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Primary Contact |
Alternate contact |
| Name |
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| Address |
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| City |
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| State |
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| Zip |
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| Work Phone |
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| Home Phone |
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| Cell Phone |
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| Fax |
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| Email |
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| Preferred Contact Time |
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| Preferred Contact Type |
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| Other |
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| Pond name |
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| Pond Location |
City: |
State:
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| Estimated Property Value Impacted by the pond? |
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| What is your current, annual pond maintenance budget? |
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| Other |
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Pond Data |
Size |
| Approximate Surface Area |
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| Approximate dimensions |
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| Average depth of pond |
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| Maximum depth of pond |
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| Shape of pond |
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Pond Facts |
| Is pond pre-formed plastic? |
Yes
No
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| Is pond lined with flexible liner? |
Yes
No
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| Is pond natural clay or dirt bottom? |
Yes
No
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| How much sludge is on the bottom? |
Feet:
Inches:
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| What is the age of the pond? |
Yrs:
Mo:
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| What is the general use of pond? |
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| Describe any specific problems? |
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| What is the source of the water? |
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| Is there an overflow or outlet structure? |
Yes
No
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| If yes, how often does water leave the overflow/outlet? |
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| How many months is the pond covered with ice? |
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| Year pond was built? |
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| If no, What is the bottom composed of? |
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Pond Equipment |
| Are you using any type of filtration system? |
Yes
No
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| Do you have an aerator in the pond? |
Yes
No
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| If Yes, How Many? |
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| If yes, Is it at or below the water surface? |
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| If yes, How many months, per year, do you operate the aerator(s)? |
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| Do you have a decorative fountain in the pond? |
Yes
No
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| Is electricity at or near the pond |
Yes
No
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If yes, Distance to the nearest electrical source? |
Distance:
Type:
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| Is there a buffer zone/natural vegetation around the pond? |
Yes
No
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Outside the Pond |
| Is there a berm around any portion of the pond? |
Yes
No
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| If yes, What percentage of the pond has a berm at its shoreline? |
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| Do you have a beach |
Yes
No
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| Is there erosion of the shoreline? |
Yes
No
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| Is there runoff into the pond? |
Yes
No
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| Is there debris (leaves, grass, clippings) entering the pond? |
Yes
No
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| Are there trees near the pond? |
Yes
No
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| If yes, What type(s)? |
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| Is there a boat access point on the pond? |
Yes
No
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Water Quality |
| What is the water temperature of the pond? |
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| Has a water chemistry analysis previously been completed? |
Yes
No
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| If yes, Please attach pdf: |
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| Is the water clear? |
Yes
No
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| What is the approximate depth that you can see clearly into the pond? |
Type:
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| Has the water ever had a foul order? |
Yes
No
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| If yes, How often? |
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Algae and Plants |
| Does the surface ever become covered with algae? |
Yes
No
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| Is the vegetation excessive? |
Yes
No
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| Is Duckweed or Watermeal a problem in your pond? (see pictures below) |
Yes
No
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| If yes, What is the extent of Duckweed/Watermeal? |
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| Is Algae a problem in your pond? (see pictures below) |
Yes
No
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| If yes, What is the extent of the Algae? |
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| Do you have any of the following pond weeds: Coontail, Euarasian Watermilfoil,
Bladderwort, Naiads, and Elodea or Hydrilla? (see pictures below) |
Yes
No
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| If yes, What is the extent of the problem? |
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| Do you have shoreline/emergent plants or brush around your pond such as:
Bullrush, Cattails, Purple Loosestrife? (see pictures below) |
Yes
No
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| If yes, What is the extent of the problem? |
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| Do you have floating plants on your pond such as Lily Pads |
Yes
No
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| If yes, What is the extent of the floating plants? |
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Fish |
| Are there fish in the pond? |
Yes
No
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| If yes, What species? |
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| Approximately how many of each species? |
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| Are they healthy? |
Yes
No
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| Do you feed the fish? |
Yes
No
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| If yes, What type of food? |
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| Do the fish have adequate habitat? |
Yes
No
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| Do you desire to manage your fishery? |
Yes
No
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Prior Management |
| Describe the history of prior management of the pond? |
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| What specific products and/or chemicals were used? |
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Priorities (1 is low, 10 is high) |
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| May we use you as a reference after you are satisfied with our service? |
Yes
No
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