Design Review Check List for Rainwater Harvesting
Applicant:________________________________
Date:___________________________________
Submitted By:_____________________________
Project Location:_________________________
1) End use(s):
_____________________________________________________________________________
Indoor, Non-Potable [ ]
Outdoor, Non-potable [ ]
2) First flush diverter (capacity and model):
______________________________________________________________________________
______________________________________________________________________________
3) Type of Pretreatment filter/screen (capacity and model):
______________________________________________________________________________
______________________________________________________________________________
4) Supplemental water source
None [ ]
Well [ ]
Municipal [ ]
Other:____________________
5) Cross connection control methods:
______________________________________________________________________________
______________________________________________________________________________
6) Applicable state and local codes:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
7) What design guidelines are being used :
______________________________________________________________________________
______________________________________________________________________________
Revised 06/2015
8) Cistern Details
a. Cistern location:______________________________________________________________
Above ground [ ]
Below ground [ ]
b. Cistern Dimensions and volume capacity:
___________________________________________________________________________
___________________________________________________________________________
c. Cistern material:______________________________________________________________
d. Cistern setback from buildings:_____________________________________________ (feet)
e. Anchoring system for underground cistern:
___________________________________________________________________________
___________________________________________________________________________
f.
Minimum cover over cistern:_______________________________________________(feet)
g. Cover material:_______________________________________________________________
h. Number and size of manways and access ports:_____________________________________
i.
Casting load rating:___________________________________________________________
j.
Equipment in cistern
Pump [ ] Level Float [ ] Sensors [ ]
Calming Inlet [ ]
Other:______________________________________________________________________
k. Pump type and capacity:___________________________
l.
Cistern invert elevation:________________________________________________________
9) Inlet pipe characteristics
a. Inlet pipe size:_______________________________________________________________
b. Inlet pipe material:____________________________________________________________
c. Inlet pipe invert elevation:______________________________________________________
Revised 06/2015
10) Overflow pipe characteristics
a. Overflow pipe size (Shall not be less than the aggregate cross-sectional area of inflow
pipes):______________________________________________________________________
b. Overflow pipe material:________________________________________________________
c. Overflow pipe invert elevation:__________________________________________________
d. Overflow pipe discharges to:____________________________________________________
e. If tailwater concerns, describe measures to protect cistern:___________________________
___________________________________________________________________________
___________________________________________________________________________
11) Contributing Drainage Area ___________________________________________ (Square feet)
12) Roof Surface Material:___________________________________________________________
13) Describe any factors that may influence the collection efficiency of your system (e.g. slope of
roof, condition of roof material, etc)
______________________________________________________________________________
______________________________________________________________________________
14) Treatment system details (filtration, neutralization, disinfection):_________________________
______________________________________________________________________________
______________________________________________________________________________
15) Attach system schematic and rainwater cistern sizing calculations
16) Operation and maintenance plan prepared?
Yes [ ]
No [ ]
Revised 06/2015
FOR REVIEWERS USE ONLY
Design appears to comply with applicable design standards, and local, state, and federal
requirements.
Design does not appear to comply with applicable design standards, and local, state, and
federal requirements.
Comments:_________________________________________________________________
___________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________________________
_______________
Name of Reviewer: __________________________________________
Date:_____________________
Signature:
____________________________________________________________________________
Revised 06/2015