Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth S� <br /> Screen Length (from) (—(to) 5-,:3' <br /> Well No.: as- ) Filter Pack (from) _(to) <br /> Bentonite (from) _(to) <br /> Inspector: l�UM r m L. Grout (from) _(to) <br /> Drilling rig type <br /> Permit No. S°I 6�5 I Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant f, '7,60KA tom_ —ev, <br /> Geologist Milu (aL •- <br /> ABOVE-GROUND <br /> COMPLETION CCOOMPLMPLY-SOX <br /> ETION <br /> SPECIAL PERMIT INFO. Ground Sumacs <br /> Distance to sewer 1' a proof <br /> Domestic well o site - (y/n) <br /> If yes, locatio and distance - e- ft- <br /> = q <br /> C <br /> SAMPLING slotted = c <br /> wcdon <br /> Holding Temperature�� tack <br /> va P <br /> Method'` <br /> Screening Method at 17 <br /> Tracking Sheet -Oy n) <br /> SPOILS <br /> Storage Method Ct—CA MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) <br /> Storage Location Casing type Z PVC <br /> Blank SI ft. Screen <br /> Slot size .-az.o <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water ^�`{S t Bags sand/gravel <br /> Mix Ratios Filter Pack type/size ik 3_iaa nnj e <br /> Installation Method f Surge Block: - (y/G>) <br /> Quantity Installed iv j ,(( � Discussed with geologist: - (y <br /> Type <br /> of method <br /> EH 29 29 <br />