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" mor IRMG�V IN5'ie�t��i`dON. OFLT <br /> CONSTRUCTION <br /> P:ex:se.N¢dress• , . Al. Total Depth <br /> Well .No. /Z Filter PaCk (from) <br /> Inspector. Gtout' m)Ora <br /> �f -`�/w�/� .Cir` �•. r .— .,r."'aF *.._ <br /> Peru No. r O.D. I.D. <br /> • �.��w.:� pil �isife .(tivCll.one) <br /> Dr�liri�t:omg�y" �N'. : _ <br /> t , <br /> PRIM <br /> Drxer. .; �& ..... _ height 4 <br /> t <br /> — <br /> C-eoloSjst •:. Jti�C�+/E�OUND �� <br /> . r - C?MP�YTfCN <br /> S?Sa.4'L F£. ' <br /> '�, QtacR <br /> Distance to sewer liae'" <br /> Domestic weg C a <br /> If yes,!*( <br /> btpt <br /> VOW <br /> Htolftg enpeiYtliie dOft <br /> f �\ ♦ 1 ` I, r.1.."�'_ ,i�. 16`i ; �r �y�� y v_.`. • _' <br /> •� <br /> saw <br /> ,. r- <br /> S4taSe Method <br /> 0 1 ahwtion Noted it) <br /> SCdit&IAtatlOn<`' <br /> N , <br /> t 9 ` <br /> 6 <br /> SIoC size 02, <br /> ,. _ <br /> t � .... ema�nt <br /> Buckers 4tosute .. . ,r <br /> ' ,. :. <br /> Depth to wsCa Bags ssad/Srsvel <br /> iylht Rados Fuer Pack typesize <br /> Itutalladon Medwd Surge Block:-(Y <br /> Quandty Itumlled Discussed with Seal*gisG , a) <br /> Type of method <br />