Surety Bond Request Form

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Low Pressure Sewer Systems (LPSS) Design Data
Today’s Date:
Job Type: (Check One)
 Grant/Rural Funding
 Private
 Golf Course/Resort
 Municipal
 Septic Tank Abandonment
Bid Type: (Check One)
 Contractor
 Developer
Bid Date:
 Municipality  Distributor
 Homeowners Association
Project Name and Address:
 Pre-Existing
Est. Bid Date:
 Flygt Branch
 Other
County, Utility District, Home Owners Association or Developer
Pressure Sewer Project Location:
Physical location of project
Engineering Firm Name and Address: Include contact person, phone, e-mail, and fax
End Users Name and Address: Include contact person, phone, e-mail, and fax
Project Description/Details: (Feasibility stage, old design put on hold, waiting on funding)
Hydraulic Modeling Required:
 Yes  No
If yes please review required information on page two of this worksheet.
Data Required For Hydraulic Analysis

Digital Engineered auto cad drawing, (DWG, DXF, TIFF, or TFW) of the proposed LPS
system scaled. Included on the drawing will be the lot lines, streets, elevations, residential
and or commercial locations.

Clearly marked terminal out flow, lift station, manhole or treatment plant.

How many residential homes will be connected to the LPS system?

Are there any commercial applications that will be connected to the LPS system and how
many?

Is the LPS system pumping into an existing force main?

How many Gallons per Day (GPD) are assigned for residential and commercial usage?
Typical EPA guidelines average for residential = 250 GPD.
 200
 250
 Other_______

 400
What Peak Factor will be required?
 2.5

 300
 350
 Commercial ________
 Yes  No
3
 3.5
4
 Other ________
What is the Pipe Type Preference?
 DR-9
 DR-11
 SDR-21
 SDR-26

The individual lots and commercial properties must be clearly marked.

The flow path through right of ways must be marked.

Topography line must be clearly marked and the elevations noted.

The drawing must be a scale drawing.

If water lines are not located on the properties, it must be indicated where the
sewer service is to run.

Is each lot serviced or is the service to be at the joint property lines, opposite the
water service.

Does the system require redundant service valves at the street?  Yes

Check valves required?  Yes
E-mail:
mike.reilly@xyleminc.com
 No
 No
or
randall.bard@xyleminc.com
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