Laserfiche WebLink
AGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> r <br /> Date• �' 5 CONSTRUCTION <br /> Premise Address: S CCS Well No. �( 3 <br /> Inspector: Total Depth <br /> S Screen Length ,,- <br /> Filter Pack <br /> Bentonite Pellets -30 --"!�-2)A <br /> Permit No. �� 0 t Grout --Z <br /> Consultant OZE 4 Completion-Stove pipe ristie box <br /> GeologistW?2UwN <br /> Auger O.D. .'Lb <br /> Auger I.D. <br /> SAMPLING -- ---- .- — <br /> Holding Temperature <br /> Q?° stick-up <br /> Method �� <br /> Screening Method 3- 7 <br /> ABOVEGROUND CHRISTY-BOX <br /> Tracking Sheet &n) OOWPLE70N <br /> COMPLETION <br /> SPOILS Ground Surface <br /> �'. • , proof <br /> Storage Method nt' i u9-(S <br /> Contamination Noted - e /no <br /> Storage Location n' <br /> — b <br /> SPECIAL PERMIT INFO. <br /> — o <br /> — o <br /> sionod — E <br /> Distance to sewer line socdcn <br /> Domestic well on site - yes/9) — t;RvW Pack <br /> If yes, location & distance <br /> ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water 48 Casing ty !S-C4 <br /> Mix Ratios Blank— ft. Screen 2 ft. <br /> Installation Method f?I(s Slot size <br /> Quantity Installed Bags cementl <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size 2/ <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />