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INVESTIGATION DETAILS Name of Investigator: _- r)1nc,kInGL,tn C j:�D Date of Investigation, Qtaalificatlons: CDO/CTO/RENS/Owner/Manager) a the rss `t+ AMMORMS-I What Is the bacteria count(MNP)for each well?(Is one well positive,which is activated at lower Xqssure vents w/o your knowied a causing the TCR MCL) If Y- system maybe sour� Is the wellhead check valve present within three feet of the well head and does ibr veil fairing it leak water back into the well? YIN yG`J If N-well is a source for s stent fail The well breathing from � Is wellhead vent installed properly(J-vent & screen,tightly screwed in, other locations, I.e.the well seal• bolts watertight, no leaks and is the well only breathing through the J vent, when it J W4e�l conduits, turns off? YIN 7 cracks in the cement ad may be source. Is wellhead seal water tight, electrical box caulked at conduit into well is the el Seai all openings to ti conduit without breaks/cracks, and bolts screwed in htl &water tilht? YIN L� be air&water tl ht' Is well head located in pit or is any piping from the wellhead submerged? YIN p —; Does the ground surface slope towards well tread? YIN Is there evidence of standing water near the wellhead? YIN tJ Are there any connections to irrigation,fire,industrial piping that wuid be inter- connected? (backflow devices removed, need re air, need to be installed) YIN N D Is the wellhead secured to prevent unauthorized access? does well appear to be tampered with? YIN To what treatment plant (type) does this well pump? (GAC, nitrate,CIS., Ar) Is the surface pad properly Installed &water tight 2-feet in all directions of casing and well casing is at least one inch above surface ad?YIN S Are there trees located within 50 feet of welJ, surface roots near wed!? YIN O Tree roots gram Into th- wgil will cause TCR MO If no seal,TC enter into What is the depth and material of annular seal? the well from rain or irrigation.sufface water. Was work done on the well prior to the failures? (sounding the well, install or removal of the purrip, chlorine added to the well,new check valve installed)YIN N D Oil+nasi be removed, If well has oil lubed turbine pump, is oil on top of water column inside the wall ming washed with casing? Is oil NSF 61 approved? Is oil stored and applied in a clean manner? , t D detergent,Hushed,then Y"NA N dlslrfected to eliminate bacteria. has well failed, after repairs and disinfection cuing AWA A methods to recalculate chlorinated water down the well casing to disinfect above the water N C) table? YIN Has a dawn-hole carnera been used to investigate the well? YIN N DegradatJon of casing may cause TCR MCL.