Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: _ , p — CONSTRUCTION <br /> Premise Address: ZS 'YYA , rA Total Depth <br /> / <br /> l <br /> Screen Length (from) (to) 16 <br /> Well No.: 6 W —L Filter Pack (from) r/ (to) <br /> Bentonite (from) /�(to) <br /> Inspector: J'yb�, ,ry Grout (from) / (to) <br /> Drilling rig type_OWjr <br /> Permit No. 454.4=:s 700 Auger O.D. 0 I.D. <br /> / 4 f Completion - Sot`Ge pipe/christie box (circle one) <br /> Drilling Company: A <br /> Driller: 41,4nwreL -6wcasing <br /> y � height <br /> Consultantt�t/ Yb rirl`A e]W ♦J+ <br /> Geologist "P74ro t,004 - <br /> ABOVE-GROUND <br /> COMPLETION C-s*-TY=BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Saran <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ <br /> If yes, location and distan n' <br /> SAMPLING <br /> Slotted _ <br /> saodon — <br /> Holding Temperature ,. _= P <br /> Method <br /> Screening Met1hCd <br /> Tracking eet - (y/n) #: _ <br /> n. <br /> SPOILS <br /> Storage Method �1¢A4E MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) p <br /> Storage Location Casing type TC 1-! 4- <br /> Blank (o ft. Screen !O ft. <br /> Slot size O.DZ.a <br /> GROUTING Bags cement <br /> Buckets bentonite3 <br /> Depth to water Bags sand/gravel 4PA -24Y,4_ <br /> Mix Ratios Filter Pack type/size VF i6WD <br /> Installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />