Laserfiche WebLink
)NITORING WELL INSTALLATION REPO' <br /> Date: 1 i 1 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) -'10 (to) (� <br /> Well NO.: Filter Pack (from) / (to)� <br /> Bentonite (from) I(p (to) <br /> Inspector. Grout (h ) (to) 16 <br /> Drilling rig type ) - o <br /> Permit No. Auger O.D. 1 b'' I.D. <br /> C Completion - Stove pipe/ ti e bo c ircle one) <br /> Drilling Company: ���IayL� �\��� <br /> Driller: casing <br /> height <br /> Consultant nn � <br /> Geologist Y,c.PW7:F_ <br /> /ABOVE-GRCUND CNRM Y-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> i <br /> Distance to sewer lined <br /> grout <br /> LOX <br /> Domestic well on site - (y : I G - ft. . fl <br /> If yes, location and dista ce <br /> 2't7 ft- <br /> .>r. <br /> SAMPLING slorod <br /> soden <br /> Holding Temperature <br /> Method �A r� ,i.�ci �d. . 1.4 G��I padC <br /> Screening Method <br /> Tracking Sheet - n ) <br /> SPOILS <br /> Storage Method V-,% MATERIALS/DEVEI.OPMENT <br /> Contamination Not d - (y , ` (f F 1 V r <br /> Storage Location Casing type �{ _ <br /> Blank � ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite �t <br /> Depth to water �s Bags sand/gravel <br /> Mix Ratios �Ea CV� Filter Pack type/size <br /> Installation Method V Va6=4i2 0 Surge Block: / n ) <br /> Quantity Installed Discussed wit geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />