Laserfiche WebLink
9ONITORING WELL INSTALLATION REPO'A <br /> Date: CONSTRUCTION <br /> Premise Address: TODD G/ Total Depth <br /> i( S Screen Length (from) (to) <br /> Well No.: /� ` T/� Filter Pack (from) (to) <br /> Bentonite (from)-(to)- <br /> Inspector: Grout (from)-(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. /T�_ I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: casing <br /> height <br /> Consultant T <br /> Geologist T <br /> ABOVE-GROUND <br /> COMPLETION CHMM-BOX <br /> SPECIAL PERMIT INFO. Ground gCOMPLEnON <br /> Distance to sewer line gran <br /> Domestic well on site - (y/ n ) 53 ft. <br /> If yes, location and distance - 5S ft. <br /> — o <br /> SAMPLING <br /> slotted — 8 <br /> sacion = r: <br /> Holding Temperature _ P <br /> Method = <br /> Screening Method <br /> Tracking Sheet - (y/n ) — <br /> t. - s- <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Z ft <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement D- <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 �L�y% <br />