State Form 35058 - Application For Construction Permit For Public Water System - 327 Iac 8-3-3(A) - Indiana Department Of Environmental Management Page 4

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I. The Public Water System's five (5) highest demand days in previous two (2) years.

Date

Demand (GPD)

2 year Average Daily Demand (average of 1 through 5 above)

GPD

4. Summary of Flow Test Data (data must be attached)

1. Date of flow test

2. Static pressure at flow test location

psi

3. Flow test flow rate

gpm

4. Residual pressure at flow test flow rate

psi

SKETCH THE FOLLOWING:

Show the relationship between fire flow test location and the point of connection of proposed water main. Include all water main piping information including

lengths, diameters and material type. Include the elevations at both fire flow location and point of connection. Show north arrow. No scale is necessary if pipe

lenghts are noted.

5. This flow test was taken at:

Fire Hydrants (wide open)

Fire Hydrants (open to sustain 20 psi residual pressure)

Flushing Hydrants (wide open)

Tank level during test ______________

Booster pump within the pressure zone of the proposed water main ____ (on) ____ (off)

5. Water main Extension Hydraulic Calculation

Enclosed Hydraulic Model

Enclosed Hydraulic Calculations

6. Alternative Technical Standard (check all that apply)

This application cites pre-approved alternative technical standards (copy attached).