Form MO780-2690 "Annual Inflow and Infiltration Report" - Missouri

What Is Form MO780-2690?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2020;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MO780-2690 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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Download Form MO780-2690 "Annual Inflow and Infiltration Report" - Missouri

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This report covers the period of:
MISSOURI DEPARTMENT OF NATURAL RESOURCES
January 1, 20____ to December 31, 20____
WATER PROTECTION PROGRAM
ANNUAL INFLOW AND INFILTRATION REPORT
Page 1 of 2
GENERAL INFORMATION
FACILITY NAME
PERMIT NUMBER
COUNTY
MILES OF COLLECTION SYSTEM (INCLUDING FORCEMAINS)
PEAK EFFLUENT FLOW RATE (MGD)
AVERAGE EFFLUENT FLOW RATE (MGD)
MANHOLE OBSERVATION
Number of manholes observed:
Dates observed:
RESULTS – MANHOLES REPLACED
Number of manholes replaced:
Types of manholes replaced:
Dates of replacement:
RESULTS – MANHOLES REHABBED
Number of number of manholes rehabbed:
Types of manholes rehabbed:
Dates of rehabilitation:
SMOKE TESTING
Linear feet of lines tested:
Dates observed:
SMOKE TESTING RESULTS – LINES CLEANED
Linear feet of lines cleaned:
Date and method used to clean lines (jet, pig, auger):
SMOKE TESTING RESULTS – LINES REPLACED
Linear feet of lines replaced:
Date, type of line replaced, and type of new line:
780-2690
(10-20)
Page 1 of 2
This report covers the period of:
MISSOURI DEPARTMENT OF NATURAL RESOURCES
January 1, 20____ to December 31, 20____
WATER PROTECTION PROGRAM
ANNUAL INFLOW AND INFILTRATION REPORT
Page 1 of 2
GENERAL INFORMATION
FACILITY NAME
PERMIT NUMBER
COUNTY
MILES OF COLLECTION SYSTEM (INCLUDING FORCEMAINS)
PEAK EFFLUENT FLOW RATE (MGD)
AVERAGE EFFLUENT FLOW RATE (MGD)
MANHOLE OBSERVATION
Number of manholes observed:
Dates observed:
RESULTS – MANHOLES REPLACED
Number of manholes replaced:
Types of manholes replaced:
Dates of replacement:
RESULTS – MANHOLES REHABBED
Number of number of manholes rehabbed:
Types of manholes rehabbed:
Dates of rehabilitation:
SMOKE TESTING
Linear feet of lines tested:
Dates observed:
SMOKE TESTING RESULTS – LINES CLEANED
Linear feet of lines cleaned:
Date and method used to clean lines (jet, pig, auger):
SMOKE TESTING RESULTS – LINES REPLACED
Linear feet of lines replaced:
Date, type of line replaced, and type of new line:
780-2690
(10-20)
Page 1 of 2
This report covers the period of:
MISSOURI DEPARTMENT OF NATURAL RESOURCES
January 1, 20____ to December 31, 20____
WATER PROTECTION PROGRAM
ANNUAL INFLOW AND INFILTRATION REPORT
Page 2 of 2
SMOKE TESTING RESULTS – LINES REHABBED
Linear feet of lines rehabbed:
Date, type of line rehabbed, and rehab material:
CCTV (CLOSED-CIRCUIT TELEVISION)
Linear feet viewed:
Dated observed:
LAMPHOLE OBSERVATION
Number observed:
Dates observed:
RESULTS – LAMPHOLES REPLACED
Number replaced:
Dates replaced:
SANITARY SEWER OVERFLOWS (SSOs)
Number of dry weather SSOs:
Number of wet weather SSOs:
BASEMENT/BUILDING BACKUPS
Number of dry weather basement/building backups:
Number of wet weather basement/building backups:
CERTIFICATION
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.
NAME (TYPE OR PRINT)
OFFICIAL TITLE
TELEPHONE NUMBER WITH AREA CODE
SIGNATURE
DATE SIGNED
Mail completed copy to: MISSOURI DEPARTMENT OF NATURAL RESOURCES
WATER PROTECTION PROGRAM
OPERATING PERMITS SECTION
P.O. BOX 176
JEFFERSON CITY, MO 65102-0176
780-2690
(10-20)
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