Laserfiche WebLink
•MONITORING WELL INSTALLATION REP041 <br /> Date: �l/ / /Dfj CONSTRUCTION <br /> --rte <br /> Premise Address: /7/Yt' r, ��/"L� Total Depth <br /> /j <br /> Screen Length (from) % (to) <br /> Well No.: �' Filter Pack (from) /S (to) <br /> f %/. a Bentonite (from) `/ (to) } <br /> Inspector: F`ktS �f Grout (from) ? (to) A <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. hng <br /> eighteight <br /> Consultant nn; —i- <br /> Geologist / <br /> ABOVE-GRCUND CHR*-TY-BOX <br /> OO W LETX)N COMPLETION <br /> SPECIAL PERMIT INFO, Ckmnd Su <br /> Distance to sewer line g(oA <br /> Domestic well on site - (y/ n) 1 ft. <br /> If yes, location and distance - / g <br /> •C R <br /> SAMPLING uy hq. ✓f4i sloKad = g <br /> sac'cn <br /> Holding Temperature = pavclyadt <br /> Method <br /> Screening Method <br /> Tracking Sheet • (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) u <br /> Storage Location Casing type )- rvc_,, <br /> Blanker ft. Screener 6 ft. <br /> Slot size U U'<C <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water / 1S 6 Bags sand/gravel : v <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: • yJ/ n ) <br /> Type of method <br /> EH 29 29 <br />