Laserfiche WebLink
Date: W3 //00 <br />Premise Address: <br />Well No.: / 3 <br />Inspector <br />Permit No. <br />Drilling Company: A_/' t-�/ <br />Driller: <br />Consultant �- <br />Geologist <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n ) <br />If yes, location and distance - <br />SAMPLING <br />Holding Temperature N/4 <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS D <br />Storage Method d <br />Contamination Noted - 6Vn ) <br />Storage Location <br />GROUTING <br />Depth to water <br />Mix Ratios <br />Installation Method <br />Quantity Installed <br />MONITORING WELL INSTALLATION REruRT <br />CONSTRUCTION <br />Total Depth <br />Screen Length (from) <br />(to) <br />Filter Pack (from) <br />(to) <br />Bentonite (from) <br />(to) <br />Grout (from) <br />(to) <br />Drilling rig type <br />Auger O.D. <br />I.D. <br />Completion - Stove pipe/cluistie box (circle one) <br />casing <br />height <br />7,11 <br />1lBCVE-GROUND CHRMTY-Box <br />COMPLETION COMPLETiCN <br />Ground Surface <br />0/1 grout <br />�• ft. <br />M <br />gIoCed J� <br />soden <br />gnvw pack <br />MATERIALS[DEVELOPMENT <br />Casing type <br />Blank ft. Screen ft. <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / ii ) <br />Discussed with geologist: -_Ly / n ) <br />Type of method <br />EH 29 29 <br />�� �, 7-1 <br />