Laserfiche WebLink
f M� ?'OFUNG WELL INSTALLATION REPORT � <br /> ,F rI .. . H <br /> S-j ] CONSTRUCTION <br /> Date: ;� ,w <br /> Premise Address: s c�r.��`"'� Total Depth (OC) <br /> 'A Screen Length (from) O (to) U <br /> Well No.: /{/GW Filter Pack (from) 620 (to)3� <br /> Bentonite (from) 38 _(toE-31 — <br /> Grout (from) 3b (to) <br /> Inspector: _ <br /> Drilling rig type <br /> Permit No. 3' 7� Auger O.D. D' I.D. <br /> Completioa- Stove pipe/christie box (circle one) <br /> Drilling Company: �2�/ <br /> N <br /> /� � <br /> =CCITT G� ? casing <br /> Driller.-- height <br /> 1 r ♦ _QW.+ <br /> Consultant <br /> Geologist "�'-"` .1 h3GV;-GROcJND CHR STY-BOX <br /> l CJ&9'.-7 CN CCMPLiICN <br /> rf Cww d sutxs <br /> SPECIAL PER-NUT INFO. <br /> M4 Qfa.•t <br /> Distance to sewer line �► ,3� ft. <br /> P Domestic well on site. - (y n v Q <br /> If yes, location and distance - - <br /> — <br /> SAMPLING <br /> Holding Tempera a `i4 r <br /> Method `` <br /> Screening Method AIOKP <br /> Tracking Sheet - �,n) � � � ft. ♦ � ft, <br /> SPOILS <br /> Storage Method f Ll�c .- v ,, MA1 RIALS/DEVELOpMBNT <br /> Contamination Noted i (yAn) ! typeSC� <br /> Storage Location L. Casing <br /> Blank D_ fr. Screen <br /> _ Al <br /> Slot size <br /> GROUTING <br /> Bags cement ` <br /> 1. <br /> 1 <br /> � �-• <br /> Buckets bentonite <br /> ! <br /> Deprh to water Bags sand/gravel L <br /> Mix Ratios TtFilter.Pack type/size 3•Z4 <br /> Insralladon Method lk ! Surge Block: - y/ n) <br /> Quantity Installed Discussed with�ologist: - y n } <br /> Type of method <br /> , L <br />