Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date:_ t C12i CONSTRUCTION <br /> Premise Address: 4 b j� Total Depth SZ <br /> P <br /> Well No.: ZW �3/� Screen Length (from) �'L (to) SZ�� <br /> Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: �ten� �fn Grout (from) (to) <br /> Permit No. Drilling rig type <br /> _ �, O S � Auger O.D. I.D. <br /> Drilling Company:. Completion - Stove pipe/christie box (circle one) <br /> ��t <br /> Driller:_ -Ten casing <br /> Consultant fA �e height <br /> Geologist (an 4A <br /> v ABOVE-GROUND <br /> COMPLETION OHMM-Box <br /> SPECIAL PERMIT INFO. COMPLETION <br /> ���-•���Orvund Staixe <br /> Distance to sewer line orart <br /> Domestic well on ' e . (y/n ) 1 <br /> If yes, locatio d distance - -T h, <br /> Ztt. ft. <br /> = m <br /> q <br /> SAMPLING = <br /> to ted = c <br /> tecIon = <br /> Holding Temper e — <br /> Method = gavel pact <br /> Screenip<Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted 1 (y/ n ) <br /> Storage Location Casing type <br /> Blank �{Z ft. Screen ld h <br /> Slot size O olp <br /> GROUTING Bags cement <br /> Depth to water - to <br /> ags sand/gravel <br /> Mix Ratios Filter Pack type/size 7, <br /> Installation Method Surge Block: - ( y/ <br /> Quantity Installed <br /> Discussed with geologist: - ( y,0) <br /> EH 29 29 Type of method= <br />