Information Requested & Contact Information
Location & Project Background
Type & Size of Facility to be Served
Effluent Discharge, Sludge Treatment, Drinking Water & Project Priorities
Information Requested
Type of information requested
Date by which you need this information
Date by which the system must be delivered
Date by which the system must be operational
Contact Information
Name
Title
Company
Work Phone
Cell Phone
Mailing Address
Physical Address
Location
The project is
Specific location if available
The system
The site has or may have permafrost
The system will be on an ice pad
Project Background
Please provide a brief description of the project
Instructions
Fill in data for applicable sections - Work Camp, Hotel / Lodge, Village, or Residence
Camp
Total # Beds
Max # People
Average # People
Estimated water use in gallons per person per day
Camp will be
Mode of transport will include (check all that apply)
Transportation Comments
The system will
Operating Period
Hotel / Lodge
Max overnight guests
Average overnight guests
Max day visitors
Average day visitors
Max staff
Average staff
Operating period
Village
Village population
Total houses
Max gallons per day to be treated
Average gallons per day to be treated
Water supply
Residence
Max number of residents
Total bedrooms
Water use in gallons per bedroom per day
Water supply
Effluent Discharge
Treated sewage effluent will be discharged to this environment
Name of waters affected
We already have a discharge permit
Sludge Treatment & Disposal
Drinking Water
Drinking water will come from
If drinking water comes from an onsite storage tank please check its corresponding location
Describe proposed (or actual) drinking water source
Describe proposed (or actual) drinking water treatment
Backwash water or other material from water treatment plant will go to the sewage treatment plant
Drinking water backwash explanation
If you need assistance with drinking water supply or treatment please explain below
Project Priorities
Your priorities in purchasing a sewage treatment plant could be stated as follows (please check all that apply)
Other explanation
Other
Please provide any other information you think is pertinent
Please upload any additional documentation
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