B01__Attach_J-02._Drawings,_permit,_and_specs.pdf

Indian Health Service

Mary Anne Hinzman Well Replacement

Plans, Specifications, and Additional Information

Contents

1. Driving directions to site 2

2. Site plan sheet 3

3. Detail drawing – 6-in well 4

4. King County preliminary well site approval 5

5. Well drilling technical provisions 10

6. Pressure system technical provisions 16

7. Submittal forms 20

8. ACK157 well log 24

9. ACK156 well log 25

Map data ©2018 Google 2000 ft

Washington 98019

Duvall, WA 98019

Duvall

1. Head west on SW Stewart St toward Main St NE

2. Turn right onto Main St NE

3. Slight right onto NE Cherry Valley Rd

4. Turn left onto Mountain View Rd NE

5. Continue straight onto 318th Ave NE

6. 318th Ave NE turns slightly right and becomes NE 183rd St

7. Turn left onto 320th Ave NE

18926 320th Ave NE

46 ft

0.2 mi

4.2 mi

1.2 mi

0.1 mi

0.2 mi

0.4 mi

Drive 6.3 miles, 12 minDuvall, WA to 18926 320th Ave NE, Duvall, WA 98019

Directions from center of Duvall to Home

SCREEN

18"-24"

GROUND

LEVEL

POWER CABLE

-3 FEET

PVC PIPE TO

HOUSE

BELL REDUCER, AS REQUIRED

6" DIA. WELL CASING

SURFACE SEAL

BRONZE

BUSHING

SHALL BE PLACED BETWEEN OVER-

SIZED CASING AND 6 INCH A

MINIMUM OF 2 INCHS ON ALL

SIDES OF 6 INCH CASING, FROM

SURFACE TO 25 FEET

INDIAN HEALTH SERVICE

WELL CAP WITH SCREENED VENT

.t.t.t.a.tr..tti. Ill-._-- CONDUIT TO PUMP HOUSE

PITLESS ADAPTER

ASSEMBLY

CHECK VALVE

PUMP

PUMP MOTOR

-1---- RISER PIPE

5' of 6" DIA. SCREEN STAINLESS

STEEL. (SEE SPEC. FOR MORE DETAIL)

NTS

DIVISION OF SANITATION FACILITIES CONSTRUCTION

OLYMPIC DISTRICT OFFICE; BREMERTON, WASHINGTON

6 INCH WELL

TYPICAL

Drawing No. Revision: Drawing Dote: Page No. DESIGNED BY: CONCURRED BY:

41-2 DRAWN BY: DATE: 4

Lucas C.

Moilan en -S

Digitally signed by Lucas C. Moilanen -S DN: c=US, o=U.S.

Government, ou=HHS, ou=IHS, ou=People, 0.9.2342.19200300.100.

1.1=2001735395, cn=Lucas C. Moilanen -S Date: 2018.07.11 15:14:26 -07'00' 9

TECHNICAL PROVISION

INDIVIDUAL WELL DRILLING

Scope

The work covered by this section includes the furnishing of all labor, transportation, tools, equipment and materials, and performing all operations in connection with the drilling, casing, screening, developing, and testing an individual water well; and site cleanup, all in accordance with these specifications and applicable drawings.

The Contractor shall drill a cased well at the location indicated on the plans. The well shall be drilled no deeper than the depth directed by the Project Manager for that particular site. If a satisfactory yield (5-10 gpm) is obtained at a lesser depth, the drilling shall be terminated and the well developed at that depth.

Drilling Rig

The drilling shall be accomplished by a cable tool, mud rotary, or air rotary drilling machine. Equipment used shall be in good repair and capable of drilling to a depth of 400 feet.

Materials and Equipment

Casing

Casing used as a permanent part of the well structure shall be seamless or electric resistance welded steel pipe conforming to ASTM A53, Type E or S, Grade B, black wall, meeting the following specifications. It shall be of standard brand manufacture and have the brand name clearly printed on each length of pipe. Manufacturer rejected pipe shall not be used.

Nominal size: 6-inches

Outside diameter: 6.625-inches

Wall Thickness: 0.250-inches

Weight per Foot: 17.01 pounds

Drive Shoes

If permanent steel casing is to be installed by driving methods, the use of drive shoes is required. The type and weight of drive shoes shall be determined by the Contractor and approved by the Project Manager. The use of drive shoes is considered incidental to the drilling and casing of the well, and no additional payment will be allowed.

Screen

Design: Continuous slot; outer windings welded to longitudinal bars

Materials: ANSI Type 304 stainless steel

Length: As directed by the Project Manager.

Fittings: The type of bottom fitting depends on method of screen installation. The fitting must close off the bottom of the screen and shall be of mild steel. The packer shall be self-sealing neoprene with a mild steel or stainless-steel collar. The contractor shall also use a 5-foot minimum riser pipe on the top of the screen. A 2- foot extension pipe shall be attached to the bottom of the screen.

Slot size: The screen shall be sized to permit the maximum practical sand-free yield after development. The diameter shall be as stated in the Bid Schedule. The size of the slot shall be based on the sieve analysis.

The length of the screen shall be dependent upon the length and type of aquifer encountered. Length shall limit the entrance velocity to a maximum of 0.1 feet per second. The screen opening size, length, and diameter shall be approved by the Project Manager before ordering or placing the screen.

Manufacturer: UOP, Johnson Division; Howard Smith Company; Well Screen Company or approved equal.

Liner Pipe

All liner pipe shall be of PVC type 1220 or 1120, SDR 21 (Class 200), or SDR 26 (Class 160).

Sanitary Grout

Cement Grout: Cement conforming to ASTM C-150, Type 1 or Type 3 (high early strength) with the least quantity of water -- not over 6 gallons per cubic foot of cement -- required to give a mixture of such consistency that it can be forced through the grout (tremie) pipe. Bentonite clay may be added in amounts from 3 to 5 pounds per cubic foot of cement to reduce shrinkage and improve fluidity. In this case up to 8 gallons of water per cubic foot of cement may be used with the approval of the Project Manager.

Wet Bentonite: Bentonite grout shall be Baroid's Aquagel or equal mixed 75 pounds per 100 gallons of water.

This type of bentonite shall not be applied dry.

Dry Grout: Dry grout shall be granular or pelletized dry bentonite.

Clearing for Well Access

The homeowner will provide access to the well site.

Drilling

Drilling shall commence at the location staked by the Project Manager. The Contractor shall begin drilling with an oversize bit for the first 25-feet or as directed by the Project Manager. This oversize hole shall be used to allow a 2-inch minimum grout seal to be positioned around the casing. Drilling shall continue below this point with a bit large enough to install the casing.

In unconsolidated formations, the Contractor shall drive the casing closely to the drill bit location with a drive block to prevent caving. Properly sized drive shoes shall be attached to the bottom of the casing to prevent possible damage.

Drilling shall be terminated after an adequate aquifer is encountered. The determination to stop drilling when an adequate aquifer is encountered shall be made by the Contractor and confirmed by the Project Manager. The determination to stop drilling when no aquifer is encountered shall be made by the Project Manager. The Project

Manager may require the Contractor to perform a yield test by using a bailer in the encountered aquifer. No additional payment shall be made for this check.

Precautions Against Contamination

The Contractor shall take all precautions necessary to prevent undesirable physical or chemical contaminants from entering the well. At all times during progress of the work, the Contractor shall protect the well so as to prevent the entrance of foreign matter, including surface water. Upon completion, the well shall be covered with a welded cover plate or similar device.

In the event the well becomes contaminated because of negligence on the part of the Contractor, he shall perform such work and supply such casing, seals, disinfecting agent or other materials as may be necessary to eliminate the contamination. No additional payment shall be allowed for such corrective work.

Welding

Surfaces to be welded shall be free from loose scale, rust, grease, paint, and other foreign material, except for mill scale which withstands vigorous wire brushing. Joint surfaces shall be free from fins and tears. The technique of welding employed, the appearance and quality of the welds made, and the methods of correcting the defective work shall conform to normally accepted standards of workmanship. All welding operations shall cease when the temperature is below 0 degrees F. When welding at a temperature below 32 degrees F the surface of all areas within 3-inches of the edges to be welded shall be heated until they are too hot to touch before welding is started.

Sections of casing after welding shall be true to line and free from twists, bends, offsets, and open joints. All welded joints shall be watertight.

Sampling of Formation

Formation sampling is considered an essential part of this contract. Samples shall not be washed and shall be kept in containers approved by the Project Manager. These samples shall be furnished to the Project Manager as drilling progresses. When an aquifer is encountered, the Contractor shall obtain a sufficient unwashed soil sample from the potential aquifer for use in a sieve analysis. The Contractor shall arrange and pay for the sample to be so analyzed by the manufacturer of the well screen, the manufacturer's representative or by persons approved by the

Project Manager. The analysis report shall include the recommended slot size of the well screen. The results of the analysis shall be submitted to the Project Manager.

The Contractor shall collect and save samples taken from each 10 feet of drilling and at every change in formation. If so directed by the Project Manager, the driller may be required to take samples at 1-foot intervals in a potential aquifer.

Well Record

The Contractor shall keep a written daily record on each hole drilled, on forms supplied by the Project Manager.

The following information shall be recorded:

I) Well location -- section, range, township.

2) Stratum information -- depth, thickness, type.

3) Water information -- static water level for each aquifer.

4) Type and length of well casing and screen.

Within one week after the completion of each well, the Contractor shall furnish the Project Manager a signed original and two copies of the completed well log.

The Contractor shall record the well log with the Washington Department of Ecology.

The Contractor shall furnish the Project Manager an as-built plan sketch of the well location and any unsuccessful holes. The sketch shall show any significant topographical features and include two measured distances from the well or abandoned hole to "permanent" features which can easily be identified and located.

Well Screen

If a well screen is needed, the well screen shall be installed by either the pull back method, the open hole method, the bail down method or the wash down method.

The screen shall be positioned in the lower 1/3 to 1/2 of the aquifer thickness. A packer shall be used to seal the annular space between the screen's extension pipe and well casing.

Well Liner

Liner pipe installed in a well shall extend or telescope at least eight feet into the lower end of the well casing. In the event that more than one string of liner is installed, each string shall extend or telescope at least eight feet into the adjacent larger diameter liner pipe. Liner pipe shall be removable. Liner pipe may be welded or hooked onto the permanent well casing but shall not be permanently fixed to a well casing or borehole wall using packers or grout which would prohibit the liner's removal.

Well Development

The Contractor shall develop the well by such methods as will effectively extract from the water bearing formation the maximum practical quantity of mud, fine sand, silt, or other fine materials. Development shall bring the well to a maximum yield per foot of draw-down, and the water shall be sand- free (Jess than 2 ppm) at the maximum stabilized capacity. One of the following methods shall be used to develop the wells: Surge plunger, compressed air, or high velocity water jetting.

Neither bailing nor pumping shall be considered to be development under this contract.

The development work must be done in a manner that does not cause undue settlement of the stratum above the water bearing formation.

Test Pumping

The Contractor shall notify the Project Manager at least 24 hours in advance of starting the test pumping. The

Contractor shall furnish all labor, equipment, materials, and power required for test pumping. This shall include all necessary equipment for accurately measuring the water level in the well and the rate of pump discharge. The pumping equipment shall be cable of pumping 15 gpm for residential and 100 gpm for community wells at the required pumping depth.

Equipment shall be approved by the Project Manager prior to test pumping. The depth gauge and flow meter shall be properly adjusted. The Project Manager may request a calibration test be made on-site on the testing apparatus.

The Contractor shall install the pump intake at the depth indicated by the Project Manager. The initial static water level shall be measured and recorded by the Contractor on the test pump forms supplied. The pumping test shall consist of maintaining a constant discharge rate and recording the time and corresponding draw-down. The discharge shall be maintained within five percent of the designated flow rate by means of a gate valve or similar type of throttling device.

Test pumping shall run for a minimum of 4 hours. Running the test beyond these times shall be done only with the approval of the Project Manager. The draw-down and time of reading shall be measured and recorded on the test pump form according to the following schedule:

from 1 to 10 minutes -- every 1 minute from 10 to 20 minutes -- every 2 minutes from 20 to 30 minutes – every 5 minutes from 30 to 120 minutes -- every 10 minutes from 2 hours to end of test – every hour

Whenever a stabilization point is reached, the pumping rate may be modified at the direction of the Project

Manager. Should the measurements not be made exactly at the times specified, the actual time of each measurement shall be recorded.

Immediately upon completion of the test pumping, the Contractor shall take recovery measurements and record them on the test pump form. The recovery readings shall be measured according to the following schedule:

from 1 to 10 minutes -- every 1 minute from 10 to 20 minutes -- every 2 minutes from 20 to 30 minutes -- every 5 minutes from 30 to 120 minutes -- every 10 minutes

Recovery readings shall last for two hours, or until the water level recovers to within 2 feet of static water level, whichever comes first. No payment shall be made for recovery measurements.

Placement of Sanitary Grout

The annular space between the oversize hole and the well casing shall be grouted from 25-feet below the surface to 5-feet below the surface (for pitless adapter installations) or to the surface (for pump enclosure installations).

When deemed necessary and at the direction of the Project Manager, this distance may be changed. A spacer plug may be used between the well casing and the drilled hole to prevent the grout from flowing below the 25-foot level. If consolidated formations are encountered above the depth shown, casing will be grouted a minimum of 5-feet into the formation. A minimum annular grout thickness of 2-inches for the entire length of casing grouted shall be maintained. A temporary casing shall be installed to insure the minimum specified grout thickness. This casing shall be withdrawn as the grout is placed. The method of grouting must be approved by the Project

Manager prior to the commencement of grouting. Wet grouting method must force the grout under pressure from the bottom of the space to be grouted towards the surface, in a single operation. No work on the well will be permitted within 72 hours after completion of grouting if Type 1 cement or bentonite is used. This period may be reduced to 24 hours if Type 3 (quick-set) cement is used.

Cement grout is required where bedrock is encountered within the grouted zone or where the static water level of the well is at or above the zone to be grouted.

Dry bentonite grouting shall be permitted only where the interval to be grouted is 30 feet or less, clearly visible from the surface and dry. Dry bentonite grout may not be used if groundwater or bedrock is encountered in the zone to be grouted. The grouting method shall use tamping or vibration of the grout to ensure that no voids are left in the grouted zone. Quantities of dry grout shall be compared to the volume of grouted space, and the

Contractor shall ensure that all voids are filled.

No grout shall be placed in the utilized aquifer. If an open hole has been drilled below the depth specified, the lower part shall also be grouted with cement. No payment shall be made for this additional footage or grouting.

Disinfection

Upon completion of construction and test pumping, the well shall be thoroughly cleaned of foreign substances including but not limited to cement, oil, grease, joint dope, and scum. The well shall then be disinfected with a chlorine solution. The chlorine solution used for disinfecting shall be prepared prior to injection into the well and shall be of such volume and strength and so applied that a minimum concentration of 50 ppm of free available chlorine shall be maintained in all parts of the well and water system for at least 24 hours before removal by the

Contractor. The Contractor shall test for this concentration and shall submit the results of the test to the Project

Manager. After the 24-hour period the well shall be pumped until the chlorine residual drops to a maximum of 0.4 parts per million. The Contractor shall test for this residual and shall submit results to the Project Manager. Use of undissolved granular HTH for disinfection is not allowed.

Abandonment

Wells shall be abandoned when there is insufficient capacity, unsatisfactory water quality, poor alignment, loss of tools, or other unforeseen problems.

Abandoned wells shall be sealed to prevent the vertical movement of water into the aquifer. The Contractor may pull the well casing from the hole while filling with grout, concrete, or puddling clay. If the casing cannot be pulled, it shall be cut off at least 2 feet below ground surface and sealed with grout, concrete, or puddling clay.

The Contractor shall adhere to the state and local health department rules and regulations for well abandonment.

The guiding principle to be followed in sealing the abandoned well is to restore the controlling geological conditions that originally existed.

If a well is abandoned due to no fault of the Contractor, he shall be reimbursed as described under the method of payment. A well abandoned due to contamination, poor alignment, loss of tools, or any other cause attributable to the Contractor shall be sealed as described at the Contractor's expense.

Water Analysis

After the well has been completed, the Contractor shall collect water samples and submit them to the state or

E.P.A. certified laboratory. Samples shall be analyzed for total coliform bacteria (at least two samples), nitrate as nitrogen, arsenic, and all other contaminants required by the state and county law.

If positive bacteriological results are obtained, the well disinfection shall be repeated and samples retaken until negative results are obtained.

Clean Up

The well site shall be restored to its original condition to the extent practical.

Marking

The well casing protruding through the ground shall have the DOE well ID scribed upon it. The steel well casing shall be scribed with a welding rod or by stamping with steel.

Well Cap

Once the well has been properly disinfected and the water analyzed, the Contractor shall temporarily cap the well with a steel plate welded securely to the top of the casing. The cap shall be watertight. No additional payment shall be made for this requirement; payment shall be incorporated in the overall well cost.

Submittals

The Contractor shall submit after construction the following information:

1. Well logs

2. Test pump record

3. Water quality tests

4. Pump installation report

5. Sieve analysis (when/if a well screen is required)

6. Payroll records showing adherence to prevailing wages

TECHNICAL PROVISION

INDIVIDUAL WATER SYSTEMS

Scope

The work covered by these specifications includes the installation of a pressurized individual water system at the site. It includes but is not limited to the submersible pump, drop pipe, fittings, electrical, pressure system, water service line, trenching and backfilling.

Construction shall be at the locations indicated on the attached schematic. It shall be the Contractor's responsibility to examine the site in advance of any work being performed.

Pitless Adapter and Well Cap

Pitless Adapters shall meet the following specifications:

Material: Bronze or brass alloy with neoprene O-ring

Well Casing Height: 12 to 18-inches above finished grade

Depth of Bury: 3-feet

Connection to Casing: Tighten adapter on to casing after hole is cut using cutting template.

Certification: PAS-1 Watertight, Pitless Adapter Division, Water System Council.

The area around the well shall be backfilled, compacted, and sloped to drain away from the well. A watertight well cap with vent and provision for electrical conduit, Monitor 6W or equal, shall be installed. A screened well vent shall be installed on the cap, Monitor 71 PS or approved equal.

The vent shall be connected to the well cap with a 1 ¼-inch diameter SCH 40 galvanized nipple 2-3 inches long.

Submersible Pump and Appurtenances

Submersible Pump and Motor

Electrical: Single Phase

Performance: 5-10 GPM @ 200-350 TDH

Pump Shaft: Stainless steel, hex or splines

Shell: Stainless steel

Discharge Head & Pump Motor Adapters: Stainless steel

Integral Check Valve: Spring loaded and built in or installed right above discharge

Size: As needed to perform, with l-inch discharge

Type: Pump and Motor shall be separate, replaceable units

Install the pump at the depth specified by the Project Manager and in accordance with state and local standards.

Check Valves

In-line check valve shall be installed immediately above the well pump. The check valves shall be equal to

Simmons Model 1503.

Drop Pipe

Drop pipe shall be 1-in. SCH 80 PVC designed for use as well drop pipe.

Submersible Cable

Annealed copper with 3/64-inch moisture-resistant, rubber insulation bonded to the copper and 2/64-inch of neoprene covering for mechanical protection shall be USE RHW UL 600V solid conductor. Submersible cable shall be sized and installed according to manufacturer and state and local standards.

Submerged Splices

Mechanical splice, STA-KON or equal, with electrical tape wrap or Goulds AW 25 splice kit or equal.

Pressure System

Structure

The Contractor shall install the pressure system components in the existing pumphouse structure. The installation shall conform with the specifications, and the contractor shall locate the components in a logical location safe from moisture and accessible. Wherever a pipe or conduit enters or exits a wall or floor, the Contractor shall caulk all gaps around the pipe or conduit and shall cover the installation with a properly sized PVC or stainless-steel pipe flange.

Heater

Provide an 18-inch minimum, 120V, single phase, 500W baseboard or wall heater (Cadet or equal). It shall be operated by a thermostat with temperature ranges of 30-80 degrees Fahrenheit. The heater shall be preset to tum on at 40 degrees and off at 55 degrees. These settings shall be marked on the thermostat with paint or permanent marker.

Pressure System - Mechanical Components

General

The layout and facilities to be installed shall be determined and proposed by the Contractor and included in the submittals. It will be the Contractor's responsibility to install all appurtenances required in an orderly arrangement in the space allotted.

Existing Components

The Contractor shall utilize the existing components from the pressure system except for the heater, pump, and controller. If the contractor determines that any of the components are no longer functional or suitable, they shall inform IHS and submit a change order.

Electrical

General

All wiring shall be in accordance with the National Electrical Code and applicable State and local electrical codes.

Inspection and approval by the state Electrical Inspector is required. The contractor shall make all arrangements and pay all fees for permits and inspections at each installation.

Use conduit throughout the pressure system enclosure and between the disconnect, pressure switch and control box for systems at the house.

Service

Separate branch circuit is required. Size wires to limit overall voltage drop from the service entrance to the pump motor to 2%. In no case shall wires smaller than AWG #12 be used, including wiring to the receptacle. Service shall be installed in accordance with all state and local standards.

Electrical Cable

All cable and wire shall be UF or USE and shall be sized according to all state and local standards.

Electrical cable between the pressure system components located inside the enclosure shall be type UF, or USE, two conductor with ground. Buried electrical cable from each well to the pressure system shall be type USE or

URD Copper. Neutral cable size shall be as specified by local and state codes.

Cable between the pressure system circuit breaker panel and the motor control box and to the well shall be three conductors with ground. At the well and the motor control box the conductors of the cable shall be vinyl taped to the color code of the pump circuit. The purpose of color code taping is to simplify troubleshooting.

Electrical Conduit

Buried electrical conduit shall be 1" minimum type 40 rigid PVC electrical conduit sized in conformance with the

NEC. It shall extend from the well cap to at least 2 feet into the ground and then 2 feet outside of pumphouse.

Electrical conduit between the pressure switch and the pressure system circuit breaker panel and between the pressure switch and the motor control box shall be U.L. listed nonmetallic liquid tite carflex conduit. Electrical conduit for the pressure system other than that specified above shall be Type 40 rigid PVC. All supports, nails, bolts, straps, and screens shall be galvanized or otherwise corrosion resistant, as approved by the Project Manager.

All conduit shall be properly connected using manufacturer's recommendations and installed in accordance with all state and local standards.

Circuit Breaker Panel

The Contractor shall use the existing circuit breaker panel for the project. The Contractor shall supply the required breakers, if necessary, for the pressure system. The Contractor will verify if the existing panel and breakers allow for 240V pump circuit. The panel shall have an insulated neutral bar and a separate ground bar kit. The panel shall not have more than six breaker knockouts. The circuit breakers must operate independently except that both poles of the 240V breaker shall be permanently installed to disconnect simultaneously. The pump circuit breaker shall be two pole 15 amp, 240V with a minimum interrupting rating of 10,000 amps.

Motor Control Box

All components shall be sized correctly for pump motor model selected. Controller enclosure will be located inside pumphouse. Box shall be mounted on wall so that it is easily accessible for maintenance. Wires shall be connected and vinyl color taped to match the color code of the pump circuit.

Piping from Well to Pressure System

The water line from well to existing pressure system shall be 1” SCH 40 PVC or PE pipe used in pressurized potable water applications, including all fittings and glue. The line must be installed according to the manufacturer’s instructions.

Ensure that pipe is free from defects and damage at time of delivery and prior to installation in the trench. Handle pipe with padding between metal machinery and pipe. Keep dirt and foreign matter away from pipe interiors and sealing surfaces. Lower pipe carefully into the trench without dropping, rolling, or dumping.

Prior to backfilling and connection to the home, the entire water line and appurtenances shall be flushed. Testing shall be accomplished by applying normal main pressure to the exposed water service line and inspecting all joints for leaks. All leaks shall be repaired.

Trenching

Install water pipe with a minimum cover of 24 inches. Place select backfill, free from all stones, frozen soil, and clods, over the first foot of pipe and compact by hand. Compact in one-foot lifts to a point 5-feet from the well.

Replace and compact remaining backfill to a density equal to that of the surrounding earth. Mound over trench line and smooth off. Dispose of any surplus material and restore area in a manner equal to that existing prior to construction. Keep pipe ends plugged during construction to prevent entrance of dirt or other foreign material.

All trench excavation shall comply with Federal and local OSHA regulations for trench safety.

Site Conditions and Utilities

Known buried utilities are shown on the drawings as an indication as to what the contractor may encounter, not for location purposes. Locations, material and sizes of any shown are approximate and not meant as a complete representation. Contractor must obtain exact locations by calling 811 prior to construction.

Disinfection of Pipes

Disinfection of the pressure system and water service line, shall be performed by the Contractor after the system is complete using liquid chlorine only with a minimum concentration of 50ppm. Use of HTH or other granular compounds will not be allowed. The chlorine solution will remain in the lines for a minimum of 30 minutes. The lines will then be flushed until chlorine residual is eliminated. Care shall be taken by the Contractor to prevent accidental water use by the homeowner. After the chlorine residual has been completely eliminated, the Contractor shall take water samples from the house for bacteriological examination by an EPA certified laboratory. Sampling methods shall be in accordance with recommendations of the laboratory. Testing shall be done at the Contractor's expense. If unsafe bacteriological results are received, the Contractor shall re-chlorinate and flush as necessary until safe bacteriological tests are obtained. Any re-chlorination and testing needed will be at the Contractor's expense.

Submittals

The Contractor shall submit for approval prior to construction product material information on the well pump, motor, controls, and pipe.

Submersible Well Pump Installation Record

Installation

Installer: ___________________ Telephone: __________ _ Street: _______________ City: _______ ,State: __ Zip: _____ _

Owner/User: ______ City: ______ ,State:_Zip: _____ Well Number: __ _ Location: ______________________ _

Well

Well Diameter: __ In.

Screened __ Or Unscreened

Well Depth. ____ .Ft. __ Cased __ Or Uncased

Casing Is: Steel __ Stainless Steel __ Plastic __ Or __

Water Temperature Is: __ F Or __ C Static Water Level Is: __ Ft.

Drawdown Level Is: __ Ft. After Pumping at __ GPM Or __ GPH For __ Hours __

Pump/Motor Is Set At: __ Ft.

Drop Pipe Is: Steel Pipe __ Rigid Plastic __ Rigid Plastic __ Or __

Flow Sleeve on the Motor? Yes __ No IfY es, Diameter Is __ In.

Wiring

Open__ Closed Transformer: KV A No. 1 __ , No. 2 __ , No. 3 __ Connected: Wye__ Delta, __

Supply Cable (Service Entrance To Control): __ Ft. of No. __ Copper __ Aluminum __

Drop Cable (Control To Motor): __ Ft. of No. __ Copper __ Aluminum __

Cable Is: Flat __ Ronnd __ Or 3 Individual Conductors __ . Jacked: Yes __ No __

Insulation Is: Neoprene __ PVC__ Or ___ _

Splice Is: Crimped __ Or Soldered __ And, Taped __ Heat Shrink __ Or ___ _

1/06 Teclmical Provisions TP 31.0 Individual Water Well Drilling Page 10

Submersible Well Pump Installation Record

Motor

Manufacturer. ______ _ Model No. Serial No. ______ Date Code ___ _ Horsepower Voltage Phase __ ~Diameter ____ _

Pump

Mfr. _____ _ Model ______ _ Rated ____ GPM At. ____ .Ft.

Insulation Check Initial Megaohms: Motor & Lead Only Installed Megaohms: Motor, Lead, & Cable

Voltage to Motor Non-Operating:

At Rated Flow Of __ GPM At Open Flow __ GPM

Amps To Motor At Rated Flow Of __ GPM At Open Flow __ GPM At ShutOFF*

Start Up Data

Black __ Yellow __ Red __ Black __ Yellow __ Red __

B-Y __ Y-R B-Y __ Y-R B-Y __ Y-R

R-B R-B R-B

Black __ Yellow __ Red __ Black __ Yellow __ Red __ Black __ Yellow __ Red __

Comments: _________________________________ _

1/06 Technical Provisions TP 31.0 Individual Water Well Drilling Page 11

U.S. PUBLIC HEALTH SERVICE

Indian Health Service

PUMP TEST FILED DATA RECODING FORM

Pr~ectNo: ______________________ __ Date ___ Page. ____ of _____ _

Owner ___________________ Location---------------

Pumping Company ___________ Operator---------------------

Observers. _________________________________ _ above Measuring Point is. ____________ Which is _____ .feet below surface.

AM

State water level _____ feet below land surface at _________ .PM ____ ,Ft.

Distance to pump ___________ feet.

Test pump data:HP ______ ~Make. ______________ Volts ___ _

CLOCK ELASPED TIME DEPTH TO DREWDOWN PUMPING REMARKS

TIME SINCE PUMPINGT WATER BELOW OR RATE

STARTED/STOPPED LANQ RECOVERY GPM

(MINUTES) SURFACE (FEET)

(FEET)

PROJECT INSPECTOR~--------

1106 Technical Provisions TP 31.0 Individual Water Well Drilling Page 12

Page_of __

CLOCK ELASPED TIME DEPTH TO DREWDOWN PUMPING REMARKS

TIME SINCE PUMPINGT WATER BELOW OR RATE

STARTED/STOPPED LAND SURFACE RECOVERY GPM

(MINUTES) (FEET) (FEET)

PROJECT INSPECTOR. _______ _

J/06 Technical Provisions TP 3LO Individual Water Well Drilling Page 13

Mary Anne's well

Gary's well