Laserfiche WebLink
ONITORING WELL INSTALLATION REPOR'C <br /> Date: I I z CONSTRUCTION <br /> Premise Address:, Total Depth �� l J J <br /> Screen Length (from) c (to ' <br /> Well No.. Filter Pack (from) (to) <br /> Bentonite (from) (to)_. �C- <br /> Inspector: <br /> to) � <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. �'� — `� 16� Auger O.D. I.D. <br /> n Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant -i- <br /> Geologist - r <br /> ABOVE-GACUND CHR*'Y-BOX <br /> COMPLETION COMPL.EMN <br /> SPECIAL PERMIT INFO. Ground Swiacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> h. <br /> Ri <br /> — c <br /> — o <br /> SAMPLING tlonod <br /> sacicn <br /> Holding Temperature ' , F <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) 'I t <br /> Storage Location Casing type 5ziA <br /> Blank Z-c� ft. Screen7�) ft. <br /> Slot size +f� <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 />