Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: 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: <br /> Driller: casing <br /> height <br /> Consultant ` <br /> 7/4 <br /> Geologist "' <br /> Ag;VE-GRCUND CHRM Y43OX <br /> OONFLfiTCN COMPL.EnCN <br /> SPECIAL PERMIT INFQs Ofourd Surfwe <br /> great <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) It. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING slor4d <br /> mets <br /> Holding Temperature <br /> Method <br /> IMS Pack <br /> v° <br /> Screening Method . _ <br /> Tracking Sheet - (y/n ) _ <br /> A <br /> SPOILS <br /> Storage Method M_ATERIM:SM;VELOPMENT <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 <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 <br />