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ROO SELL. <br />Well / Water supply system (check all that apply) <br />❑ public service water supply (if not checked, complete the remaindsr of this page, <br />and include a water analysis of untreated water). <br />water use <br />❑ domestic <br />❑ irrigation domestic garden <br />❑ irrigation commercial crops <br />❑ livestock <br />® combined domestic and agricultural <br />❑ commercial (explain) <br />❑ no water source at the site (explain) <br />❑ cistem <br />Size gallons <br />Age <br />Su lied by., <br />Lj rainwater <br />❑ sling <br />❑ runofflstream <br />location: <br />above ground <br />buried <br />Material• <br />concrete <br />plastic <br />metal <br />other (explain) <br />❑ spring <br />❑ stream <br />❑ other (explain) <br />❑ dug well <br />de th It age <br />�] brick lining <br />❑ stone lining <br />❑ other (explain) <br />❑ pump type & size <br />❑ drilled well <br />steel casing <br />plastic casing <br />❑ other (explain) <br />Casing depth rt • ff <br />Casing diameter in. <br />Web screWiner diameter____b. <br />Depth ff. to ft. <br />Wea screen type <br />Vent ty;wsize <br />WeN driller Surnay5i 6 <br />Pump type & size a4t <br />Water quantity <br />Has well ever gone dry? ❑ yes JM no <br />Has well capacity ever been <br />measured? R) yes ❑ no f yes list <br />data (recharge rate): g h gprr► <br />How many people u t is water <br />supply? <br />Water quality <br />Does the water cause staining? <br />❑ yes ® no <br />Stain cola: <br />Items stained. <br />Are there particulates (solids) in the <br />water? ❑ yes j@ no <br />If yes describe the particles (color, <br />texture): <br />Does the water have an odor? <br />❑ yes (0 no If yes describe the odor. <br />