Laserfiche WebLink
OONITORING WELL INSTALLATION REP( <br /> Date: �J �� ��1 ) CONSTRUCTION <br /> Premise Address: �7�1] �li Total Depth <br /> I ^ Screen Length (from) (to) 13 <br /> Well No.: lY Filter Pack (from) (to) 11 <br /> Bentonite (from) 1l' (to) J, <br /> Inspector: Grout (from) (to) <br /> Drilling rig type l' j <br /> Permit No. Auger O.D. o)", I.D <br /> Drilling Company: <br /> Completion - Stove pipe istie box circle one) <br /> Driller: J casing <br /> height <br /> ,, <br /> Consultant i ��I( II Oiz <br /> Geologist �tAIrY�1N I/1� •- T <br /> A80V&GFOUND <br /> COMPLETIOCHAIM-BOX <br /> N CCMPlE71CN <br /> SPECIAL PERMIT INFO. Ground Sur}acs <br /> IT <br /> Distance tosewer line grout <br /> Domestic well on site - (y/ <br /> If yes, location and distance - ft. <br /> n. <br /> .�n. <br /> = m <br /> — e <br /> SAMPLING slotted <br /> �I <br /> section <br /> � — <br /> Holding Temperature Ni _ gmyd <br /> Method — <br /> Screening Method <br /> Tracking Sheet - Cy/ n ) , <br /> SPOILS <br /> Storage Method Z 6 1 / MATERIALS/DEVELOPMENT <br /> Contamnation iNoted - ( y/0) <br /> Storage Location Casing type WL Sut' yV <br /> Blank Iti ft. Screen IS ft. <br /> Slot size D•-#w <br /> GROUTING Bags cement _ <br /> Buckets bentonite b,./Li- <br /> Depth <br /> .✓Depth to water 'V IA Bags sand/gravel S, <br /> Mix Ratios la Filter Pack type/s ze Z�/7 <br /> Installation Method Surge Block: . n ) <br /> Quantity Installed Discussed with ologist: - (y/ n ) <br /> Type of method W v <br /> EH 29 29 <br />