Rainwater Harvesting / Rooftop Precipitation Survey

First Name: *

Last Name: *

Permit No. as it appears on the envelope: *

(This will aid us in matching your survey resopnse to the permit in our database)

1. What prompted you to request a permit for a rooftop precipitation collection system for your residence? (mark all that apply):

Wells in my area are not reliable, or new wells sometimes do not encounter water.

Wells in my area have water quality issues.

I believe a rooftop system will be less expensive than drilling and operating a new well.

I believe a rooftop system will reduce my reliance on my existing well.

I currently must haul water to my location.

Other

If other please elaborate

2. Will your rooftop system be your only source of water at your residence?:

Yes

No

If NO: What other source will supply water to your residence? (mark all that apply):

Well

Hauled water

Other

If other please elaborate

3. For what uses do you intend to use the water collected in your rooftop system? (mark all that apply):

If other please elaborate

4. What uses of water are authorized in the well permit for your residence? :

Limited to in-house only (drinking and sanitary uses inside the home)

Limited to ordinary household purposes, fire protection, livestock watering, and irrigation of up to one acre

I don't know

Other

If other please elaborate

5. Do you intend to treat the water you collect in your rooftop system prior to use?:

Yes

No

If YES: What type of treatment do you intend to use (mark all that apply):

Filtration

Chemical treatment

Ultraviolet (UV) treatment

Other

If other please elaborate

6. Has your rooftop system been installed?:

Yes

No

If you answered YES, please answer the following questions a. through f.

a. Who designed the rooftop system?:

The manufacturer of the rooftop system materials

An engineering/design consultant

I designed the rooftop system myself

c. How satisfied are you with your rooftop system at this time?:

Very satisfied

Satisfied

Somewhat unsatisfied

Very unsatisfied

d. What has been the greatest benefit you have realized from your rooftop system?:

e. What has been the greatest shortcoming of your rooftop system?:

f. Would you recommend a rooftop system to your neighbors?:

If you answered NO to question 6, please answer the following questions g through i.

h. What has prevented you from installing the rooftop system so far?:

Waiting for an approved permit from the Division of Water Resources

Need to design the rooftop system

Rooftop system has been designed; need to acquire the materials

Rooftop system has been designed and materials acquired; need to install the system

Other

If other please elaborate

i. Would you be interested in obtaining assistance from an engineering/design consultant in the design of your rooftop system?:

Yes

No

Apple Gate

Rainwater Harvesting / Rooftop Precipitation Survey