Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: 2- _ _( CONSTRUCTION <br /> Premise Address: 7� l�u/ w Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> 1 J L Bentonite (from) (to) <br /> Inspector. d I Grout (from)—(to)- <br /> .Drilling <br /> from) (to).Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: T casing <br /> height <br /> Consultant N �f��Q — 7V ` <br /> Geologist /�✓` ��' `�� <br /> ABOVE-GACUND C>4it5TY30X <br /> CCWL_ETiCN C MPtEMN <br /> SPECIAL PERMIT INFO. G=M$�'� <br /> Distance to sewer line ora t <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> M <br /> = O <br /> C <br /> SAMPLING slorni <br /> socicn —_ <br /> Holding Temperature = y ,vd yxk <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - (y/ ri <br /> ft <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank fc. 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/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />