Laserfiche WebLink
MONITORING WELL INSTALLATION_REPORT <br /> til. t. <br /> __ nfF.vya..11.t r Y nno-tM if �� •� 4 � -.:. <br /> Date: /G '� _ ' '„ ! k• _� CONSTRUCTION � <br /> Premise Address: S �� Total Depths <br /> a <br /> Well No.: .`' `� ' . .% Screen Length (from) 0 (to) 76 <br /> Filter Pack' (from) (to} 3 <br /> Beritonite (from) (to) <br /> Inspector. -_ #�16rout (from) (to) <br /> r ... <br /> Drilling rig type <br /> Permit No. - °; - ` Auger O.D. tI.D. <br /> µ , <br /> i Completion - Stove pipe/clu•istie box (circle one) <br /> Drilling Company: c <br /> Driller: - �_ -,, i , ► �?:. 4 s�'. _ - casillgt 4. <br /> .. '� <br /> he, <br /> Consultant , ] <br /> Geologist <br /> • - ABOVE-GRCUND <br /> CONFLETION STY-3OX <br /> ON <br /> SPECIAL PERMIT INFO. T •'1 *;Y' Grour d sudwo <br /> Distance to sewer line '` ? grout <br /> Domestic well on site- (y/ n) n-'•- � Y - - - � �� <br /> If yes, location and distance - <br /> SAMPLING slcr.aLi — <br /> Holding Temperature N — <br /> ' Method vol <br /> . Pz pack <br /> Screening Method . <br /> Tracking Sheet - (y/ n ) .... l <br /> .? _ R• �+. it _ �, w. �. ssw r.. e + `C1F..w��I1. � � I ie <br /> SPOILS <br /> �+ .v Rms•w. w.;-v,... a .a. w ,�- ...- .y+.;, .. � .- -rn. t!r tP <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n )° ✓� � <br /> Storage Location Casing type d"K <br /> Blank 76 ±_ ft, s -Screen./L7 h: <br /> Slot size D+or-es <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water__ Bags sand/grlvel 3 !oo <br /> Mix Ratios t Filter Pack pee'01( <br /> Installation Method Surge BlockQuantity Installed _... Discussed�wi -geologist: - (y/ n) <br /> S <br /> • 41 Type of method <br /> EH 29 29 <br />