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RING WELL INSTALI.ATI- � �.,T • .� •' ,�. ,a. ---- � <br /> _ N MONITORING ON REF R <br /> Date: <br /> CONSTRUCTION <br /> .[ !•` a�°I ;8.�;�- ,. _ .w; �. .. ` ,,y . r� 1..F ►" �' <br /> Premise Address: <br /> Total Depth { <br /> u Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) r <br /> Inspector: Grout (from) (to) <br /> - - .. . Drilling rig type <br /> Permit No. Auger O.D. I.D. ' <br /> Completion - Stove pipe/christie box ,(circle one) <br /> Drilling Company: I <br /> .. . �. � _ ... .� ...� casing <br /> Driller: <br /> .. �.. _ height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND /�{ �/��/ <br /> ON COMPLETION <br /> SPECIAL PERMIT INFO. Y - Grou <br /> nd Surlace <br /> grout <br /> Distance to sewer line — - -- <br /> i Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> O <br /> f SAMPLING alovad y c <br /> aacdon <br /> Holding Temperature ' <br /> gmvW pack <br /> ' Method <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> SPOILS <br /> � s <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/n ) <br /> Storage Location a ;. :. Casing type <br /> F - Blank 1 ft Screen fr. <br /> Slot size0.p21J <br /> GROUTING .t v Bags cement <br /> •' Buckets bentonite'- <br /> , ` , Bags sand/gravel <br /> Depth to water ` <br /> G Mix Ratios ' if " Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> �., _ • s Type of method - <br /> EH 29 29 <br /> j � �, <br />