Please complete the following form to tell us about your application. All fields must be completed before submitting. Please insert “N/A” for non-applicable or unknown fields.
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to save and complete the form from your computer in Microsoft Word format. |
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Project Name:
(as permitted) |
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Project Location:
(Street, City, County, State, Zip) |
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| Project Owner's Name: |
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| Engineering Firm: |
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| Project Engineer's Name: |
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| Engineer's Email Address: |
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Firm Address:
(Street, City, State, Zip) |
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| Firm Phone Number: |
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| Firm Fax Number: |
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| Please describe in detail the type of facility, with the description of facility services (including square footage), which the pump station will serve (Ex: food handling, car washes, number of rest rooms). If it is a residence, please include a complete description (single family, multi-family, attached, detached) and include the number of units, sq. footage, and number of bedrooms per unit. For parks, churches and stadiums please include the number of seats or visitors: |
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| Please indicate the public utility that will be accepting the wastewater flow from your application: |
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| Please indicate the running length of force main in feet, including any aqueous crossings, the number of, and degree of turns, and any type of above-surface crossings: |
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| Please indicate how the wastewater is being discharged: |
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Manhole
Gravity Line
Force Main
Drainfield |
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| If wastewater is being discharged into a force main, what are the static pressures of the force main? Please indicate: |
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| High Pressure: |
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| Low Pressure: |
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| Please list below the elevations of your application: |
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| 25 year flood elevation (FEMA): |
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| 100 year flood elevation (FEMA): |
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Influent pipe elevation:
(The elevation at which the wastewater will enter the wet well) |
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| Station grade elevation: |
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| Highest grade elevation between pump station and the force main discharge point:
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| Identify Available Power: |
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208 Volt 1 Phase
230 Volt 1 Phase
208 Volt 3 Phase
230 Volt 3 Phase
460 Volt 3 Phase
To Be Determined |
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| Please attach the site plan in PDF format:
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