Laserfiche WebLink
,viONITORING WELL INSTALLATION REPOt%. <br /> Date: L 3, D p CONSTRUCTION <br /> Premise Address: `�'sG Total Depth / <br /> Screen Length (from) (to) <br /> Well No.: — CV 5 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) o <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:_ Iv <br /> �. <br /> Driller: �"C casing <br /> height <br /> Consultant �y <br /> T <br /> Geologist e-► <br /> VE-GROUNDCtiAim-80X <br /> COMPLETION C <br /> SPECIAL PERMIT INFO. Ground Surface <br /> i <br /> Distance to sewer line �"S!� gr <br /> outq <br /> Domestic well on site - ( y n ) n. <br /> If yes, location and distance - ft. <br /> — o <br /> SAMPLING slotwd <br /> sacton — <br /> Holding Temperature __ Ravd pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) Casing <br /> Storage Location g tyPe <br /> Blank_­j ft. Screen !() ft• <br /> Slot size .01 y <br /> GROUTING Bags cement/0 f 9 d" '0- <br /> Buckets bentonite 30 2 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios �Q 4:16'*7,w 1 it Filter Pack type/size2 12 <br /> Installation Method J Surge Block: - (y/ n ) <br /> Quantity Installed �D t35 r D 0 Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />