Indiana Farmstead Assessment for Drinking Water Protection
Use this survey to assess the risk to groundwater quality posed by your pesticide storage and handling practices. Circle the answer that best describes the situation of your pesticide storage system. At the end of each section sum the numbers that correspond to each answer for the section total. When you have completed the survey sum the section totals for the risk assessment score. Refer to Fact Sheet 2 for more information on pesticide handling and storage practices.
For each question, a (1) represents a higher risk to drinking water than a (3).
1. Where do you get the water that you mix with the pesticides?
directly from well (1) tank separate from well (3) 2. What is the minimum distance between any pesticide mixing/loading area and your well? less than 20 feet (1) between 20 to 100 feet (2) greater than 100 feet (3) 3. Are all pesticide mixing/loading areas downslope from the water well? Yes (2) No (1) 4. What precautions do you take to prevent back-siphoning? permanent air gap (3) water tank separate from well (3) anti-backflow devices (2) none of the above (1) 5. Have you ever dropped a water supply hose below the fluid level in the mixing tank? Yes (1) No (3) 6. Is someone present during pesticide mixing and loading operations to watch for spills and other mishaps and to take corrective action? present entire time (3) present most of the time (2) start filling, leave and return after set time (1) 7. Have you ever had a spill that you did not clean up? Yes (1) No (3) 8. Are there signs such as dead vegetation that indicate chemical movement away from the mixing/loading area? permanent dead vegetation (1) some patches of dead vegetation (2) no signs, vegetation healthy (3) 9. What is the condition of the mixing/loading area? concrete pad with curbs / no cracks, or sealed cracks (3) concrete pad / no curbs, no cracks (2) no pad, soil or gravel surface (1) Mixing and Loading Practices section total __________
10. Are most of your pesticides stored within 20 feet of:
a water well? Yes (1) No (3) surface water? Yes (1) No (3) 11. Is your pesticide storage area locked to prevent accidental valve opening or vandalism? Yes (3) No (1) 12. What type of floor does your pesticide storage area have? concrete floor (3) soil or gravel floor (1) 13. Are there inside drains in the pesticide storage area? No (3) Yes, drain has sump (3) Yes, drain runs in back of building (1) Yes, drain runs to city sewer (1) 14. Do you store any cancelled or banned pesticides? No (3) Yes, store in its own secondary containment (can in a can to catch leak) (3) Yes, not stored in any special manner (1) 15. In case of a fire does your fire department know to let the chemical storage area burn and not add water? Yes (3) No (1) Storage section total = __________
16. Where do you apply the rinsate from pesticide sprayers?
field (3) farmyard, more than 100 feet from well (2) farmyard, less than 100 feet from well (1) 17. Where do you clean pesticide application equipment? field (3) farmyard, more than 100 feet from well (2) farmyard, less than 100 feet from well (1) 18. Do you triple rinse plastic pesticide containers prior to disposal? always (3) sometimes (1) 19. Where do you dispose of plastic pesticide containers? farm dump or burn pile on farm (1) recycle or take to appropriate landfill (3) Cleanup and Container Disposal section total ________
(circle Yes or No)
Do you store all pesticides together? Yes No Do you use containers for other purposes? Yes No Is the pesticide storage area clean and neat? Yes No Do you keep a current pesticide inventory onsite? Yes No Are containers marked with purchase date? Yes No Are materials separated by type (herbicide, insecticide)?Yes No Are pesticides stored in the original containers? Yes No Are pesticides stored off floor and low to ground? Yes No Are dry formulations stored on pallets? Yes No Are storage areas free of spills or leaks? Yes No Do you have a shovel and absorbent materials readily available? Yes No Are "Keep Out" signs posted? Yes No Is the storage area well-lit and ventilated? Yes No Is there pesticide safety equipment in the pesticide storage area? Yes No Total number of Yes answers: _______ Total number of No answers: _______ If you had more Yes answers than No, the section total is 3; otherwise the total is 2. Other Management section total _________
WARNING: Indiana has in effect regulations that govern pesticide storage. This review is not intended to identify those areas for which you are out of compliance. Contact your local extension educator for details on these regulations.
Add the following totals:
Mixing and Loading Practices section total ____ x 4 = ________ Storage section total ____ x 3 = ________ Cleanup and Container Disposal section total ____ x 2 = ________ Other Management section total = ________ Survey 2 Score ________________ ---------------------------------------------------------------------- Low Moderate High 198 - 151 150 - 99 98 - 64 ----------------------------------------------------------------------
Click below for Fact Sheet 2
Pesticide Handling & Storage Fact Sheet
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