FOR Watershed Ground Water Survey

 

1.                  What is your water supply?       [  ] Well,     [  ] Spring,     [  ] Public,     [  ] Other

 

2.                  How deep is the well? _____________________________________________________

 

3.                  Are you concerned about the depth of your well?          [  ] Yes  [  ] No

 

4.                  What is the well=s storage capacity? ___________________________________________

 

5.                  What is the flow rate (gallons/minute)? 0-3 _____         3-8 _____        8-20 _____ 20+ ____

 

6.                  Has the flow rate changed in recent years?                    [  ] Yes  [  ] No

 

7.                  What is your water pressure like? ____________________________________________

 

8.                  Are you having any supply problems?                [  ] Yes  [  ] No

 

9.                  Do you have good water quality?                                  [  ] Yes  [  ] No

 

10.              When was the well last tested? _______________________________________________

 

11.              What were the results? _____________________________________________________

 

12.              Do you have sediment in your water?                            [  ] Yes  [  ] No

 

13.              Do you have a water treatment system?             [  ] Yes  [  ] No

 

14.              If so, why are you treating your water? __________________________________________

 

15.              Where is the water treatment system located? ___________________________________

 

16.              What kind of treatment system is it? __________________________________________

 

17.              How old is the treatment system? ____________________________________________

 

18.              Who drilled/dug your well? _________________________________________________

 

19.              When was your well drilled/dug? _____________________________________________

 

20.              What is the well=s diameter? _________________________________________________

 

21.              What casing material was used? ______________________________________________

 

22.              How deep is the casing? ____________________________________________________

 

23.              What repairs and maintenance have been done? _________________________________

 

________________________________________________________________________

 

24.              How often have repairs been made? ___________________________________________

 

25.              Who did the repairs? ______________________________________________________