <br /> Screen Length FM 9. to 5 T <br /> Filter Pack_ F'M y Y. S 143 t- _ <br /> Bentonite Pellets <br /> Permit No. 9C�-/S/ /`/ Grout <br /> Consultant 1141A Completion-Stove pipe/christie box <br /> Geologist <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature Y C- •tk*•up <br /> Method_ Rj 6a - <br /> Screening Method n ✓N) <br /> 7// <br /> ABOVE-GROUND CHRISTY•80X <br /> Tracking Sheet ©/n) COMPLETON COMPLETION <br /> Grund Sumac. <br /> SPOILS <br /> of out <br /> Storage Method dM <br /> Contamination Noted - ye /no ��• <br /> Storage Location ov, ft• <br /> ft. <br /> _ u <br /> n <br /> SPECIAL PERMIT INFO. = a <br /> c <br /> _ o <br /> . 1 <br /> Distance to sewer line �`{ sloltid"cdon <br /> Domestic well on site - yes = UP <br /> ack <br /> If yes, location & distance <br /> ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water. Casing type P11C <br /> IV Sc H 4/0 <br /> Mix Ratios Blank 't' ft. Screen Zoft. <br /> Installation Method Slot size_ O . DL C) <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br />