Laserfiche WebLink
• <br />DOMESTIC/MUNICIPAL WELL INSPECTION SHEET <br />• <br />Address: A <br />TT/1777 AyAak Well ID: <br />Date: <br />7 - <br />Site Conditions/Access: <br />Accessibility: Good: Fair: <br />Poor: <br />Vicinity of well clear of weeds and/or debris (Take Photo): <br />Yes: <br />No: <br />Presence of depressions or standing water around well: <br />No: _ <br />Location: (Latitude and Longitude - GPS): <br />��YY/ee�s: <br />�v <br />I� <br />7 <br />Remarks: <br />Well Pad: <br />Integrity: Good: Inadequate: <br />Presence of depressions or standing water around well: <br />Yes: <br />No: <br />Remarks: <br />Protective Outer Casing: Material: <br />Condition of Protective Casing: Good: �_ <br />Damaged: <br />Condition of Locking Cap: Good: <br />Damaged: <br />Condition of lock: Good: 7_'�I <br />Damaged: <br />t4 <br />Condition of Weepholes: Good: <br />Damaged: <br />Remarks: <br />Well Riser: Material: 1 <br />Condition of Riser: ood:_ <br />Damaged: <br />Condition of Riser Cap: Good: x <br />Damaged: <br />Measurment reference point: Yes: <br />No: <br />Remarks: <br />Dedicated Pump: Type: <br />Condition: Good: Damaged: <br />Missing: <br />Pumping Rate (gpm): Current (Hz): <br />(check if electrical <br />problems suspected) <br />Remarks: <br />Field Certification: .N ' ✓ (f /"�--b Ll <br />l r / <br />0 <br />Signed Date <br />