CLEAN-FLO – Improve water quality

540 East Union Street, Suite I
West Chester, PA 19382
Phone: 610-431-1934 / 1-800-328-6656
Fax: 610-431-1959

info@CLEAN-FLO.com

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

Are there incoming streams?

Yes

Does water flow through the lake/pond?

Yes

When?

How many homes with on-lot septic systems are around the pond?

Is fertilizer used around the shoreline?

Yes

LAKE WATER CHEMISTRY

Is the water chemistry known?

Yes

Have you had fish kills?

Yes

Is the water murky?

Yes

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

If not describe the odor:

Do bubbles rise up from the bottom?

Yes

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

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

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?