Laserfiche WebLink
OONITORING WELL INSTALLATION REPGO <br /> Date: CONSTRUCTION <br /> Premise Address: s Total Depth Z9• <br /> A Screen Length (from) (to) <br /> Well No.: 'f Filter Pack (from) (to) <br /> Bentonite (from) (to) 6 <br /> Inspector: Grout (from) (to) _ <br /> 2 Drilling rig type <br /> Permit No. � 6 �� / Auger O.D. I� I.D. <br /> 16 <br /> p Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: A <br /> t Z <br /> Driller: --�� casing <br /> height <br /> Consultant I <br /> Geologist �,pyE.GgpOND <br /> COMPLETION (t=#T <br /> SPECIAL PERMIT INFO. Ground S <br /> ? grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - 7 11 <br /> tt. <br /> = m <br /> n <br /> = m <br /> = c <br /> SAMPLING dotted = ' <br /> Holding Temperature !I V = 73"g Pack <br /> Method — <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS / /) <br /> Storage Method '� � MATERIALS/DEVELOPMENT <br /> ContaminationNoted - n ) n �r / <br /> Storage Location s �""tq Casing type cxu <br /> V/ Blank �t-/0 fr. Screen � fT• <br /> Slot size <br /> GROUTING Bags cement /88 <br /> Buckets bentonite 106 <br /> Depth to water G S Bags sand/gravel 3 U <br /> Mix Ratios Filter Pack type/size tlsLLtunw `�� <br /> Installation Method 44-4— Surge Block: - ( y/ n ) <br /> Quantity Installed _ ZS Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />