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Table 3.6 Example of Sanitary and Field Survey Report for Hydrogeologic Assessment
Well Location and Characteristics
Water System Name/Address/Fed ID# ________________________________________________
________________________________________________
________________________________________________
Name of Site _____________________________________________________________________
Description of Device ______________________________________________________________
Name and Description of Nearby Surface Source(s) _______________________________________
________________________________________________________________________________
________________________________________________________________________________
Describe Datum for Elevations _______________________________________________________
Is there a USGS gauging station nearby, or are other flow records available?
______________________
Static Water Level
as a Depth ________________ Date ________________
as an Elevation ____________ Date ________________
Pumping Water Level
as a Depth ________________ Date ________________
as an Elevation ____________ Date ________________
Characterize pumping practices or spring flow (rates, seasonally, etc.)
________________________________________________________________________________
________________________________________________________________________________
Describe the vertical distance between the aquifer and the surface-water under pumping conditions
________________________________________________________________________________
________________________________________________________________________________
Describe the horizontal distance between the aquifer and the surface-water source under pumping
conditions _______________________________________________________________________
________________________________________________________________________________
Well Construction
Construction date __________________
Does construction conform to the current standards (i.e., Ten State)? _________________________
Construction methods/materials ______________________________________________________
________________________________________________________________________________
Casing _________________________________________________________________
Grouting _________________________________________________________________
Screening ________________________________________________________________
Well House _______________________________________________________________
Other Information _________________________________________________________
Is a detailed plan/drawing available? __________
Hydrogeology
Is a geologic log for this well available? ____________________________________
What is the thickness of the unsaturated zone? _______________________________
What is the hydraulic conductivity of the unsaturated zone and the aquifer? ______
Is there a confining layer? At what elevation(s)? _____________________________
Describe ____________________________________________________________
Does the surface-water body penetrate the aquifer? ___________________________
Draw the aquifer(s), confining unit(s), and water table using one or more cross-sections with at
least one cross-sections parallel to the flow direction ___________________
Summary of Sanitary Conditions
Describe the results of past sanitary surveys and give the location of written reports
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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