Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> ja! — —TFW—f <br /> Geologist <br /> ABOVE-GROUND <br /> COMPLETION COOMPLMPLETTIONION <br /> C <br /> SPECIAL PERMIT INFO. Ground Surfac9 <br /> Distance to sewer line flf°'n <br /> Domestic well on site - ( y/ n ) ft <br /> If yes, location and distance - <br /> ft. <br /> _ ft. <br /> SAMPLING <br /> •to ttad : � <br /> -- <br /> a#Caon — <br /> Holding Temperature <br /> va <br /> Method ; __ `w ` <br /> Screening Method <br /> Tracking Sheet ( y/ n ) 5. <br /> ft. <br /> SPOILS <br /> Storage Method MA'IERIALS�EVELOPMENT <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/gr-avel <br /> Mix Ratios 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 />