Laserfiche WebLink
MONITORING WELL INSTALLATION REP+►,a <br /> Date: CONSTRUCTION <br /> Premise Address: 7, Total Depth <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/christie box (circle one) <br /> Drilling Company: �--e�d� <br /> Driller: casing <br /> T height <br /> Consultant <br /> _E <br /> GeoIagist -- T <br /> /ABOVE-GACUND <br /> C?OMPtEriON GiA�STY-80X ' <br /> CC)MPLEnON <br /> SPECIAL PERMIT INFO. Ground Surfaca <br /> ., /i,►4 grout <br /> Distance to sewer line (/� 1 <br /> Domestic well on site - (Y(/ nT-- -- - ft. <br /> If yes, location and distance--- <br /> Ll Cr <br /> SAMPLING stored <br /> D aocicn <br /> Holding Te erature <br /> vy <br />�.S Method graPackZ eW "' _ <br /> x <br /> Screening Method ,r <br /> Tracking Sheet y n ) <br /> ft. <br /> SPOILS <br /> Storage Method �� MATERIALS/DEVELOPMENT <br /> Contamination Noted (K 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 BIock: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />