Seepage Control, Inc. -- specializing in construction of liners for sealing lakes and ponds

Job-Site Questionnaire
Please feel free to fill out all or none of this form. The most important field is your email address so we can contact you. The more information that you can give will help our sales team better prepare to help you with your lake.

Name:	Referred by:
Title:	Email:

Date (dd/mm/yy): / /	Address:
City:	State:
Country:	Zip Code:
	Phone#(w/country code):

1) Is this an existing lake? Yes No
How Old? yrs.

2) Is there water in it right now? Yes No

3) Is it losing water? Yes No
If yes, about how much is it losing per day?

4) Approximate Size? , Depth

5) Slope Angle (ie. 3:1, 2:1, etc.)?

6) Is there ground water present in the lake? Yes No

7) Has anyone attempted to seal this lake before?
Yes No
If YES, with what:

8) Has there been any testing done on the soil?
Yes No
If YES, Results:

9) Is the site around the lake established?
Yes No
If YES, is there accessibility to the lake without damaging the existing surroundings?
Yes No

10) What are the soils like in the area?
Clay? Yes No
Sand? Yes No

11) Are there any fish in the pond? Yes No

12) Are there any structural problems? Yes No
Rock layers, sinkholes, evidence of leaking of
flowing water through a dam, etc.
If yes , what are they?

13) Do you have a permanent water source to fill the pond other than rainfall? Yes No

Additional Comments: