Intake well report format

1. REPORT OF THIRD PARTY INSPECTION Customer Inspection Ref. No(s) :
Report No:
Issued on:
For visit Period:
Page 1 of 1
REPORT OF THIRD PARTY INSPECTION – OPEN WELL / INTAKE WELL
NIT No. :
Contract Agreement No. :
Name of Division :
Name of Sub Division :
Name of Block & Village :
Name of Contractor :
Name of Work :
Stage of Work
(On going/Completed)
:
Running Account Bill No :
II. Source: (Open well/Intake well) If no of well are more than one, then provide details for each Bore well
A. Whether Geo survey has been done : Yes / No
B. Dia. of well (in mm) :
C. Depth of well executed :
D. Whether Stening wall constructed :
E. Quality of Stening work :
F. Whether Yield test conducted : Yes / No
G. Yield (lpm) :
H. Whether Water Quality Test available
(If Yes, enclose report)
:
I. Whether water quality is as per BIS
standard
: Yes / No
Remarks:
Signature of TPIA
Overall Grading: Satisfactory / Unsatisfactory
Recommendation for Payment: Yes /No
Date: Place:
Name, Designation and signature of the
PHED Officials Representative
Name, Designation and signature of Village
Panchayat