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SITE DATA WORKSHEET

Site Information

Notes
_____________________________________

Water Source

Name: _______________________

_____________________________________

Address: _____________________

City Water Meter:

City: ______ State: ___ Zip: ______

Well:

Contact: ______________________

HP: _______ PSI _______ GPM: _______

_____________________________________

Day Phone: _____________

Surface Water:

_____________________________________

Email: ________________

Water Quality: Good

Plans Available: Yes No

Water Purveyor: ____________________

Elevation Change:

Contact: __________ Phone: __________

_________

Soil Information

Centrifugal:

_____________________________________

Sub:

Effluent:
Fair

_____________________________________

Poor

_____________________________________
Electrical Source

Meter Location: _____________________

Voltage: ________
Location: _______________________________________

Sand

Rock Removal

Meter Size (Inches) __________________

Sandy Loam

Rock Teeth req.

Service Line Type & Size: _____________

Loam

Steep Slopes

Static Pressure:______________________

Clay Loam

Hard pan over top soil

Clay

Additional Grading req.

Climate
Cool Humid
Warm Humid
Hot Humid

Backflow Regulations: ________________


___________________________________

Cool Dry
Warm Dry
Hot Dry

Worst case daily PET (in. per day): _____________

Hydrozones (Attach sketch of property)


#

Description

Density

Irrigation Method

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