POND QUESTIONNAIRE





POND QUESTIONNAIRE

FOR

CLEAN-FLO SYSTEM INSTALLATION


Community: Pond Name:
Contact: Phone: eMAIL:
Address1: Address2:
City: State: Zip:

The purpose of this questionnaire is to provide information for the
design, construction and installation of the environmentally friendly
CLEAN-FLO SYSTEM.

Since no two water bodies are the same, it is important to tailor the
CLEAN-FLO SYSTEM specifically to the lake or pond under consideration.
To initiate this evaluation process the following minimum information
is required.

 
Surface Acres: Maximum Depth: Average Depth:

WATERSHED CHARACTERISTICS:

Size of watershed:        
Please describe the watershed by %:          
FOREST DAIRY FARM

WETLAND

 COMMERCIAL
AGRICULTURE RESIDENTIAL INDUSTRIAL OTHER
Is there a neighborhood storm water collection lake/pond? Yes No  
Are there incoming streams? Yes No  
Does water flow through the lake/pond? Yes No  
  When?      
How many homes with on-lot septic systems are
around the pond?		        
Is fertilizer used around the shoreline? Yes No  

LAKE WATER CHEMISTRY

Is the water chemistry known? Yes

No

  
Have you had fish kills? Yes

No

  
Is the water murky? Yes

No

  

SEDIMENT CHARACTERISTICS

Describe the bottom (Example: It is a sand and
gravel base with muck starting at the shoreline and becoming about 3 feet
deep in the middle).

 
When you stir up the water does it smell like
rotten eggs?		 Yes No  
  If not describe the odor:      
Do bubbles rise up from the bottom? Yes No  
  Time of year:      
Describe visual pollutants:

WEEDS AND ALGAE

What problem weeds are present?          
 

Yes

No

  

Yes

No

 

Yes

No

  

Yes

No
BLADDERWORT

WATER MEAL

POND WEED

MILFOIL

WATERSHIELD

WATER LILIES

COONTAIL

OTHER


What type of algae is present?          
 

Yes

No

  

Yes

No

 

Yes

No
FILAMENTOUS

GREEN PLANKTONIC

CHARA

BLUE-GREEN

NITELLA

OTHER

Please provide an overall assessment of the weed
and algae problem:

CURRENT TREATMENT AND COST

What management practices have been used in the
past?
What chemicals have been used to treat the
vegetative weeds and algae.?		          
 

Yes

No

 

Yes

No

 

 Yes No
RODEO

COPPER SULFATE

CUTRINE

REWARD

NAVIGATE 2,4-D

OTHER

FISH POPULATION AND CHARACTERISTICS:

Have you had a fish population evaluation
performed?		 Yes No  
What species of fish are in the lake/pond
(Estimate %)		          
BASS

PERCH

PICKEREL

CRAPPIES

TROUT

SUNFISH

BULLHEADS

OTHER

DESIRED LAKE/POND USE:

What do you want to use the lake/pond for? (List
by priority #1 first)		          
BOATING

SWIMMING

WATER RETENTION

WATERSCAPE

FISHING

WATERSOURCE

SAILING

ICE SKATING

ICE FISHING

SNOWMOBILE

OTHER

   
Is the pond used for irrigation? Yes No  
  If so, please describe the amount and frequency:
Type of power available:
115 Single Phase

230 Single Phase

230 or 460 volt 3-phase 60 Hz

Please explain what you want to accomplish by
installing the CLEAN-FLO system:

Is there anything else we should know?