| Company*: |
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| Job Name*: |
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| Contact*: |
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| Address*: |
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| Phone*: |
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| Contact: |
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| Phone: |
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| Is swimming or boating permitted in the water source?: |
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| Total gallons per minute (gpm) of pump station?: |
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| Water source (pond, lake, river, stream, etc): |
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| Distance from shore to adequate water depth: |
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| Water depth from normal pool to lake bottom: |
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| Water depth from highest pool to lake bottom: |
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| Water depth from lowest pool to lake bottom: |
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| Distance from wet well to water's edge: |
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| Flume pipe (type of pipe, i.e., pvc, steel, CMP): |
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| Diameter of flume pipe: |
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| End of flume pipe (flanged, open, etc.): |
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| Length of flume pipe: |
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| Wet well material (CMP, RCP, etc): |
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| Distance from flume pipe to water surface: |
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| Distance from slab elevation to water surface: |
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