Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> (� Q� CONSTRUCTION <br /> � <br /> !/c�l�/ -lD.irri � t Total Depth <br /> Premise Address: Screen Length (from) (to) <br /> L j S/ F Filter Pack (from) (to) <br /> Well No.: /� "� Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Drillen' �� height <br /> Consultan <br /> Geologist ABOVE-GRCUVD ct- STY 3oX <br /> COtripLFrbN CONk tETICN <br /> Ground Suiaxt <br /> SPECIAL PERMIT INFO. <br /> preen <br /> Distance to sewer line ft. <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> i + <br /> O <br /> SAMPLING socicn _ <br /> Holding Temperature ;= <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) — <br /> ' ft. <br /> ft. — <br /> SPOILS <br /> MATERIALS/DEVEi.OPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage LocationBlank fr, Screen f' <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to waterier Filter Pack type/size <br /> Mix Ratios Surge Block: - ( y/ n ) <br /> Installation Method Discussed vrith geologist: - (y/ n) <br /> Quantity Installed Type of rnetliod <br /> EH 29 29 <br />