"Vermont Monthly Water System Operations Report for Filtered Surface Water Systems" - Vermont

Vermont Monthly Water System Operations Report for Filtered Surface Water Systems is a legal document that was released by the Vermont Department of Environmental Conservation - a government authority operating within Vermont.

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  • Released on February 1, 2020;
  • The latest edition currently provided by the Vermont Department of Environmental Conservation;
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FORM
Drinking Water and Groundwater Protection Division
Vermont Monthly Water System Operations Report
For Filtered Surface Water Systems
For the Month of ____________ 20__ WSID#______ Name of Water System______________________________
Town/City__________________ Operator Name_____________________ Phone: ______________
Total Water Production (in gallons) for the month.
Total monthly Fluoride (mg/l)
The credited volume (in gallons) for disinfection before the first service (VO)
Turbidity
Disinfection
Fluoride
Temp.
Day
Water Production/Demand
(N.T.U.)
(mg/l)
(mg/l)
pH
(C)
CT
Production
Peak Hourly Flow,
Individual
Plant
Distribution
(Gallons/Day)
(Q)
Raw
Combined Filtered
Filtered
(Lowest
(Lowest
Plant
(Gallons/Minute)
(daily avg.)
(daily avg.)
(daily high)
Residual)
Residual)
(Highest Residual) Finished avg. daily Finished avg. Daily
(VO/Q)xC
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I certify, as the Authorized Representative* of this water system, that I have completed this form, or reviewed it if completed by another, and that I
have taken the necessary steps to ensure that the information shown is correct. In making this certification, I understand that civil and or criminal
penalties may be imposed for submitting false information.
Signature
Date
Please Type or Print Name
*”Authorized Representative” means the owner, co-op president, elected official, or other person with general management, financial, operational and
maintenance responsibilities for a water system
February 2020
1/2
FORM
Drinking Water and Groundwater Protection Division
Vermont Monthly Water System Operations Report
For Filtered Surface Water Systems
For the Month of ____________ 20__ WSID#______ Name of Water System______________________________
Town/City__________________ Operator Name_____________________ Phone: ______________
Total Water Production (in gallons) for the month.
Total monthly Fluoride (mg/l)
The credited volume (in gallons) for disinfection before the first service (VO)
Turbidity
Disinfection
Fluoride
Temp.
Day
Water Production/Demand
(N.T.U.)
(mg/l)
(mg/l)
pH
(C)
CT
Production
Peak Hourly Flow,
Individual
Plant
Distribution
(Gallons/Day)
(Q)
Raw
Combined Filtered
Filtered
(Lowest
(Lowest
Plant
(Gallons/Minute)
(daily avg.)
(daily avg.)
(daily high)
Residual)
Residual)
(Highest Residual) Finished avg. daily Finished avg. Daily
(VO/Q)xC
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
I certify, as the Authorized Representative* of this water system, that I have completed this form, or reviewed it if completed by another, and that I
have taken the necessary steps to ensure that the information shown is correct. In making this certification, I understand that civil and or criminal
penalties may be imposed for submitting false information.
Signature
Date
Please Type or Print Name
*”Authorized Representative” means the owner, co-op president, elected official, or other person with general management, financial, operational and
maintenance responsibilities for a water system
February 2020
1/2
I.
Disinfection Reporting Requirements:
1. Record the date and duration of each period when the residual disinfectant concentration of water entering
the distribution fell below 0.2 mg/l and when the state was notified of the occurrence (provide detail
separately)
YES
NO
Was the duration longer than 4 hours?
2. Number of instances where the residual disinfectant concentration was measured in the distribution system
but not detected.
II.
Turbidity Reporting Requirements:
1. Number of monthly turbidity measurements taken for combined filtered water:
Note: If continuously monitoring turbidity please indicate here “continuous”.
2. The number and percentage of combined filtered water turbidity measurements taken during the month
which are:
A. Less than or equal to the Maximum Contaminant Level specified below:
,
%
B. Less than or equal to the target turbidity guidelines specified below:
,
%
(If monitor continuously, enter percent only)
Maximum Contaminant Level (NTU)
Target Turbidity Guidelines (NTU)
Target – Finished Water (NTU)
Raw Water (NTU)
Conventional or Direct Filtration 0.3
>1.0
<0.3
>0.5 to 1.0
70% Reduction
Slow Sand Filtration
1.0
<0.5
Demonstrate effective coagulation
Note: These turbidity ranges do not apply to some filtered systems (e.g. Slow Sand Filters)
3. The date and value of any turbidity readings during the month which exceed 1 NTU in combined filtered
water. (provide details separately)
III.
Treatment Operating Status: Removal/Inactivation:
YES
NO
Did the water system consistently achieve 99.9% (3 log) removal and/or inactivation of Giardia Lambilia
cysts and 99.99% (4 log) removal and/or inactivation of viruses for this reporting month?
(The answer is yes only if the water system meets the CT disinfection goal daily during peak hourly flow, and
turbidity is less than Maximum Contaminant Level in 95% of the turbidity measurements taken.)
IV.
Compliance Status:
(If no is indicated for any of the following statements, provide detail separately.)
YES
NO
1. Disinfectant residual entering the distribution system was 0.2 mg/l or greater during entire month.
YES
NO
2. The “CT” goal was met each day for the entire month during peak hourly flow.
YES
NO
3. Disinfectant residual, pH and temperature at entry point to distribution system met minimum monitoring
requirements during entire month.
YES
NO
4. Greater than 95% of turbidity samples of combined filter effluent were less than or equal to 0.3 NTU.
YES
NO
5. At no time during the month did the combined filter effluent exceed 1.0 NTU.
YES
NO
6. Minimum monitoring requirements for combined filter effluent were met this month.
YES
NO
7. Minimum monitoring requirements for each individual filter were met, and no individual filter had
turbidity greater than 1.0 NTU in any two consecutive 15 minute periods during the entire month.
Please submit this form within 10 days after the end of the month to the following address
This form and related environmental information are available electronically
at: www.dec.vermont.gov/water
Drinking Water and Groundwater Protection Division
1 National Life Drive, Davis 4
Montpelier, VT 05620-3521
Phone: 802-828-1535
Fax: 802-828-1541
February 2020
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