Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date:_ I f 5',IGCONSTRUCTION <br /> r <br /> Premise Address:_2 1(5PD (-{—y 9 Total Depth O <br /> I Screen Length (from) 17- (to) <br /> `wr— <br /> ell No.:_ Filter Pack (from)_ f 6 (to) 1Vp <br /> Bentonite (from)_ / (to) /6 <br /> Inspector. _ DwvY� Grout (from)_ 10 (to)_/ s _ <br /> Drilling rig type <br /> Permit No. L4 Auger O.D. I.D. <br /> Completion Stove pipeycluistie box (circle one) <br /> Drilling Company:- <br /> Driller: tcasing <br /> height <br /> Consultant It's .�� �� � •� <br /> �,,C/,; • A OVE-GRCUNDCOWLEDON <br /> ck-ASrY-aox <br /> SPECIAL PERMIT INFO. Gr,:Kjr�Su{acs _� <br /> Distance to sewer line ora <br /> Domestic well on site .- ). <br /> If yes, location and-distance - <br /> ft. ft. <br /> v' o <br /> • <br /> ' r <br /> C <br /> SAMPLING <br /> ilaC.4d s; C <br /> :ocicn <br /> Holding Temperature o-.-, t 6- <br /> Method -Method <br /> Screening Method <br /> Tracking Sheet (y/ n ) <br /> tt. <br /> SPOILS <br /> Storage Method -y 6 MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Casing type Z <br /> Blank-____L-3- fr- Screen "2.-0 ft• <br /> Slot size •ou> <br /> GROUTING Bags cement y <br /> Buckets bentonite ( . .,- <br /> Depth to water ^' 6 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> --�nstalladon Method Surge Block: - (y/( <br /> Quantity Installed Discussed vrith geologist: - (y/V <br /> Type of nediod <br /> EH 29 29. . <br />