Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: � pz' CONSTRUCTION <br /> Premise Address: Total Depth__& I>b S <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/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant IV <br /> /1,16 <br /> Geologist -- <br /> ABOVE—GRMND C gRZTY-BOX <br /> COMPL.EMN COMPL_=MCN <br /> SPECIAL PERMIT INFO. around Surfaas <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING •foroi _ <br /> sxicn '– <br /> Holding Temperature <br /> Method — F <br /> Screening Method <br /> Tracking Sheet - (y/ n) — <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVF.LOPMENT <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/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 />