University of New Hampshire
Pre-Treatment Survey Questionnaire for Small Water Systems (Surface Water)
GENERAL INFORMATION
1
Name of water system:
(required)
2
Address:
(required)
3
State/Province:
(required)
4
Phone Number:
5
Age of water system:
years
6
Capacity of water system:
(indicate units)
gal per min
gal per day
million gal per day
7
Population Served:
people
8
Most common violation:
(not including administrative or non-reporting)
9
What are your most challenging pre-treatment needs (Check all that apply)
Rapid Fluctuations in Water Quality
Turbidity loadings
Taste & Odor
Seasonal Water Quality Changes
Total Organic Carbon
Color
Algae
Other (describe):
WATER QUALITY INFORMATION
10
Raw Water Quality
Pre-Filtered Water
Filtered Water
Min
Max
Avg
Min
Max
Avg
Min
Max
Avg
Turbidity (NTU)
Color
Total Organic Carbon (mg/L)
Algae (counts/ml)
WATER FILTRATION INFORMATION
11
Pre-Treatment:
Check type(s) of prefiltration processes used:
None
Preozonation
Riverbank Filtration
Activated Carbon
Riverbed Filtration
Coagulant Addition + Flocculation
Sedimentation (Plain)
Dissolved Air Floation
Plate Settlers
Other (describe):
Roughing Filtration
12
Rate your existing pre-treatment performance:
Poor
Fair
Good
Excellent
13
Filtration:
Check type of filtration process used:
Direct Filtration (Rapid Sand)
Slow Sand Filtration
Membrane Filtration
Pressure Media Filtration
Diatomaceous Filtration
Other (describe):
14
Total Filter Area:
sq. feet
15
Average Filter Cycle Duration:
days
COST INFORMATION
16
Capital cost of the treatment system:
$
in the Year
17
Operation and maintenance costs per year:
$