Laserfiche WebLink
AONITORING WELL INSTALLATION REP* <br /> Date: /f L a ��x�/ T/' QO CONSTRUCTION <br /> Premise Addr ss: (J� " L� Total Depth <br /> Screen Length (from)— (� --(to) S S <br /> Well No.: cSV�/ Filter Pack (from) yt �_(to)52- <br /> Bentonite (from) (to)_ ,57/ <br /> Inspector: Grout (from)—(t) <br /> SO / Drilling rig type <br /> Permit No. Auger I.D. <br /> ✓/ Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: ('Ldp / --TT casing <br /> height <br /> Consultant <br /> Geologist ABOVE-GROUND <br /> COMPLETION CNRISTY-BOX <br /> SPECIAL PERMIT INFO. Ground S�'� <br /> grout <br /> Distance to sewer line 1 G� <br /> Domestic well on site ( n ) /S--ft. <br /> If yes, location and dis nce - T " ft. <br /> 55 tt. <br /> SAMPLING slatted = E <br /> / J vection '- $ <br /> Holding Temperature,�C/ <br /> Method — <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> SPOILS �/ Q <br /> Storage Method SSS` � �� MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) j't P JO, <br /> Storage Location /),I, � � Casing type <br /> Blank 55 ft. Screen 'tS ft. <br /> Slot size 02-0 N <br /> GROUTING 'WBags cement <br /> Buckets bentonite S' <br /> Depth to water ^�J 4aV sand/gravel <br /> Mix Ratios Q4 '�4+ <br /> Filter Pack type/size �5 <br /> Installation Method 444Surge Block: - (yrn7�> <br /> Quantity Installed 0§2cak Discussed with geoTo'gist: - (y� <br /> Type of method <br /> EH 29 29 <br />