Laserfiche WebLink
• DOMESTIC/MUNICIPAL WELL INSPECTION SHEET <br />• <br />0 <br />Address: 31 q2 SSLVNn dell ID: <br />Date: wIzoln <br />Site Conditions/Access: <br />Accessibility: Good: Fair: <br />Poor: <br />eIt <br />1 <br />Vicinity of m clear of weeds and/or debris (Take Photo): <br />Yes: No: <br />t <br />Presence of depressions or standing water around weW <br />Yes: No: ✓ <br />Location: (Latitude and Longitude -GPS): _ �2� 2fi �' 681 , <br />3'\ • �a 8�l 3rq <br />Remarks: yJ�,\\ �Y1 1oq�.\�,yand r%o+ v� b�� rrll`C�vY� Sgt'Y1�,Z <br />Well Pad: h1a <br />Integrity: Good: Inadequate: <br />Presence of depressions or standing water around well: <br />Yes: No: <br />Remarks: <br />Protective Outer Casing: NA Material: <br />Condition of Protective Casing: Good: <br />Damaged: <br />Condition of Locking Cap: Good: <br />Damaged: <br />Condition of Lock: Good: <br />Damaged: <br />Condition of Weepholes: Good: <br />Damaged: <br />Remarks: <br />Well Riser: NA Material: <br />Condition of Riser: Good: <br />Damaged: <br />Condition of Riser Cap: Good: <br />Damaged: <br />Measurment reference point: Yes: <br />No: <br />Remarks: <br />Dedicated Pump: NR 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: <br />tocoIon . <br />