Laserfiche WebLink
WAGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: El CONSTRUCTION <br /> Premise Address: Well No'. W. - <br /> Inspector: Total Depth_ („S <br /> Screen Length_ ]_,S f <br /> Filter Pack___ <br /> } 22 Bentonite Pellets <br /> Permit No. ` S D Grout <br /> Consultant Completion-Stove pipe/ hri.stie box <br /> Geologist <br /> Auger O:D.- rr - <br /> Auger I.D. <br /> SAMPLING --- <br /> Holding Temperature •tdc�p <br /> Method_ <br /> Screening Method.- -Qt 0 ._ <br /> ABOVE-GROUND" CHRISTY-BOX <br /> Tracking Sheet ft/n) cOWLEC:ION <br /> COMPLEnoN. <br /> Ground Surface <br /> SPOILS <br /> grcKA <br /> Storage Method S q3 <br /> " ft. <br /> Contamination Noted yes Pe 5 ft. <br /> Storage Location v <br /> b ft. <br /> m <br /> SPECIAL PERMIT INFO. <br /> :lofted <br /> Distance to sewer line—> secrian " <br /> Domestic well on site - yes/ff voi P <br /> ack <br /> If yes, location & distance - = <br /> ft. — ft. <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water. D! Casing 'type " J-r' p q <br /> Mix Ratios ow <br /> N� Blank_ ft. Screen �S. ft. <br /> Installation Me , od ' " .rufl� Slot size DO 1 <br /> Quantity Installed _ ICD - //r3 Bags cement <br /> Buckets bentonite " <br /> Bags sand/gravel LA <br /> Filter Pack type/size ' "Ztia <br /> Total Billed Time 'Peer Site <br /> Date Permit Finalized <br />