Laserfiche WebLink
MON11UR1NU WELL INSTALLATION REPORT <br /> Date: S'L����- CONSTRUCTION <br /> Premise Address:_ 16 )11 Z_ F4rnnc" l cJTotal Depth <br /> Screen Length (from) 3 7' (to) S " <br /> Well No.: m W- cl MW- 10 Filter Pack (from) 3 (to) <br /> Bentonite (from) 3 Z' _(to)_ 3 <br /> Inspector: b VAACCAIL- Grout (from) ?f (to) 3 =- <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: J,Joct-,b.J� <br /> Driller: casing <br /> height <br /> Consultant /1,_ C <br /> Geologist boo <'W <br /> —WW-f <br /> —�- ABOVE-GROUND <br /> COMPLETION CHRISM-8OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Cron <br /> Domestic well on sit y/ n ) <br /> If yes, location distance - Z ft. <br /> .�.�.ft. <br /> O <br /> SAMPLING <br /> slattad <br /> sacaon <br /> Holding Temperature ' <br /> Method �" P <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> _.5_ft. °� S tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) <br /> Storage Location_ o y. 51 b Casing type_ Z "-)°V e- <br /> Blank ft. Screen_ Z_4�' ft. <br /> Slot size -oy o <br /> GROUTING Bags cement —t;- <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size zl t Z <br /> Installation Method n,.,,,,,z -}u xn ice Surge Block: - ( y/ ) <br /> Quantity Installed —� � Discussed with geologist: - (y'� <br /> Type of method <br /> EH 29 29 <br /> r � / <br />