Laserfiche WebLink
Y . - <br /> AGE 7i OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: /�ylJ `� CONSTRUCTION <br /> Premise Addre s: �� • lltACt4llx Well No. VInspector: <br /> � - Total Depth <br /> Screen Leng <br /> Filter Pack <br /> Bentonite'Pellets <br /> Permit No 90-23 7 Grout <br /> Consultant Completion-Stove. pipe istie bo <br /> Geologist 111 <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING - ------- - <br /> Holding Temperature stjdcp <br /> Method ri <br /> Screening Method <br /> ABOVE-GROUND CHRIS1Y43OX I <br /> Tracking Sheet (y/n) COMPLETION COMPLETION � <br /> Ground Surfacs q <br /> . SPOILS <br /> proiA <br /> Storage Method <br /> Contamination Doted -- yes/no �. <br /> Storage Location ft. <br /> SPECIAL PERMIT INFO. c <br /> o <br /> ' siott4d = E <br /> Distance to sewer line saidOn <br /> III< Domestic well on site - yes/no jrgm,;W pack <br /> ;. <br /> If yes, location & distance - <br /> ft. <br /> GROUTING <br /> MATERIALS USED: <br /> t <br /> Depth to water Casing type^ <br /> Mix Ratios Blank tC ft. Screen ft. <br /> Installation Method Slot size <br /> a <br /> Quantity Installed Bags cement <br /> Buckets Aentonite <br /> Bagssan /gravel <br /> Filter Pack type/size J:P?/ <br /> ;.Total Billed Time Per :Site <br /> :Date Permit Finalized <br />