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

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APPLICATION FOR CONSTRUCTION PERMIT FOR
Attachment D
PUBLIC WATER SYSTEM - 327 IAC 8-3-3(a)
Storage Facilities
State Form 35058 (R5 / 9-98)
Approved by State Board of Accounts 1998
Indiana Department of Environmental Management
Drinking Water Branch
B. What type of storage facility is this? (standpipe, elevated, ground, etc.)
A. What is the 100 year or highest known flood elevation in the area?
D. What is the elevation at the base of the storage facility?
C. What is the capacity of the storage facility?
E. What is the purpose of the water storage facility?
F. Are there other existing water storage tanks within the system?
a. Volume
b. Pressure
c. Fire protection
Yes
No
G. What is the size (gallons) of the existing tank(s) and overflow elevation?
H. What is the average daily consumption of the system?
I. How is the storage facility isolated from the distribution system?
J. What is the filling rate of the storage
K. What size is the overflow pipe?
Is the overflow pipe screened?
What size screen?
facility?
Yes
No
L. What is expected to be the operating head range of the storage facility?
M. What provisions have been made to monitor water levels in the storage facility?
N. What provisions have been made to allow for draining of storage facility?
O. Where are the sampling taps located?
P. How is the storage facility protected from trespassers, vandalism and sabotage?
Site fenced
Yes
No
Alarm
Yes
No
Ladder guard
Yes
No
Lighting
Yes
No
Hatch locked
Yes
No
R. Is cathodic protection being used?
S. How is the storage facility being protected from freezing?

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