Information Requested & Contact Information

Location & Project Background

Type & Size of Facility to be Served

Effluent Discharge, Sludge Treatment, Drinking Water & Project Priorities

  • Information
  • Location
  • Facility
  • Effluent
  • Other

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




Work Phone

Cell Phone

Mailing Address

Physical Address



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


Fill in data for applicable sections - Work Camp, Hotel / Lodge, Village, or Residence


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 population

Total houses

Max gallons per day to be treated

Average gallons per day to be treated

Water supply


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


Please provide any other information you think is pertinent

Please upload any additional documentation

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