Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack (from).(to <br /> Inspector: Bentonite (from) (to) <br /> Grout (from) (to)-- <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (cir— cle— o— ne) <br /> Driller: Y <br /> casing <br /> Consultant � height <br /> Geologist _qVT <br /> ABOVE-GROUND <br /> COMPLETION CHRZ Y-BOX <br /> SPECIAL PERMIT INFO. Ground SCOMPLETION <br /> wiaca <br /> Distance to sewer line <br /> Domestic well on site - (Y/ nQfout <br /> ) <br /> If yes, location and distance - j ft <br /> ft. ft. <br /> v = m <br /> SAMPLING a <br /> tlattad — c <br /> Holding Temperature socjon <br /> Method = 9r+ pack <br /> Screening Method <br /> Tracking Sheet - (y/ n) �' <br /> SPOILS <br /> Storage Method <br /> Contamination Noted - (Y/nMATERIALS/DEVELOPMENT <br /> ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - (y/n ) <br /> Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />