Laserfiche WebLink
MONITORING WELL INSTALLATION&RT <br /> Date: /1— - 2 CONSTRUCTION <br /> Premise Address: `- <br /> S. �r - Total Depth / <br /> 1 Screen Length (from) F (to) 7,� <br /> Well No.: 1ba i 1 1 Filter Pack (from) (to) <br /> / Bentonite (from) (to) <br /> Inspector: Grout (from) (to) 1 �- <br /> Drilling rig type <br /> Permit No. ? Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: _�.�n,ln <br /> Driller: casing <br /> height <br /> Consultant �G1/./.J�/>'t,o <br /> 7,1 <br /> Geologist •- <br /> ABOVE-GROUND <br /> COMPLETION CMAISTY-80X <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. �S Ground Surlwo <br /> Distance to sewer line v�S ` " '' GfOul <br /> Domestic well on site - (y <br /> If yes, location and distance - ft. <br /> 4E0 pp ft' <br /> s� lb Mw 1� - <br /> - m <br /> � _ b <br /> SAMPLING slotted _ c <br /> seclon — <br /> Holding TemperaturegmvW_ P <br /> ack <br /> Method <br /> Screening Method =_ <br /> Tracking Sheet - ( y/ n ) _ <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type �V'(�_ <br /> Blank ft. Screen '/0 ft. <br /> Slot size g <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size_ <br /> Installation Method Surge Block: - ( /(n,) ti <br /> Quantity Installed Discussed with geologist: - (y/ ) <br /> Type of method <br /> EH 29 29 <br /> ��� <br />