Laserfiche WebLink
MOI . , i ORING WELL INSTALLATION REPORT <br /> I' �y <br /> Date: ' � ' 2q " II CONSTRUCTION — SQ2 per p Kvt, i <br /> Premise Address : / �( . NN (Il� Total Depth <br /> �q� Screen Length (from) (to) <br /> Well No. : UVt P- L _ _ Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: A lb& ) Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company:. L��P <br /> I Ai�O// Completion - Stove pipe/cluistie box (circle one) <br /> Driller: casing <br /> height <br /> C Consultant k/ i <br /> Geologist t J •- <br /> T <br /> ABOVE=GROUND GHAtSTY BOX <br /> �A4�LEfION COMPLETION <br /> SPECIAL PERMIT INFO. GroundS <br /> Distance to sewer line grout <br /> Domestic well on site - ( y / n ) <br /> tt° <br /> If yes, location and distance - <br /> n. <br /> ft. <br /> SAMPLINGeloaad <br /> aac Pon <br /> Holding Temperature <br /> — gmW pack <br /> Method = <br /> Screening Method <br /> Tracking Sheet - ( y / n ) <br /> n. = n° <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted • ( y / n ) 3� p PVC <br /> Storage Location Casing type P P <br /> BlankL.LSPD ft. Screen ft. <br /> Slot size 4fe" <br /> GROUTING Bags cement <br /> Buckets bentonite v <br /> Depth to water Bags sand/gravel I <br /> Mix Ratios Filter Pack type/size Ar Atj 5 <br /> Installation Method Surge Block: - ( y / n ) N`/r a <br /> Quantity Installed Discussed with geologist: - ( y / n ) IJ/w <br /> Type of method �dL <br /> EH 29 29 <br />