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1' <br /> .:. i <br /> WELL DATA SHEET (Page 2 of 3 <br /> Complete as much information as possible. Leave blank if information is not available, use N.A. if not applicable. <br /> 'Indicates items required for Source Water Assessment <br /> **Indicates additional items required for assessments and Ground Water Rule <br /> (separate multiple entries in Actual, Estimated <br /> field with semi-colon) or Default? <br /> WELL CONSTRUCTION (continued) <br /> Conductor casing used? ("YES", "NO" or"UNKNOWN") (See Note 2) <br /> Conductor casing removed? ("YES", "NO" or"UNKNOWN") <br /> ' Depth to highest perforations/screens (ft below surface) (or <br /> "UNKNOWN") <br /> Screened Interval Beginning Depth/Ending Depth (ft below surface); <br /> 2nd Screened Interval Beg. Depth/Ending Depth; 3rd Screened Interval, etc. <br /> *Total length of screened.interval (ft) <br /> (default= 10%pump capacity in gpm) (or"UNKNOWN") <br /> *Annular Seal?("YES", "NO" or"UNKNOWN") (See Note 3) <br /> * Depth of Annular Seal (ft) <br /> yMaterial of Annular Seal (cement grout, bentonite, etc.) <br /> Gravel pack, Depth to top (ft below ground surface) <br /> Total length of gravel pack(ft) <br /> AQUIFER <br /> *Aquifer Materials <br /> (list all that apply: sand, silt, clay, gravel, rock, fractured rock) <br /> I <br /> * Effective porosity (decimal percent) (default= 0.2) (or"UNKNOWN") I <br /> i <br /> * Confining layer(Impervious Strata) above aquifer? ` <br /> 1 <br /> i <br /> ("YES","NO" or"UNKNOWN") <br /> Thickness of confining layer, if known (ft) <br /> . Depth to confining layer, if known (ft below ground) <br /> I *Static water level (ft below ground surface) <br /> Static water level measurement: Date/Method <br /> Pumping water level (ft below ground surface) <br /> Pumping water level measurement: Date/Method i <br /> WELL PRODUCTION ; <br /> Well Yield (gpm) <br /> Well Yield Based On (i.e., pump test, etc.) ` <br /> Date measured <br /> Is the well metered? ("YES" or"NO"). <br /> Production (gallons per year) <br /> Frequency of Use (hourstyear) <br /> Typical pumping duration (hours/day) <br /> PUMP <br /> Make <br /> Type <br /> Size (hp) <br /> Capacity (gpm) <br /> Depth to suction intake (ft below ground surface) <br /> Lubrication Type <br /> Type of Power: (i.e., electric, diesel, etc.) <br /> Auxiliary power available? ("YES"or"NO") <br /> Operation controlled by: (i.e., level in tank, pressure, etc.) <br /> Pump to Waste capability? ("YES" or"NO") <br /> Discharges to: (i.e., distribution system, storage, etc.) <br /> REMARKS AND DEFECTS (use additional sheets as necessary) <br /> j <br /> Well Data Sheet Final21Weil Data Sheet Rec: 11-16-99 <br />