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 V <br /> Geologist e <br /> ABOVE-GRCUND CtGZTY-Box <br /> CONVLET1ON CCt,{Ptc' nCN <br /> SPECIAL PERMIT INFO. t=rd Suixr <br /> Distance to sewer line oraa <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - tt <br /> —ft. <br /> — _ a <br /> = m <br /> = o <br /> — o <br /> SAMPLING <br /> aoc'cn —_ <br /> Holding Temperature <br /> Method = <br /> Screening Method _ <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) <br /> Storage Location Bank ripe ft Screen <br /> 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/ n ) <br /> Quantity Installed Discussed vrith geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />