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Supplemental Discharge Point Information Sheet N/A <br />Discharge Point No. or Name: <br />1) Select the appropriate box for the source of water being discharged: <br />h Treated effluent <br />F' Groundwater <br />1, Other <br />2) Location of discharge point will be /is at Latitude ° N, Longitude °W, <br />also bearing feet from the corner of the <br />Original Survey No. Abstract No. , in County, Texas. <br />Provide the latitude and longitude coordinates in decimal degrees, to at least six decimal places, and indicate the <br />method used to calculate the diversion point location. (i.e., GPS Unit, USGS 7.5 Topographic Map, etc.) <br />3) Location from County Seat: miles in a direction from <br />, <br />County, Texas. <br />Location from nearby town (if other than County Seat): miles in a <br />direction from a nearby town shown on county highway map. <br />4) Zip Code: <br />5) Water will be discharged into stream /reservoir, <br />(tributaries) <br />Basin. <br />6) Water will be discharged at a maximum rate of cfs ( gpm). <br />7) The amount of water that will be discharged is acre -feet per year. <br />8) The purpose of use for the water being discharged will be <br />9) Additional information required: <br />For groundwater <br />1. Provide water quality analysis and 24 hour pump test for the well if one has been conducted. <br />2. Locate and label the groundwater well(s) on a USGS 7.5 Minute Topographic Map <br />3. Provide a copy of the groundwater well permit if it is located in a Groundwater Conservation District. <br />4. What aquifer the water is being pumped from? <br />For treated effluent <br />1. What is the TPDES Permit Number? Provide a copy of the permit. <br />2. Provide the monthly discharge data for the past 5 years. <br />3. What % of treated water was groundwater, surface water? <br />4. If any original water is surface water, provide the base water right number. <br />Form TCEQ -10201 (revised 2/2010) Page 4 <br />Error! Unknown document property name. 9 <br />