Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: t -I- <br /> Premise <br /> l b I q CONSTRUCTION <br /> Premise Address. 1Mc, In n� ^ c�_ Total Depth 01 -4 <br /> Screen <br /> 1 - <br /> Screen Length (from) 2.' (to) Cl �— <br /> Well No.: Filter Pack (from) 19,0 (to) `: <br /> Bentonite (from) a�s=(to)_ �o' <br /> Inspector. �,/��-tom...n o,� Grout (from) -ems (to) -+Ii� ' <br /> Drilling rig type <br /> Permit No. r) 'L\ Z,,CS '1-6 Auger O.D. I.D. <br /> Completion Stove pipe (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant W A.,� �N&L.n,�..�"� IV -WWT <br /> 7//,l <br /> Geologist ,�AT==; -- <br /> A8CVE-GRCUND CNMM-Box <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. around Suiact <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) g <br /> ft. <br /> If yes, location and distance - <br /> 19 Z' <br /> SAMPLING •icra,i = c <br /> = 3 <br /> sQc'icn — <br /> Holding Temperature <.: <br /> gnY91 Pack <br /> Method <br /> Screenin;Method = <br /> :C• <br /> Tracking Sheet - ( y/ n ) <br /> .s: <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) a,, V G <br /> Storage Location Casing type <br /> Blank $'L- ft. Screen Is- <br /> Slot <br /> s-Slot size . 010 <br /> GROUTING Bags cement 3 2-- <br /> Buckets <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> ' 3A sm6e— <br /> Mix Ratios %j I. S--Y ,.,,..�C Filter Pack type/size 7� 1-4- <br /> Installation <br /> Z., <br /> Installation Method�,,.A,...... SL_- j ./� �_d_`_",""_'_, Surge Block: - (y/ n ) <br /> Quantity Installed It �v Z.S'oo*�ao Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />