11221 St. Johns Industrial Parkway North Jacksonville, FL 32246 Voice 904.928.0700 Ex. 202 Fax 904.928.0790 Toll Free 877.978.4286 [email protected]

Wastewater Collection System Design Request Water Resource Technologies is pleased to provide lift station design assistance to municipalities, engineers, wastewater operators, and homeowners free of charge¹. Water Resource Technologies is also proud to provide complete system analyses by the use of custom models to determine proper pipe sizing for a wide array of hydraulic situations ranging from multiple lift stations operating simultaneously to entire low pressure sewer systems and future system capacity analyses. By completing the form below Water Resource Technologies can prepare all the required calculations, details, and specifications to meet your project’s unique requirements and constraints².

Project Details Please complete the following as thoroughly as possible with the information available to you. If information is not known or unavailable, please leave blank.

Owner Contact Info Name __________________________________ Title ___________________________________ Phone__________________________________ Email___________________________________

Engineer Contact Info Name __________________________________ Title ___________________________________ Company/Entity __________________________ Phone__________________________________ Email___________________________________

Contractor Contact Info Name __________________________________ Title ___________________________________ Company/Entity__________________________ Phone__________________________________ Email___________________________________

Project Description (*) Items required *Project Name ________________________________________________________________________ Location: Address______________________________________________________________________ County _________________________________ State_________________________________________ GPS Coordinates (if known)_______________________________________________________________ Will this project go out to bid? If yes, when?_________________________________________________ Are you Interested in trenchless construction?_______________________________________________ Page 1 of 6

*Please state if this design is for a new lift station, infrastructure upgrade, new development, septic tank abandonment, or etc. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ *What will the lift station be servicing? (i.e. commercial** or residential property) _____________________________________________________________________________________ ** If commercial what are the hours of operation? Total hours per day _____________________ (Hours)

Flow Rates What is the average daily flow (ADF) per unit being serviced? Gallons per day___________________________ Number of units _______________________________ *Total AFD ______________________________(GPD) Worksheet: A=Type of Unit

B=Number of Units

C=Flow per unit (ADF)*

D=Total Average Daily Flow (ADF) Column B x C

Single Family Home Mobile Home Apartment Commercial* *TOTAL

GPD

*How was the ADF obtained? (i.e. From historical usage, water bill, published guidelines, etc.) _____________________________________________________________________________________ _____________________________________________________________________________________ What Peaking Factor should be used? _______ (e.g. 4) (Factor of safety desired or required)

Has approval from wastewater treatment facility been obtained? _______________________________ (If yes, please attach letter or authorization and state maximum flow allowed below)

Maximum flow allowed _________________________________ mgd Page 2 of 6

Future Parameters Are the system parameters planned to change, such as an increase or reduction in flow rates, tie in pressure, etc.? (If yes, please provide a brief description below) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Site/System Parameters *Top of station elevation

___________ feet

*Adjacent grade elevation

___________ feet

*Elevation of inlet(s) including sizes and pipe type (i.e. 4” SCH40) Inlet #1 ___________ feet _________ size _________ type Inlet #2 ___________ feet _________ size _________ type Inlet #3 ___________ feet _________ size _________ type Inlet #4 ___________ feet _________ size _________ type *Cover over discharge required ___________ inches Lowest Finish Floor Elevation of Building(s) being serviced or top of lowest gravity manhole upstream of lift station ___________ feet Describe upstream infrastructure (storage) - such as manholes, storage tanks, grease traps, etc. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Are there any known geotechnical constraints? If yes, please provide geotechnical reports if available _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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*Are there any force main type and size requirements imposed by the municipality of this project (i.e. 2” HDPE SDR11 IPS pipe) _____________________________________________________________________________________ _____________________________________________________________________________________ *Force main characteristics – (A zone indicates a change in pipe type or size) Zone 1 Length ___________ feet _________ size _________ type Zone 2 Length ___________ feet _________ size _________ type Zone 3 Length ___________ feet _________ size _________ type

*Describe discharge tie-in location including distance and direction from closed street intersection. _____________________________________________________________________________________ _____________________________________________________________________________________ *Tie in pressure – ☐ ☐

*Static Head conditions

Manhole Force main Pressure range

_0__ psi Min Avg. Max

High point elevation Low point elevation

____ psi ____ psi ____ psi ____ feet ____ feet

Describe any safety or security requirements, if applicable _____________________________________________________________________________________ _____________________________________________________________________________________ Describe loading requirements (i.e. Will the station be protected from heavy loads?) _____________________________________________________________________________________ _____________________________________________________________________________________ Is the proposed lift station to be located in an environmentally sensitive area? _____________________ If yes, please describe conditions _____________________________________________________________________________________ _____________________________________________________________________________________ Is the proposed lift station private or public and will it remain that way into the foreseeable future? _____________________________________________________________________________________ _____________________________________________________________________________________ *Please attached site plan if available Page 4 of 6

Station and Panel Requirements *Power available on site

__________ Volts _________ Phase ______ Hz

Wet well storage requirements

__________ Gallons __________ Hours

Storage requirement is to be below the

☐ ☐

Inlet Top of station

*Pump type preference (e.g. non-clog, grinder, effluent, etc.) _____________________________________________________________________________________ _____________________________________________________________________________________ Manufacture preference – If this is for a replacement pump, provide model number _____________________________________________________________________________________ _____________________________________________________________________________________ Material requirements for wet well and piping _____________________________________________________________________________________ _____________________________________________________________________________________ Minimum number of pumps required (i.e. as imposed by local agency) _____________________________________________________________________________________ _____________________________________________________________________________________ Station/Pump Options Guiderails ☐Yes ☐ No Level Indicator ☐ Floats ☐ Transducer ☐ Bubbler ☐ UltraSonic Seal Fail Sensor ☐ Yes ☐ No Explosion Proof ☐ Yes ☐ No Enclosure type NEMA 4x Fiberglass ☐ NEMA 4x Stainless Steel ☐

Panel Options Generator Receptacle Elapsed Time Meter(s) Phase Monitor (3ph) Voltage Monitor (1ph) Seal Fail Light Battery Backup Auto Dialer Dead Front UL Listed GFCI Outlet SCADA Ready Heater / AC Oversized Enclosure

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☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

High Efficiency Equipment High Efficiency Pumps ☐ Variable Frequency Drive ☐

SCADA System Land infrastructure Radio Phone line Wireless Cellular Satellite Other

☐ ☐ ☐ ☐

___________________________ ___________________________ ___________________________

Design Review and Permitting Please describe who will be reviewing the project plans and list all permits that may be required for this project (i.e. Department of Environmental Protection) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

DATE ________________________________

Upon review a Water Resource Technologies Territory Manager in your area will contact you to follow up on your request. Should you have any questions or require assistance in completing this form, please do not hesitate to contact our Engineering Department and one of our experienced Applications Engineers would be happy to assist you. Thank you for your inquiry and we look forward to helping you complete this project and that this may be a start, or continuance, of a great relationship.

Best Regards,

Brandon Shugart, BSCE, EI, PSM | Engineering Manager | [email protected] Water Resource Technologies | 11221 St. Johns Industrial Parkway North | Jacksonville, FL 32246 T 904.928.0700 Ex. 202 | F 904.928.0790 | www.wrtllc.com

¹ Other engineering services in Florida and Georgia are available to help assist you in completing your project. ² Information in this form will be used to provide a preliminary lift station design which will be used to provide budgetary pricing and can be used as a reference, or basis of design, and should not be used for construction purposes. WRT assumes no responsibility as to the accuracy of the information provided in this form. This service is not to be considered an engineering document.

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