Laserfiche WebLink
. 1 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth ' <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack Mom) (to) <br /> Inspector: Bentonite' (from) (to) <br /> Grout (from) (to) <br /> Permit No. Drilling rig type <br /> Auger O.D.—_ I.D. <br /> Drilling Company: Completion- Stove pipe/chm'stie box <br /> (circle one) <br /> Driller: <br /> casing <br /> Consultant � height <br /> Geologist <br /> ABOVE-GROUND <br /> SPECIAL PERMIT INFO. COW'LETION CHR--Y-80X <br /> COMPLEr70N <br /> CiroundSurfxw <br /> Distance to sewer line <br /> Domestic well on site - (y/n) grout <br /> If yes, location and distance - <br /> ft. <br /> ft. _ ft. <br /> r = <br /> SAMPLING = m <br /> O <br /> Holding Temperature ilotlYftaeon = <br /> Method 8 <br /> _— <br /> Screening Method = gravel pack <br /> Tracking Sheet - (y/n) <br /> SPOILS ft. <br /> Storage Method <br /> Contamination Noted - (Y/n) MATERIALS/DEVELOPMENT <br /> Storage Location <br /> Casing type <br /> GROIITLNG Bl�_ft• Screen��fr <br /> Slot size <br /> Bags cement <br /> Depth to water <br /> Buckets bentonite <br /> Mix Ratios Bagssand/gravel <br /> Installation Method Filter pack <br /> Quantity Installed-- - typesize <br /> EH 29 29 <br /> Discussed with geologist: - (Y/n) <br /> Type of method <br />