Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT i <br /> G CONSTRUC <br /> A TTON <br /> Date: l <br /> Total Depth <br /> Premise Address: S Screen Length (from) {to) Z2 <br /> Well No.: Filter Pack (from) 3 " (to) /,-7 <br /> Bentonite (from)_ f,s- _(to) <br /> Grout (from) X. S' (to) / r <br /> Inspector: v Drilling rig tYPe C�K <br /> Permit No.—C-3- Auger O.D./ Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company-- `=� <br /> / casing <br /> Driller': U ( height <br /> Consultant 6' <br /> 'T <br /> T <br /> Geologist - ABOVE-GRCIND <br /> '~ CA MPLETiO h! Ci-�1ST•Y-�30X <br /> CpX,iPLEE MN <br /> SPECIAL PERMIT INFO. G=u rd S Lxtxs <br /> —+-- <br /> Gf= <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) f t• <br /> If yes, location and distance - - <br /> SAMPLING <br /> &edcn <br /> Holding Temperature <br /> Method =} <br /> Screening Method <br /> Tracking Sheet - {y/ n) <br /> = r f1. <br /> SPOILS <br /> Storage Method MATEPLIL§IDEVELOPMENT <br /> Contamination Noted. Cy/ n) Casing type Q O <br /> Storage Location Blank ft. Screen S ft. <br /> Slot size 1 v <br /> GROUTING Bags cement <br /> Buckets bentonite ` b� <br /> Depth to water Bags sand/gravel 3 l <br /> Mix Ratios Filter Pack type/size ,' ^-'kv <br /> --Installation Method <br /> Surge Block: - y/ n ) <br /> eolggist: <br /> Quantity Installed Discussed with g - (y/ ) <br /> Type of method `�n �� <br /> EH 29 29 <br />