Checklist for Drinking Water Source Assessment Horizontal Well Data Sheet

Form Template

Public water systems can use the Checklist for Drinking Water Source Assessment Horizontal Well Data Sheet mobile app with a smartphone or tablet to inspect and document drinking water sources and risk ratings.

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The app information should be contained in the drinking water source assessment submittal. This app includes a detailed Checklist for Drinking Water Source Assessment Horizontal Well Data. The protection zone for groundwater sources are a set of three circles surrounding the source. (For springs and horizontal wells, if determined to be groundwater sources, the protection zones need not include those portions of the circles down gradient of the source.) The radius of the protection zone is determined in the Delineation section of the assessment and depends upon the aquifer material, well pumping rate, screened interval, and aquifer porosity. At the discretion of the regulatory agency, the water system may request that the regulatory agency prepare a map displaying the source and zones.

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