Attach__4_Exhibits.pdf

Attachment #4

WELL LOG

Well Owner: Phone No: ____________________ Location: _____________________________________________________________________ Drilled By: Date: _________________________ Project No: Contract No: _______________________________

Depth (in feet): Description of Formation (Specify Water Bearing Aquifers) _______ to _______ ______________________________________________________ _______ to _______ ______________________________________________________ _______ to _______ ______________________________________________________ _______ to _______ ______________________________________________________ _______ to _______ ______________________________________________________ _______ to _______ ______________________________________________________ _______ to _______ ______________________________________________________ _______ to _______ ______________________________________________________

SIZES AND MATERIALS USED

All Depths Measured from Top of Well Casing

Top Casing Line: Nominal I.D._______ Material____________________________________ Depth Cased _______ Ft. To ______ Ft. Wt/Ft. Lbs.

Any Reduced Casing Sizes: _______________________________________________________

Grout Envelope: Thickness In.

Depth Grouted Ft. To Ft.

Pitless Adapter: Make Model _________________________________ Depth of Discharge Ft. Cap Type: _____________________ Well Screen: Make Material _______________________________

Type ________________________________________________________

Diameter Ft. Length Ft. Slot In.

Depth Screened Ft. To Ft. Slot In.

Ft. To Ft. Slot In.

Spacer(s) _____________________________________________________

Fitting at Top __________________________________________________ Fitting at Bottom _______________________________________________ Packer Description _____________________________________________

Gravel or Material ______________________________________________________ Sand Pack: Thickness: In. Depth: Ft. To: Ft.

Attach Graduation Curve

Total Depth to Bottom of Well Ft. (FROM TOP OF CASING) Total Depth to Bottom of Casing Ft.

Total Depth to Bottom of Drop Pipe Ft.

Total Depth to Pump Inlet Ft.

PUMP DATA

Pump Type: Manufacturer: __________________________ Model No.: Diameter: In. Length In.

Series: GPM Serial No.: _____________________________ Motor Type: Make: _________________________________ Volt Amp Wire Phase H.P.

Drop Pipe: Nominal I.D. In. Material: _______________________________ Length Ft. Wt/Ft.: Lb.

PUMP DATA

Static Water Level: Ft.

Pumped at: GPM for: Hours with a resulting drawdown of: Ft.

Bacteriological Test: Safe Unsafe _____________ Date Date _______________ Chemical Test: Yes ( ) No ( )

NOTES:_______________________________________________________________________

DRAWINGS NOTES:

Attach any available information on materials and equipment, pump performance curves, pump test data (drawdown and recovery), and any other pertinent data.

Prepared by: Date: ___________

U.S. PUBLIC HEALTH SERVICE

INDIAN HEALTH SERVICE

Office of Environmental Health and Engineering

AQUIFER TEST FIELD DATA SHEET

Owner Unique Well Number__________________

Location _________________________ Project No.__________________________

Contractor Operator ___________________________

Observers Date _______________________________

Measuring point is _________________ which is ________ meters above the surface.

Static water level is _________ meters below the measuring point at _____o’clock.

Test pump is set at ____________________ meters below the measuring point.

Test pump size: __________________ Pump Type: _________________

DRAWDOWN TEST DATA SHEET

CLOCK TIME ELAPSED TIME

SINCE START

(MINUTES)

DEPTH TO

WATER (FEET)

DRAWDOWN

(FEET)

PUMPING

RATE (GPM)

REMARKS

RECOVERY TEST DATA SHEET

CLOCK TIME ELAPSED TIME SINCE

STOP (MINUTES)

DEPTH TO WATER

(FEET)

RECOVERY

(FEET)

REMARKS