COMPLIANCE INFO_2009-2014 - Laserfiche WebLink

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INVESTIGATION DETAILS Name of Investigator: Date of Investigation : Qualifications : CDO/CTO/REHS/Owner/Manager) SOURCE : Do the results indicate well is positive for bacteria. Y/N COMMENTS If no, go to next section . If yes, inspect each source : Well ID Well ID Well ID Well ID What is the bacteria count (MNP) for each well? (Is one well positive, which is activated at lower pressure events w/o your knowledge, causing the TCR MCL If Y- system maybe source , Is the wellhead check valve present within three feet of the well head and does for well failing it leak water back into the well? YIN If N- well is a source for s stem failing 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 electrical conduits, turns off? YIN cracks in the cement ad may be source. Is wellhead seal water tight, electrical box caulked at conduit into well, is the el Seal all openings to conduit without breaks/cracks, and bolts screwed in tightly & water tight? YIN be air & water tight Is well head located in pit or is any piping from the wellhead submerged? YIN Does the ground surface slope towards well head? YIN Is there evidence of standing water near the wellhead? YIN Are there any connections to irrigation , fire, industrial piping that could be inter- connected? (backflow devices removed, need repair, need to be installed) YIN 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, Cl2, 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 pad? YIN Are there trees located within 50 feet of well, surface roots near well? Y/N Tree roots grown into the well will cause TCR MCL. If no seal, TC enter into What is the depth and material of annular seal? the well from rain or irri ation surface water. Was work done on the well prior to the failures? (sounding the well, install or removal of the pump, chlorine added to the well, new check valve installed) Y/N Oil must be removed, If well has oil lubed turbine pump, is oil on top of water column inside the well casing washed with casing? Is oil NSF 61 approved? Is oil stored and applied in a clean manner? detergent, flushed, then Y/N/NA disinfected to eliminate bacteria. Has well failed , after repairs and disinfection using AWWA methods to recalculate chlorinated water down the well casing to disinfect above the water table? YIN Has a down-hole camera been used to investi ate the well? YIN Degradation C casing 9 ma cause TCR MCL.