Laserfiche WebLink
_JNITORING WELL INSTALLATION REPO. <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: /�'y ` 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 'd <br /> _q <br /> Geologist •� T <br /> ABOVE-GRCUND CNFiiM_80X <br /> COM?LET10N COMPLEMCN <br /> SPECIAL PERMIT INFO. G=nd Surface <br /> Distance to sewer line Gf01n <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - K_ <br /> SAMPLING abraj <br /> aocicn <br /> Holding Temperature Pack <br /> Method <br /> 2 <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> 3 5 tt. w — ` S ft• <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <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 %6 _ <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size `� <br /> Installation Method Surge Block: - ( y/(w- <br /> Quantity <br /> n <br /> Quantity Installed Discussed with geologist: -((7y)/ n ) <br /> Type of mediod <br /> EH 29 29 <br />