Private Well Water Assessment
Sample Identifier |
|
Well/Spring/Sample Location Lat/Long (mynasadata.larc.nasa.gov)
Water use: Human or animal consumption, crops
(H, A, and/or C)
Well Type (hand dug, bored, drilled, driven, don't know)
(HD, B, Dr, Drv, DK)
Well Depth
(ft)
Screen Length
(ft)
Depth to Screen
(ft)
Well Casing Material (steel, galvanized, steel and plastic, PVC, don't know
(S, G, S/P, PVC, DK)
Well Grouted
(Y, N)
Plumbing Material (lead, copper, galvanized, PVC/PEX, other)
Pb, Cu, G, PVC/PEX, O)
Septic System
Y/N
Distance between well and septic tank/drainfield
(ft)
Identify other potential sources of contamination nearby
Distance between well and other potential source of contamination
(ft)
Last time water tested ( # of years, never, don't know)
(Y, N, DK)
Is water disinfected?
(Y/N)
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Bator, Daniel |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |