Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: 12 2r 10 %- CONSTRUCTION <br /> Premise Address:_ Total Depth �5 <br /> Screen Length (from) (to) sz •4 <br /> Well No.:_ 141- ( 3z Filter Pack (from) <br /> Bentonite (from) (to) ;7 <br /> Inspector: _ 114AII �,� Grout (from) �( _(to)_ A, <br /> Drilling rig type <br /> Permit No. $-Z Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: iioov��l (g23A Sfems <br /> Driller: casing <br /> height <br /> Consultant_ <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION C-S STY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ofout <br /> Domestic well o�- ) <br /> If yes, location ft. <br /> .�3 ft. ft. <br /> _= C <br /> SAMPLING = <br /> slotted — <br /> sec'ron '— <br /> Holding Temperature <br /> Method —' 720 Pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method �r t,�� ,�o�,.g,'-(Z MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type Z"pV N <br /> Blank ,a' ft. Screen tQ ft. <br /> Slot size 02-C <br /> GROUTING Bags cement ti I( <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios--I- 9'('tk «, V �,�,.e ATO Filter Pack type/size <br /> Installation Method_ %2cnn,6..--&a, 4:n Surge Block: - (y/� <br /> Quantity Installed_ ti t C �.0 E Discussed with geologist: - ( y/ ray) <br /> Type of method <br /> EH 29 29 <br /> 'raw` `► <br />