Laserfiche WebLink
M#ORING WELL INSTALLATION REPORT <br /> Dace: 2-23 -l3 <br /> � CONSTRUCTION <br /> ?:erose Address: ` � Total Depth <br /> Well No.: v" -"1 Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Inspeckor. 9FKa Bentonire (from) (to) <br /> Grout (from) (to) <br /> P 1n3 003-" Drilling rig type <br /> permit No Auger O.D. I.D. <br /> Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company: <br /> Driller: -fcasing <br /> height <br /> Consultant 7 V <br /> Geologist <br /> ABCVE-GROUND <br /> CCAFLiICN CHR* Y.gCX <br /> =MPS_ii ICN <br /> SPECIAL PEILkffT INFO. Ground Suiaca r <br /> Distance [o sewer line <br /> prod <br /> Domesdc well on site - (y <br /> If yes, location and distance - ft <br /> ft. <br /> — o <br /> e <br /> SA-M?LNG slotted — c <br /> sacion s` _ <br /> Holding Temperature = VRYWPack <br /> Method <br /> Screening Method = <br /> Tracking Sheer - (y/ n ) <br /> SPOILS <br /> Storage Method MA—I RIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft Screen ft <br /> GROUTING Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Depth [o water Bags sand/gravel <br /> Nlix Rados Filter Pack type/size <br /> Insmiladon Method Surge Block: - ( y/ n) <br /> Quantity Ins[alled Discussed with geologist: - (y/ n ) <br /> Type of method <br />