Laserfiche WebLink
r <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: L`�'e`�' � Total Depth <br /> Screen Length (from) (to) <br /> Well No.: /�-�Sr 4 SFilter Pack (from) (to) <br /> Bentonite (from) (to) / <br /> Inspector. ,� �- � Grout (from) I (to) c <br /> Drilling rig type <br /> Permit No. Auger O.D. 1'I4 I.D. / <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company-.,_7,_Z7 <br /> Driller: � casing <br /> heighC <br /> /- - <br /> Consultant / <br /> Geologist _ <br /> ABOVE-GRC:UND <br /> COMPLETION COMPLEC7 % <br /> SPECIAL PERMIT INFO. Ground Suiws — <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - /S ft. <br /> ft. <br /> wh O <br /> Y- M <br /> ~ X <br /> SAMPLING sloro.i <br /> socicn <br /> ackr <br /> Holding Temperature = 7vVIP <br /> Method = <br /> Screenin;Method <br /> Tracking Sheet - (y/ n) <br /> ftVr ft. <br /> SPOILS f? <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) Casing e e ''Hl'- S �6 <br /> Storage Location Blank ft. Screen z ft- <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water A4) qu Bags sand/gravel DD <br /> Mix Ratios Filter Pack type/size 3 <br /> 4pstallation Method Surge Block: - (y/W7Y <br /> Quantity Installed Discussed with geologist: - kf/ n) — <br /> Type of mediod <br /> EH 29.29 <br />