Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Len <br /> Wel] No.: (to) <br /> Filter Pack (fro) <br /> (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout <br /> (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> --t— <br /> Consultant height <br /> Geologist 3 —QV <br /> ABOVE-GROUND <br /> COMPLETION CHR:S7Y-BOX <br /> SPECIAL PERMIT INFO Ground SurtCOMPLEnON <br /> aca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - t n, <br /> n. n. <br /> — o <br /> SAMPLING c <br /> ,lotted — .2 <br /> Holding Temperature taction — <br /> Method = Va%-W pads <br /> Screening Method <br /> Tracking Sheet - (y/n ) <br /> b` <br /> tt• n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Filter Pack type/size <br /> Installation Method Surge Block- - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />