Laserfiche WebLink
UMONITORING WELL INSTALLATION REPt, <br /> Date. 9 CONSTRUCTION <br /> Premise Address: /// 0 <br /> // d C` 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 /> A`iY� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ <br /> Driller: casing <br /> height <br /> Consultant T —OWT <br /> 75,N <br /> Geologist •- <br /> AE&E-GROUND CHRSSlY-SOX <br /> COMPLETION COMPLEMON <br /> SPECIAL PERMIT INFO. Ground Sudace <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - . <br /> ft. <br /> c <br /> a <br /> SAMPLING Matted >.= <br /> socdon <br /> Holding Temperature grzyw Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) ' <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 />