Estimated Check if applicable Measured Check if applicable Max. gal/day pretreatment pretreatment Methods Indiana without applicable of with if Avg. gal/day Sewer, waters Disposal others Sewer tank applied hauler List groundwater Water Sanitary Sanitary Storm Surface Evaporation Septic Land To Include Source Method(s) Disposal See Below Possible Estimated Check if applicable Measured Check if Worksheet applicable Disposal Max. Total: gal/day and Use, Avg. Total: gal/day Supply, (S) Water Source Below Water Source See List II.
II. Water Supply, Use, and Disposal Worksheet Estimated Check if applicable Possible Water Disposal Methods Sanitary with pretreatment Sanitary Sewer, without pretreatment Storm Sewer Surface waters of Indiana Evaporation Land applied To groundwater Septic tank hauler Include others if applicable Measured Check if applicable Max. gal/day Avg. gal/day Disposal Method(s) See Source List Below Estimated Check if applicable Measured Check if applicable Max. gal/day Total: Avg. gal/day Total: Water Source (S) See Source List Below
WPCP-FCD-0005.docx