Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: 6 I ► �-�d� CONSTRUCTION <br /> Premise Address: ct :5, Total Depth � <br /> �— Screen Length (from) E, - (to) S. <br /> Well No.: �.1�'Z - Filter Pack (from) 43 `° -(to)--4 <br /> f..; . <br /> Bentonite (from). + " (to) _ <br /> Inspector: - C" i' �C o..I-- + Grout (from) (to) �d <br /> I xrv-'Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: Cp,2C&t:e� - <br /> Driller: din 3A-- ' casing <br /> Theight ,. <br /> Consultant s121CA, 91. ' <br /> Geologist •- <br /> fMti ABOVE-GROUND ; +,e. C}iR1S7Y 80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. '.r Ground Surface r '� <br /> Distance to sewer line - grout <br /> Domestic well on site - (y/n) <br /> If es location and distanc . �., _ p t• ft. <br /> Y ft. <br /> ' = m <br /> SAMPLING C.. j slotted <br /> &action <br /> ' Holding Temperature <br /> Methods " ktia5s614"Jn / f� � <br /> � ok, Cra _ 4*aystpacfc <br /> Screening Method: pl 17 ` <br /> Tracking Sheet <br /> SPOILS t . <br /> j . Storage Method ;- < T MATERIALS/DEVELOPMENT = <br /> Contamination.Noted - <br /> Storage Location m.,Sl Casing type 7 QVC' �,�. YO-- <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water N 6 3 ' Bags sand/gravel_ 'W%z_ 5d <br /> Mix Ratios Filter Pack type/size z <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity.Installed Discussed with geologist: - (y/ n ) <br /> ' ' + Type of method <br /> EH 29 29 <br /> r <br />