Indiana Farmstead Assessment for Drinking Water Protection

Household Wastewater Treatment

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).

Quantity & Quality of Effluent (Wastewater)

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__________

Collection & Pretreatment of Effluent

 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 __________

Liquid Waste Disposal

13. Do you dispose of the liquid por tion of the wastewater on your farm?

	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

	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

	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

	Yes (3)
	No  (1) If No, STOP here.

24. Do you have a state permit (IDEM) for surface application of

	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 _________

Risk Assessment for Household Wastewater Treatment

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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