Indiana Farmstead Assessment for Drinking Water Protection
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Use this survey to assess the risk to groundwater quality posed by your household wastewater treatment. Circle the answer that best describes the situation of your household. At the end of each section sum the numbers that correspond to each answer for the section total. When you have completed the survey, sum the section totals for the risk assessment score. Refer to Fact Sheet 6 for more information on household wastewater treatment.
For each question, a (1) represents a higher risk to drinking water than a (3).
1. How much wastewater is generated in your household?
less than 25 gallons per person per day (3) 25 to 100 gallons per person per day (2) over 100 gallons per person per day (1) 2. Do any of your water fixtures drip or leak? Yes (1) No (3) 3. Have you installed any water conserving fixtures in your home? many (3) some (2) none (1) 4. How many times a week is your water softener set to recharge? twice or less (3) more than twice (1) 5. Approximately how many times do you use a kitchen garbage disposal per week? 2 times or less per week (3) 3 to 5 times per week (2) daily (1) 6. How much household chemicals (cleaners, detergents, etc.) do you add to the wastewater? none (3) cups per week (2) quarts or more per week (1) 7. How much toxic cleaning agents and solvents (paint thinner, etc.) are added to the wastewater? none or minimal amounts (3) moderate amounts (2) extensive amounts (1) 8. How often (or amount) do you dispose of oils and greases into the sink or sewer? minimal amount/seldom (3) moderate amount/occasional (2) extensive amount/frequent (1) Quantity & Quality of Effluent section total__________
9. Select the answer that best describes your collection system.
All wastewater and some clear water collected for treatment. No leaks. .... (3) Some wastewater diverted or some leakage of water. Clear water infiltration. ........... (2) Clear water infiltration. Leakage loss of water that should be treated. ................ (1) 10. How far is the collection system from the well? more than 50 feet (3) 25 to 50 feet (2) less than 25 feet (1) 11. Which collection / pretreatment of system do you use? direct discharge to the surface, ditch or stream STOP here. Surface discharge of untreated effluent is a violation of Indiana Code. Risk is HIGH. septic tank Go to Question 12. 12. Circle the response that best describes your septic tank system. Tank more than 50 feet from well. Serial tanks or added retention system. Pumped every 3 years. No leakage. Baffles and tank inspected regularly. ................ (3) Tank located 26 to 50 feet from well. Single tank. Pumped every 4 to 6 years. .......................... (2) Less than 25 feet from well. Leakage. Tank pumped every 7 or more years. Tank located 3 feet from water table or bedrock. ..................................... (1) Collection & Pretreatment of Effluent section total __________
13. Do you dispose of the liquid por tion of the wastewater on your farm?
Yes No If No, skip to Question 23 14. Which method of liquid disposal do you use? subsurface application or soil absorption Go to Question 15. distributed on land surface Skip to Question 21. 15. What system of subsurface application of liquid waste do you use? trench system (3) cesspool, drywell, seepage pit or bed (2) drainage tile (1) 16. What is the texture of the soil at the liquid waste application site? loam (3) clay (2) sand (1) 17. Is your liquid disposal area downslope from the water well? Yes (3) No (1) 18. Is your liquid waste disposal more than 50 feet from the water well? Yes (3) No (1) 19. Do you apply the liquid waste at a rate below, equal to or above the design capacity of the system? below (3) equal (2) above or uncertain (1) 20. Do you have seasonal problems with slow operation and wet areas in the yard or effluent discharge area? Yes (1) No (3) 21. Do you apply liquid wastewater to the land surface or ditch? Yes (1) If Yes, go to Question 22. No (3) If No, skip to Question 23. 22. Do you have a state permit (IDEM) for surface application of domestic wastewater? Yes Go to Question 23.No If No, STOP here. Surface application without a permit and approved disposal system is a violation of Indiana Code. Risk is HIGH. Liquid Waste Disposal section total __________ 23. Do you dispose of the solid sludge por tion of wastewater on your farmstead? Yes (3) No (1) If No, STOP here. 24. Do you have a state permit (IDEM) for surface application of sludge? Yes (3) No (1) 25. What is the soil texture of the sludge disposal site? loam (3) clay (2) sand (1) 26. Is the sludge disposal site more than 200 feet from the well? Yes (3) No (1) Solid Waste Disposal section total _________
Add the following totals:
Quantity and Quality of Effluent section total = _____ Collection & Pretreatment of Effluent section total ____ x 2 = _____ Liquid Waste Disposal section total ____ x 2 = _____ Solid Waste Disposal section total = _____ Survey 6 Score _________ ---------------------------------------------------------------------- Low Moderate High 94 - 70 69 - 30 29 - 12 ----------------------------------------------------------------------
click here for fact sheet 6:
Household Water Treatment Fact Sheet
Reviewed 5/1/01 |
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