Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: /�/r9n CONSTRUCTION <br /> Premise Address : ,! 4- � Total Depth <br /> Screen Length (from) (to) <br /> Well No. : Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: C / Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/clu-isde box (circle one) <br /> Drilling Company. �/ ( — <br /> Driller:./ �!h —f � C c � yp? 4�4 casing <br /> height <br /> Consultant 6 <br /> 4 <br /> Geologist <br /> ABOVE-GACUND Ct4i15TY 80X <br /> I�MPL�bN COMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - . <br /> = c <br /> SAMPLING <br /> alor.Ai � <br /> D - socicn —_ <br /> G <br /> Holding <br /> Tempera e — <br /> _ p,Yd PackMethod / T <br /> = <br /> Screening Method = <br /> Tracking Sheet n ) <br /> % <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel_ <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y / a ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />