Laserfiche WebLink
. ..dIONITORING WELL INSTALLATION REPI;,:f <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (froze) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from)_ _(to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant T7 T <br /> Geologist -- <br /> ABOVE-GROUND <br /> COfNPLFf'10N Ci�RiS�Y-80X <br /> COMPLET]CN <br /> SPECIAL PERMIT INFO. Ground Surfaea <br /> Distance to sewer line flrazt <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft' <br /> -ft. <br /> ft. <br /> m <br /> A <br /> SAMPLING •Intted c <br /> sec an <br /> Holding Temperature <br /> Method _ <br /> Screening Method _ <br /> Tracking Sheet ( y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Sags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> Eli 29 29 <br />