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• DOMESTIC/MUNICIPAL WELL INSPECTION SHEET <br />• <br />0 <br />Address: 35(00Sung Well ID: <br />Date: (�/ ! <br />Site Conditions/Access: <br />Accessibility: Good: ✓ Fair: <br />Poor: <br />Vicinity of well clear of weeds and/or debris (Take Photo): <br />Yes: No: <br />Presence of depressions or standing water around well: <br />Yes: No: <br />Location: (Latitude and Longitudg - 5): <br />Jt^e —61 v5ed Ir wt1t(4(fW- iMjSS� <br />e <br />gg , tec <br />Remarks: Sa'-y.( ,u, WGLI <br />l <br />Well Pad: <br />Integrity: Good: _L-1, Inadequate: <br />Presence of depressions or standing water around well: <br />Yes: No: <br />Remarks: <br />Protective Outer Casing: Material: m t'9Ffi.Jr_- <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: Material: N 4! � <br />wl +14 <br />Condition of Riser: Good: <br />Damaged: <br />Condition of Riser Cap: Good: <br />Damaged: <br />Measurment reference paint: Yes: <br />No: <br />Remarks: <br />Dedicated Pump: Type: I in/wn D t, - <br />Condition: <br />Condition: Good: Damaged: <br />Missing: _ <br />Pumping Rate (gpm): Current (Hz): (check If electrical <br />problems suspected) <br />Remarks: <br />Field Certification: <br />