Preparation of Rights-Based Municipal Water Supply, Sewerage and Sanitation Sector Plans (MW4SPs) Page 1 of 1

Data Form: Proposed (Future) Water Source

Region/Province: _______________________ Municipality: ___________________________

Data on Proposed (Future) Water Source

Instructions: This form is intended for proposed or potential water sources for drinking supply within the Municipality.

Name of Interviewer: ____________________________ Date of Interview : __________________________

Department/Office: ___________________________ Data Source/s : __________________________
Name/Position/Office

Estimated Location
Estimated Distance
Discharge Estimated
from Geographical Coordinates
No. Source Type* Elevation Remarks
Proposed Name of Barangay
(mamsl) Service Area Longitude Latitude
(Liters/sec)
(km) (in deg/min/sec) (in deg/min/sec)
1
2
3
4
5
6
7
8
9
10

Notes: *Source Type: 1. Spring, 2 Deep Well (>20m deep bored well), 4. Shallow Well (<20m deep bored well), 5. Dug Well (shallow large diameter well), 6. Surface Water (creek),
7. Surface Water (river), 8. Surface Water (lake).
mamsl - meters above mean sea level
Use additional Forms if there are more than ten (10) sources