Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Total Depth <br /> Well No.: Screen Length (from) (ta) <br /> Filter Pack (from)-------(to) <br /> Inspector- <br /> from) (to)InspectorBentonite (from) (to)~` <br /> Permit No. <br /> Grout (from) <br /> Drilling rig We <br /> Auger O.D. I.D. <br /> Drilling Company; Completion - Stove pipe/cliri.stie bos <br /> (circle one) <br /> Driller1. <br /> _,r r casing' <br /> Consultant height,�lr <br /> Geologist <br /> ABOVE-Gr'{UMD 7W <br /> SPECIAL PERMIT INFO. OC&'LETICN C-11RZ y-80X <br /> Cxrxrrd 5(xfacr CN <br /> Distance to sewer line ' <br /> Domestic well on sire . [y/n ) bran <br /> if yes, Iocadon and distance - <br /> .tij o <br /> SANG <br /> C <br /> �farai <br /> Holdingo <br /> Temperature taricn <br /> Method <br /> Screenlno Method w <br /> Tracking Sheet • (y <br /> SPOILS Eft. 4� <br /> Storage Method <br /> Contamination Noted - (y-1 n} MATERTAIS EVEI.OPMENT <br /> Storage Location <br /> Casing type <br /> BIank . ft Screen <br /> GR-- O— G Slot size <br /> Bags cement <br /> Depth to Water Buckets bentonite <br /> Mix Ratios Bags sand/graveI <br /> Installation Method Filter Pack type/Size <br /> Quantity Installed Surge Block: - (y/ ti ) <br /> Discussed with geologist: - (y <br /> Ei-i 29 29 Type of method <br />