Sample Survey

Sample WaterVIEW™ Survey


	Home Water Use Analysis
Please answer the following questions based on your family 's water usage over the last 12 months. The answers you provide to this questionnaire will be saved for your future use if you return here on other occasions. It may be convenient to print out the questions before completing the survey.
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Your e-mail address

	*Describe your home.*
	nearest weather location
	type of residence
	age of home	years

	*Describe the number of people in your home (include yourself).*
	children (17 or under)
	adults (18 to 64)
	seniors (65 or older)

	*Describe your landscape.*
	Grass		Plants
approximate area	sq. ft.		sq. ft.
soil type
slope
appearance
irrigation system
sprinkler head type
predominant grass type
area in noon shade	%
Watering Schedule	Frequency	Minutes/ Day	Frequency	Minutes/ Day
spring
summer
fall
winter


*Sprinkler Head Types*
To determine your sprinkler head type:
impact / rotor (Rainbirds)	has an "arm" that interrupts or hits the water flow
spray	water flow may be steady or oscillating
stream / rotor	gears turn sprinkler to throw water in patterns

*Grass Types*
To determine your grass type:
cool season grass	stays mostly green in the winter, such as Kentucky Blue, Fescues or Marathon
warm season grass	turns brown in the winter, such as Bermuda or St. Augustine

		*Describe the toilets.*
Gallons per Flush		Water Saving Devices	Leaks	Leak Location
1.
2.
3.
4.
5.


*Gallons per Flush*
To estimate the gallons per flush based on year the toilet was installed:
before 1980	5 gallons per flush
from 1980 to 1992	3.5 gallons per flush
after 1992	1.6 gallons per flush

*Leaks*
To determine the leakage add a few drops of red food coloring to the tank and wait 15 minutes, then observe the color of the bowl water.
light	slight traces of color are found in the bowl water
moderate	color is found throughout the bowl water
heavy	color immediately flows in the bowl from tank
severe	color immediately flows in the bowl from tank and includes the sound of water flowing

	*Describe the showers.*
	Flow Rate (gallons per minute)		Number of Showers Weekly	Leaks ...seconds for 10 drips
	1.
	2.
	3.
	4.
	5.


*Flow Rate*
If you count the seconds needed for the shower to fill a 2 quart container, the following would be your estimated flow rate.
6 seconds	5 gallons per minute
9 seconds	3.5 gallons per minute
12 seconds	2.5 gallons per minute

To estimate a general flow rate based on year the showerhead was installed:
before 1980	5 gallons per minute
from 1980 to 1992	3.5 gallons per minute
after 1992	2.5 gallons per minute

*Leaks*
Use a watch to count seconds passing for 10 drips to fall from a leak.

	*Describe the faucets.*
	Location		Aerator	Leaks ...seconds for 10 drips
	1.
	2.
	3.
	4.
	5.
	6.
	7.
	8.
	9.
	10.


*Leaks*
Use a watch to count seconds passing for 10 drips to fall from a leak.


	*Describe other water uses.*
		Number per Week
	baths (not showers)
	clothes washer loads
	dishwasher loads
	car washes
		Description
	use a water softener
	use a reverse osmosis water purifier
	number of months evaporator cooler is used during the year
	hours per week evaporator cooler runs during the months used
	garden area	sq. ft.

	*Describe your Spa / Pool.*
		Spa	Pool
	location
	size
	use a cover regularly

	Month	Water Cost
	Enter your utility bills for the past year. This information can be supplied to you by your utility company. This section must be completed to provide you with an analysis of your home's water use.
	January
	February
	March
	April
	May
	June
	July
	August
	September
	October
	November
	December

Copyright © 2005 Viewtech Financial Services, Inc. All rights reserved.

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