Laserfiche WebLink
VRONITORING WELL INSTALLATION REPO0 <br /> Date: �� T' Z-00(0 10_ e CONSTRUCTION <br /> Premise Address: t9w? 45 • J�� Total Depth <br /> Screen Leng[h (from) ni (to) <br /> � <br /> Well No.: Filter Pack (from) q (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from (to) 2 <br /> c� Drilling rig type Lk/ <br /> Permit No. C 5,-t(6 Auger O.D. .D. <br /> �¢ Completio - Stove pipe/c 'stie box (circle one) <br /> Drilling�C�oQm�pa�n/y� <br /> Driller.jq,�p/��`- cas i <br /> heigh t <br /> Consultant <br /> Geologist -- <br /> ACOWPLRr CHRZTY43OX <br /> ��� COMPLETION <br /> SPECIAL PERMIT INFO. Ground Saixw <br /> Distance to sewer line grout <br /> Domestic well on site - n ) tt <br /> If yes, locatiipand distance - <br /> _ t C <br /> SAMPLING slated = ' <br /> Ae sac�an <br /> Holding Temratr� QMVW PackMethod ad(C " <br /> Screening Method <br /> Tracking Sheet - n ) <br /> tt. tt. <br /> SPOILS p Q S <br /> Storage Method (M ( o MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 1 <br /> Storage Location Casing type 2 <br /> Blank ft. Screen <br /> Slot size 'f:>20 it <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water �5 Bags sand/gravel (go <br /> Mix Ratiost l7 G Filter Pack type/size <br /> Installation Method C Surge Block: - (y/ n ) <br /> Quantity Installed /3 t (a Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />