Organization/Agency: _______________________

Contact Person: _______________________

Title: ______________________________

Phone: _____________________________

Email: ______________________________

1. Name of the reclaimed water project (please fill out one survey for each project if your utility has multiple reuse projects/facilities):

2. Rated design capacity of the project (in MGD) and estimated annual production for:

2.1. Non-potable reuse applications: ___________

2.2. Potable reuse applications: ____________

3. Year(s) constructed:

4. Treatment processes included in:

4.1. Column (a) for treatment required for wastewater disposal:


4.2. Column (b) for Non-potable treatment beyond Column (a):


4.3. Column (d) for Potable reuse treatment beyond Columns (a) and (b)

5. Major uses of effluent (e.g., further treatment, irrigation, agriculture, cooling, groundwater recharge, wholesale to another entity, discharge to water bodies):

5.1. Wastewater disposal:


5.2. Non-potable treatment:


5.3. Potable reuse treatment:

6. Please fill out the attached Excel spreadsheet with regard to each of the three water treatment grades listed above for each of the following:

6.1. Capital costs, including all subsidies, as $/Kgal of rated plant capacity. Please, if possible, separate these costs according to major project components (e.g., treatment system, spreading system, distribution system) and include the year constructed for each.

6.2. Annual Operation and Maintenance Cost, in $/yr/Kgal of rated plant capacity in terms of

6.2.1. Personnel

6.2.2. Energy (Electricity, Natural Gas, etc.)

6.2.3. All other operations and maintenance costs

Note that only the yellow spreadsheet cells should be filled in. The other cells will total automatically. See attached explanation sheet for more details.

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