Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack Cfrom) _(to) <br /> Inspector: Bentonite (from) <br /> Grout (from)— (to) <br /> � <br /> Permit No. Drillinri (to) <br /> g <br /> g type <br /> Auger O.D. _ I.D. <br /> Drilling Company: Completion Stove pipe/christiebox (cir— cl— a ane) <br /> Driller: <br /> casing <br /> Consultant height <br /> Geologist <br /> ABOVE-GROUND <br /> SPECIAL PERMIT INFO. 00kFLE70N CHRZT1=80X <br /> Ground Surface CCMPL.ETION <br /> Distance to sewer line <br /> Domestic well on site - (y/n) grout <br /> If yes, location and distance- <br /> n. <br /> n ft <br /> ISAMPLING <br /> abttad — O <br /> Holding Temperature uc5on = S <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> _ .. <br /> SPOILS ft' <br /> Storage Method <br /> Contamination Noted - (y/n) M—ATERIALS/DEVELOPMENT <br /> Storage Location <br /> Casing type <br /> Blank ft. Screen g <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - (y/n) <br /> Discussed with geologist: - (y/n) <br /> EH 29 29 Type of method <br />