Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date:_/ /y CONSTRUCTION <br /> Premise Address: 4 o S 5 �f 1�vru�% 5� cr.0 j/ Total Depth <br /> Screen Length (from) 3 (to) <br /> Well No.: ��w M w 7 Filter Pack (from) .:Pv 3-S (to)_ <br /> Bentonite (from) �� (to) r s <br /> Inspector: Grout (frost) (to) <br /> Drilling rig type_ I� <br /> Permit No. S �' ov -710� L � <br /> Auger O.D. ro <br /> Drilling Company: 6-f <br /> Completion - Stove pip christie bo (circle one) <br /> .eNa �f,���.•r,.� <br /> Driller:_ Ro-Ljzf- - (N- ,WRjc,5- casing <br /> l 4 height <br /> Consultant <br /> Geologist <br /> A80 VE-G RCUN D <br /> C OWPLETICN CHRS7Y-8GX <br /> SPECIAL PERMIT INFO. CCMPLETICN <br /> Ground Surlscs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - S h, <br /> ..G.c.�ft. ft. <br /> — m <br /> SAMPLING = Q <br /> cloned — c <br /> m <br /> sacjon <br /> Holding Temperature — <br /> Method <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type_ p, <br /> Blank z:) ft. Screen <br /> Slot size o <br /> GROUTING Bags cement .o �v <br /> Depth to waterBuckets bentonite <br /> _ Z Bags sand/gravel_ 1 -7 <br /> Mix Ratios Filter Pack type/ ' e_ � -L 6 <br /> Installation Method Surge Block: - (y' n ) <br /> Quantity Installed Discussed with g�/ologist: - (y/ n ) <br /> EH 29 29 Type of method <br />