Laserfiche WebLink
-WPAGE_ OF l <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: Z/ //`� /p CONSTRUCTION <br /> Premise Address: ����t7(.YL�� Well No. <br /> Inspector• �j T— 774 _. Total Depth ( (-2 <br /> Screen Length ZLO <br /> Filter Pack—/ao' - <br /> e� Bentonite P llets <br /> Permit No. _l ���b 7 Grout f--'"- rO i"`-, ` <br /> Consultant Completion-stove pipe/g1l—ri setie-)box <br /> Geologist _. <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING ---.--_ <br /> Holdinq Temperature 7 StI(*•Up <br /> MethodA- 'tib <br /> Screening Method / T <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet /n) COMPLETION COMPLETION <br /> SPOILS �—Ground Sufaco <br /> Vt grout V� <br /> Storage Method L -�- C�"'"""� lL �- �( u <br /> Contamination Note - ye n• 2`� <br /> Storage Location Fn,-:-e� `'{5 /� - „• a.� <br /> 2v fl. <br /> — o <br /> 0 <br /> SPECIAL PERMIT INFO. <br /> o <br /> done <br /> Distance to sewer line/ section <br /> Domestic well on site - yes/n;' <br /> gravaI pack <br /> If yes, location & distance' <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water `X Casing type <br /> Mix Ratios Blank-�'7} ft. Screen J- IS ft. <br /> Installation Method, Slot size <br /> Quantity Installed Bags cement 'et, <br /> Buckets bentonite 7 <�,. <br /> Bags sand/gravel � v-f <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />