State Form 35058 - Application For Construction Permit For Public Water System - 327 Iac 8-3-3(A) - Indiana Department Of Environmental Management Page 7

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APPLICATION FOR CONSTRUCTION PERMIT FOR
Attachment C
PUBLIC WATER SYSTEM - 327 IAC 8-3-3(a)
Pumping Station
State Form 35058 (R5 / 9-98)
Approved by State Board of Accounts 1998
Indiana Department of Environmental Management
Drinking Water Branch
A. What is the 100 year or highest known flood elevation in the area?
B. What is the pumphouse floor elevation?
C. What is the elevation of the finished grade at the
D. How many pumps are provided? (attach pump
E. What is the peak demand (gpm) the
pumphouse location?
curves)
pump(s) designed for?
F. What is the rated capacity (gpm) of each proposed pump and total dynamic head (TDH)?
G. How will power be supplied to the pumps in the event of an interruption to the primary power source?
H. What kind of monitoring will be provided and what is the form of communication?
I. Does each pump have a pressure gauge on its
J. Is there a low suction cut-off control?
If Yes, what is its setting?
discharge line and a compound gauge on its
suction line?
Yes
No
Yes
No
K. How is the total discharge of the pump(s) measured?
L. Does the pump have a check valve?
If Yes, where is the check valve located?
Yes
No

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