Laserfiche WebLink
`evfONITORING WELL INSTALLATION REPOW <br /> Date: 4 Lz-7 t(c) CONSTRUCTION V%wl5 4 v1t.w15 <br /> Premise Address: Total Depth rX 4 <br /> �— Screen Length (from) (to) Q <br /> Well No.: YIhW S fl WLti+ 2 S Filter Pack (from) (to) S <br /> Bentonite (from) S (to) <br /> inspector: Cri(rah��i Grout (from) i (to) o' <br /> Permit No. <br /> Drilling rig type C L4AC'kS o <br /> Auger O.D. 1,0' I.D. I <br /> Drilling Company: �— <br /> Completion - Stove pipe/christie box (circle one) <br /> ��-�-L�SIB't.. <br /> Driller:-1 Oq casing <br /> height <br /> Consultant <br /> Geologist Cv,4- <br /> ABOVEGROUND CHAISTY-80X <br /> O <br /> SPECIAL PERMIT INFO. COWLETIONGmub g�{yy <br /> Distance to sewer line Groot <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - n• <br /> ft. <br /> n. <br /> = m <br /> — e <br /> = m <br /> SAMPLING <br /> slotted = -d <br /> wc�cn 4. = <br /> Holding Temperature _ P <br /> Method — vival <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> 4— h. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type Q o 5r In Mt-- <br /> Blank---t(• ft.' Screen S [ ft. <br /> Slot size {,-i A <br /> GROUTING Bags cementLilk IS <br /> ,.� I Buckets bentonite <br /> Depth to water tr Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 2 <br /> Installation Method CAI..A (y.nom �i)c Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />