Laserfiche WebLink
MONITORING WELL INSTALLA'T'ION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: 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 r <br /> ABOVE-GROUND <br /> CC MIP LE-r C N U-GISTY-BOX <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. ppb Surf act <br /> Distance to sewer line Grp <br /> Domestic well on site - ( y/ n ) 1 ft <br /> If yes, location and distance - _L_. <br /> .yi p <br /> SAMPLING ° <br /> slotted W -- d <br /> soon " _ <br /> Holding Temperature <br /> Method ' __ fl""a pack <br /> a; — <br /> Screening Method } — <br /> Tracking Sheet - ( y/ n ) r' _ <br /> ft. '� = Ift. <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 />