Appendix F
Lifewater Canada Well Record
| Well Location | |
| Country: | Location Sketch
N Scale: |
| Province/State: | |
| Easting: | |
| Northing: | |
| Site Description: | |
Distance to nearest pollution sources (ft) - describe: | |
| Depth
(m) |
Soil Type
(Describe) |
Thickness
(m) |
Drilling Notes
(Drilling Speed, bit vibration, water temperature etc) | ||
Depth at which water encountered:
Depth to Water Table:
Depth of Borehole:
| Borehole Yield | |
| Yield: | Duration of Test (minutes): |
| Describe how yield measured: | |
| Well Screen & Casing | |
| Material (PVC, Other): | Casing/screen diameter: |
| Thickness (Schedule 40 or 80): | Length of screen sump: |
| Number of slot columns: | Vertical spacing between slots: |
| Length of slots: | Screen Length: |
| Installed length of casing: | Total length of screen/casing: |
| Describe screen centralizers (number, where/how attached): | |
| Describe drive shoe (shape, material, size etc): | |
| Well Completion | |
| Gravel pack material diameter (inches): | Gravel pack volume: |
| Type of stabilizer material: | Stabilizer material volume: |
| Grout mix (sand:cement ratio): | Grout volume: |
| Pad concrete mix (sand:gravel:cement): | Thickness of cement pad: |
| Size of cement pad: | Well protected by fencing (Y/N): |
| Distance from ground to pump cylinder: | Cylinder diameter: |
| Well Development | |
| Technique Used: | Development Time (hours): |
| Describe process (turbidity in discharge water over time and depth):
| |
| Chlorination | |
| Type of chlorine used: | Volume of chlorine used: |
| Length of disinfection period: | Chlorine odour in discharge water (Y/N): |
| Describe how chlorine was mixed with well water: | |
| Water Quality | |
| Colour: | Turbidity: |
| Odour: | Taste: |
| Bacteria test type: | Bacteria Test Results: |
| Other tests or characteristics (pH, Total Dissolved Solids, nitrate, staining etc): | |
| Completed Well Performance | |
| Piston clearing cylinder top&bottom (Y/N): | Waste water drainage: |
| Sustainable pumping rate (Gal/min): | Pump stable: |
| Other (cylinder secured with safety rope? etc): | |
Date Drilling Started:
Date Work Completed:
Number of Workers:
Construction Foreman's Name (Print):
Foreman's Signature:
Action Agency/Lifewater Inspector Confirmation
Name (Print):
Signature:
Inspection Date:
Well Record Copies:
1) Lifewater Canada
2) Local Drill Team
3) Local Government
PHOTOGRAPHS: (Well Overview Required. Pump close-up, Surroundings, People Desirable)
