Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: >- 2, Z CONSTRUCTION <br /> Premise Address:—�� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> p Bentonite (from) - (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> 7— height <br /> Consultant <br /> Geologist AgpNE-GFCUND <br /> COMPLETfON Ct�1iSTY-80X <br /> CCMPLEMN <br /> SPECIAL PERMIT INFO. Ground Sudacs + <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) It• <br /> If yes, location and distance - ft- <br /> a....,_,ft. <br /> Z - m <br /> - C <br /> _ O <br /> SAMPLING ilorai <br /> socicn = <br /> V91 PackHolding Temperature <br /> Method — <br /> Screening Method <br /> Tracking Sheet - (y/ n) Y <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Casing type <br /> gl ft. Screen R• <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 />