Laserfiche WebLink
..ONIToRING WELL INSTALLATION REPOI,-/ <br /> Date: CONSTRUCTION / <br /> Premise Address: �, S [Ty v-�'l _ Total Depth Q <br /> Screen Length (from) S (to) t <br /> Well No,: Vv Filter Pack (from) (to) +� <br /> �- Bentonite (from) (to) <br /> Inspector: <br /> Grout (from) (to) d <br /> 4 Drilling rigtype <br /> Permit No. D <br /> Auger O. . , 77 I.D. <br /> 11 Completion - Stove pipe/christie box (circle one) <br /> Drilling Company:, fVV1 <br /> Driller: casing <br /> � <br /> Consultant E1 COV"\'Sk GO' 6height <br /> Geologist � � .r <br /> ABOVE-GACVND CiiFit W-WX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. b S <br /> Distance to sewer line grout <br /> Domestic well on site - (y <br /> If yes, Iocation and distance - M <br /> ft. <br /> qR r <br /> �r <br /> 4 <br /> SAMPLING alotted <br /> &*do <br /> c <br /> Holding Temperaturegn Pack <br /> I vi — <br /> Method 4 _ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) :` = <br /> SPOILS <br /> Storage Method 5 MATERIALS/DEVEi.OPMENT <br /> Contamination Noted - y P <br /> /n ) g' ( V f <br /> Storage Location- Casing type 1` ti <br /> Blank 70 ft. Screen__ <br /> Slot size <br /> GROUTING Bags cement <br /> /;� / Buckets bentonite <br /> Depth to water MIS I S Bags sand/gravel <br /> Mix Ratios M. `b Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed, , Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />