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Is this an existing lake?                                           Yes No

Is there water in it right now?                                  Yes No

Is it losing water?                                                    Yes No

If yes, how much is it losing per day?                     vertical inches

Approximate Size:                                                    sq feet or acres

Average Depth:                                                        feet

Is there ground water present in the lake?             Yes No

Has anyone attempted to seal the lake before?     Yes No

If yes, with what?                                                  


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


Are there any fish in the pond/lake?                       Yes No

Please describe any structural problems:
(Rock layers, sinkholes, evidence of leaking of flowing water through a dam, etc. )


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

Additional Comments:
Please include any other important information about your lake here.

Thank you for taking the time to fill out this form.
The Sales Team at Seepage Control, Inc.

If you prefer, you can fill out a pdf version of the form here.