Laserfiche WebLink
0 <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: A �I CONSTRUCTION <br /> f <br /> Premise Address: C A(,-" Total Depth <br /> Screen Length (from) � S (to) 10 <br /> Well No.: (�� Filter Pack (from) 9 (to)D-1 <br /> f' <br /> Inspectr. � � Bentonite (from) <br /> (to) <br /> Grout (from) L <br /> (to) <br /> Drilling rig type_ <br /> Permit No. Auger O.D. I.D. <br /> j ✓i Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: Y �` <br /> Driller: �� casing <br /> � � he_ght <br /> Consultant (- �i ' <br /> Geologist <br /> ABCVE-GRCUND <br /> CCNVLFTION Ck ffISiY 30X <br /> COhAPLETICN <br /> SPECIAL PERMIT INFO. Ground Sul <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) �- It <br /> If yes, location and distance - <br /> ft. <br /> r) ft. <br /> = o <br /> — o <br /> SAMPLING ilormi <br /> a en <br /> Holding Temperature <br /> Method <br /> Screenin;Method <br /> Tracking Sheet - (y/ n ) _- <br /> ft. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) n <br /> Storage Location Casing type a1c S <br /> Blankfc. Screen IS ft- <br /> Slot size_ U 01 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water e Bags sand/gravel <br /> Mix Ratios n7 (vvi-12 Filter Pack type/size L l7 <br /> .installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed vAth geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 y <br />