Laserfiche WebLink
t,,l"MTORING WELL INSTALLATION REPOn14-1' <br /> I <br /> Date: 12- 15• a CONSTRUCTION <br /> Premise Address: 2-194 f . �} dt Total Depth <br /> S Screen Length (from) (to) <br /> Well No.: Filter Pack (from)_(to)- <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: sC_ Grout (from) (to) <br /> Drilling rig type <br /> Permit No.— ©d Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> —EFW-F <br /> Geologist�.( L2 <br /> ABOVE-GROUND CHSZTY•3OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surlacr <br /> Distance to sewer line PRO RR <br /> grout <br /> r <br /> Domestic well on site - (y 53 L ft <br /> If yes, location and distance - <br /> Z(t. <br /> _ C <br /> SAMPLING slonnd = g <br /> section = .2 <br /> Holding Temperature = g -W Pck <br /> Method = <br /> Screening Method r <br /> Tracking Sheet - ( y/ n ) ��1 <br /> tt. tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) ,t T V L CQ <br /> Storage Location Casing e T V -S� <br /> Blank ft. Screen Ib h. <br /> Slot size .0?A <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water s Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> �y • �5 . 3 S•s"" <br />