Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: (��02� D S CONSTRUCTION <br /> Premise Address:_ l W ( 1--)6A Total Depth v <br /> 3-S Screen Length (from) (to) /DO <br /> Well No.: Filter Pack (from) (to)1 6-D <br /> Bentonite (from) .S (to) _ <br /> Inspector: Grout (from) ! (to) <br /> ( � (VO-3 <br /> Drilling rig type nJ �� � <br /> Permit No. lO- Auger O.D._?j '` I.D. <br /> Drilling Company: <br /> Le�� Completion - Stove pipe/ stie bx (circle one) <br /> Driller: casing <br /> / height <br /> Consultant YrC� <br /> Geologist a,u 4ZUfiT <br /> ° ABOVE-GROUND <br /> COMPLETCN G-(MM-BOX <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line Ofout <br /> Domestic well on site - (y/nZ(/:s ft. <br /> If yes, location and distance 12 ft.- <br /> ft. <br /> a <br /> SAMPLINGsl <br /> otted <br /> saclon <br /> Holding Temperature =: <br /> Method —' vs'W Pack <br /> A. <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> eft. '' _ O ft, <br /> SPOILS ff 22 <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) i' ^V <br /> Storage Location Casing type f� <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 />