Submersible Motor Installation Record
| RMA No. _____________ |
INSTALLER’S NAME ___________________________ | OWNER’S NAME _________________________________ |
ADDRESS ___________________________________ | ADDRESS ______________________________________ |
CITY __________________ STATE_____ ZIP________ | CITY ____________________ STATE_____ ZIP________ |
PHONE (____) _____________ FAX (____) _________ | PHONE (____) _____________ FAX (____)____________ |
CONTACT NAME ______________________________ | CONTACT NAME ________________________________ |
WELL NAME/ID _______________________________ | DATE INSTALLED __________ DATE FAILED__________ |
WATER TEMPERATURE ________ °F or ________ °C |
|
Motor: |
|
Motor No. __________________ Date Code ___________________ hp ________ Voltage _________ Phase ______
Pump:
Manufacturer _________________ Model No. _________ Curve No. _________ Rating: ______ gpm@______ft TDH
NPSH Required ___________ ft NPSH Available_________ ft Actual Pump Delivery__________gpm@ ______ psi
Operating Cycle ______________ON (Min/h) _________________ OFF (min/h) (Circle Min or h as appropriate)
YOUR NAME ___________________________________________________________ DATE ______/______/______
WELL DATA:
Total Dynamic Head ________________ft
Casing Diameter __________________ in
Drop Pipe Diameter ________________ in
Static Water Level __________________ft
Drawdown (pumping) Water Level _____ft
Check Valves at _________ & _______ &
_________ & _______ ft
❑Solid ❑ Drilled
Pump Inlet Setting _________________ft
Flow Sleeve: ___No____Yes; Dia. _____in
Casing Depth______________________ft
❑Well Screen ❑ Perforated Casing From_____to_____ft & ______to______ft Well Depth ________________________ft
TOP PLUMBING:
Please sketch the plumbing after the well head (check valves, throttling valves, pressure tank, etc.) and indicate the setting of each device.
Form No. 2207 8/00
