Laserfiche WebLink
AGE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: !Aj1-9 a CONSTRUCTION <br /> Premise Address: G/00 'Aj. uilciv ► /v/V1 Well No.. <br /> Inspector: Total Depth 'ZY <br /> S• G'4�ftj"7,6 W Screen Length 2, <br /> Filter Pack �2$' -�•�i -7 A <br /> f' _ Bentonite Pellets - 7 ^+ • 'S <br /> Permit No. q0- Z a 5 Grout •51--> <br /> Consultant Lt .S , roc_ Completion-Stove pipe christie box <br /> Geologist ty'ydiI1 IDIbeE12_, <br /> Auger O.D. <br /> Auger I.D. Z,yC' <br /> SAMPLING - --- - -- —-- - - <br /> Holding Temperature ¢0 at -up <br /> lcA <br /> Method /G <br /> Screening Method T <br /> AE&E-GROUND CHRIS7Y-BOX <br /> Tracking Sheet 0n) COMPLETION COMPLETION <br /> Ground Suriacs <br /> SPOILS <br /> grout <br /> Storage Method /NevtJK S <br /> Contamination Noted -d�Dbno n' <br /> n. <br /> Storage Location n, <br /> C71J SI _' <br /> _ m <br /> -- O <br /> m <br /> SPECIAL PERMIT INFO. <br /> 0 <br /> f slotted _ c <br /> Distance to sewer line >60 section _ <br /> Domestic well on site - yes gravel pack <br /> If yes, location & distance - '- <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type S �J Ak I+'g) <br /> Mix Ratios T Blank ft. Screen 24)'* ft. <br /> Installation Method Slot size 0. O/ 0 <br /> Quantity Installed Bags cement <br /> Buckets bentonite �.. <br /> Bags sand/gravel <br /> Filter Pack type/size 3 <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />