Laserfiche WebLink
• &E_Z�OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:—--�Z�ZGo CONSTRUCTION <br /> 20 �/� U /().% <br /> Premise Address- 7 J� Well No. <br /> Inspector: Total Depth ,Z3 Z- • 2Z <br /> Screen Length a3- `6 z - 7 '2Z' 7 <br /> Filter Pack 23- 6 '7- -1-6 <br /> Bentonite Pellets -S - S a-S <br /> Permit No. Grout S- / 5 S-1 <br /> Consultant L Completion-Stove pipe ristie box <br /> Geologist t krcrvr S <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature 1'e-® ttldc-uP <br /> MethodSrJ I(+ 5P200 <br /> Screening Method <br /> AE;OVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (ykt COMPLETION COMPLETION <br /> ���Orourd Surleee <br /> SPOILS <br /> 11 grout <br /> Storage Methods IQef <br /> Contamination Noted (0/no �ft. <br /> Storage Location o�7 5, <br /> m <br /> SPECIAL PERMIT INFO. _ c <br /> C <br /> slotted = 8 <br /> Distance to sewer linen woton <br /> Domestic well on site - yeslri6� <br /> if yes, location & distanceC� — <br /> ft• = ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type eV C <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size .O Z <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel �Y <br /> Filter Pack type/size 4 -3 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />