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I <br /> k_.,}. � - +f-� -.r-_:.G-• ,.:r-..C_ -.s. s',:a.a�... _�.— _ -r._ --�:• l:t.,r:� .e+r..:+vs -x_,r=` _ <br /> 'AGE F <br /> MONITORING WELL INSTALLATION REPORT <br /> Dates_ At C) <br /> CONSTRUCTION <br /> _ ?J1� QTc °n A �r�,_ 5 ... <br /> -`a - - Premise Address: well No. l _ <br /> _ inspectors Total Depth '0 <br /> - F^ <br /> Screen Length <br /> Filter Pack _ - 7t::1.6- 5-3, <br /> Z �-` Bentonite Pellets_- 5 1 - <br /> Permit leo.-- 3 Grout - <br /> -Consult:tn 45 Completion-Stove pipe c stie x <br /> Geologist <br /> Auger O.D.- <br /> Auger <br /> .D. _.Auger I•D.- A <br /> lam <br /> Holding emper tare T <br /> Method IA- 3 <br /> Screening Method----- T <br /> ABOVE ROCIND CHRIM4)OX <br /> -Tracking sheet (y&R OOAPLETM CCMPLFTION <br /> around Sudan <br /> Storage Method 110OW51ev5 <br /> Contamination Doted - yel&D <br /> B. <br /> .. Storacast p:s OC � s - !'t. <br /> � r <br /> SPECIAL PERMIT_ MAL <br /> sioiwd <br /> Distance to sewer line 5 . xr. <br /> Domestic well on site - yes n R 1 <br /> If yes, location a distance - <br /> :q. <br /> rr .Y• ` <br /> GROUTING +° <br /> MATERIALS USEDs <br /> Depth to water Casing t�►pe <br /> Ove <br /> Mix Ratios Blank ft. Screen 4-5 ft. <br /> installation Method Slot size_. c22 <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel r <br /> Filter Pack type/size <br /> Total BilledTime Per Site <br /> Date Permit Finalized <br />