Water Quality: Protecting Household Drinking Water
Module 3

Lesson 2 - Domestic Well Maintenance Record Activity
Acknowledgement: Taken from "Living on the Land 2001"


Address________________________________________________________________

 

Well

Name of driller____________________________________________________________

Phone number___________________________Date drilled________________________

Type of well (dug, drilled, etc.)________________________________________________

Location________________________________________________________________

Capacity (gallons/minute)____________________________________________________

 

Pump 

Name of pump installer_____________________________________________________

Phone number____________________________________________________________

Type of pump_____________________________________________________________

Pump capacity (gallons per minute)____________________________________________

Brand name______________________________________________________________

Serial number and model____________________________________________________

Depth to pump or intake line___________________Date purchased__________________

 

 Water Quality (save a copy of each laboratory analysis for comparison) 

Date tested

Tests

Problems Noted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Well Repairs 

Date Repaired

Type of Repair Done

Shock Chlorinated?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(top)