WASHING OR BATH TACILITE
No. of washing - bach facilites
Type(s)
[ J sink
No. dwelling units/facility
[ ] tub
[ ] shower
[ ] other, specify
Comments
WATER SUPPLY
Source
{ ] rainwater
( ] Commmity system
{[ ] ground water [ ] other, specify
{ ] Beth
( ] Individual
Storage capability of island
No. and size of tanks or cisterns
a ee ee;
Total gallons of capacity
If eisterns ~ catchment area
Is emergency storage availabie
Distribution
[]no
[ ] piped inside house
[ ] yes, if yes, capacity
[ ] ptped outside
( ] other, specify
Treatment
{ ] none
[ ] filter
{ ] disinfection
{ ] good
{ ] fair
{ ] poor
{ J] ne
( ] yes
Comment
Sanitary condition
Protaction from contamination
Use
{ ] domestic only: [ ] domestic plus agriculcure
{ ] other, specify
Coumencts