Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: Z7� CONSTRUCTION <br /> Premise Address:l5�� ��IyYG� Well. No.—/0V/,/ / <br /> Inspector: V Total Depth Z f <br /> Q % Screen Length <br /> Filter Pack ! - J3 <br /> Bentonite Pellets13- 111 <br /> Permit No. (� Grout <br /> Consultant " Completion-Stave pip christie box <br /> Geologist v I <br /> f Auger O.D. <br /> Auger I.D. <br /> SAMPLING - <br /> Holding Temperature •tldc-uP <br /> Method <br /> Screening Method <br /> A$OVF_-GROUND CHRISTY-BOX <br /> Tracking Sheet {y/n} COMPLEMN COMPLETION <br /> ocmuW Surface <br /> SPOILS <br /> __,,�� 1 grain <br /> Storage Method WIJ n T C- <br /> Contamination Noted - ye tt. <br /> Storage Location ^ft. <br /> 46 <br /> r <br /> SPECIAL PERMIT INFO. c <br /> e <br /> alotlod :. <br /> Distance to sewer line .pion `: <br /> Domestic well on site - ye o park <br /> If yes, location & distance - <br /> WZ /rz V - J. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water 4 � Casing ty <br /> Mix Ratios Blank ft. Screen -ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> buckets bentonite <br /> Bags sand/gravel21 <br /> Filter Pack type/size <br />