Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: 3 I I iS CONSTRUCTION <br /> To I <br /> Premise Address: 64L Total Depth <br /> Screen Length (from) (to) <br /> Well No.: IN��—�/ Filter Pack (from) (to) <br /> Bentonite (from) (to) <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: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist •- <br /> ABOVE-GROUND <br /> COMPLETION CCOMPtET1MPLETI OX <br /> 0N <br /> SPECIAL PERMIT INFO. Ground Surfxs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft' <br /> .�sS2_ft. ft' <br /> q <br /> SAMPLING = ° <br /> Clotted � <br /> wcaion '— <br /> Holding Temperature <br /> Method ` —" gm�Pack <br /> Screening Method — <br /> Tracking Sheet - (y/ n) — <br /> ft. "= = IFft, <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <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: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y! n ) <br /> Type of method <br /> EH 29 29 <br /> ``. .,.i <br />