Form DPH-DWS-WSPX "Water Supply Plan Completeness Cross-walk" - Connecticut

What Is Form DPH-DWS-WSPX?

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

Form Details:

  • Released on May 23, 2016;
  • The latest edition provided by the Connecticut State Department of Public Health;
  • 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 DPH-DWS-WSPX by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Public Health.

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Download Form DPH-DWS-WSPX "Water Supply Plan Completeness Cross-walk" - Connecticut

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WATER SUPPLY PLAN
Completeness Cross-Walk
PWS Name:
Date:
Reviewed By:
Name:
Title:
Organization:
Date:
NOTE: Required plan content pursuant to the Regulations of Connecticut State Agencies section 25-32d-3.
WATER SUPPLY PLAN
Completeness Cross-Walk
PWS Name:
Date:
Reviewed By:
Name:
Title:
Organization:
Date:
NOTE: Required plan content pursuant to the Regulations of Connecticut State Agencies section 25-32d-3.
(THIS PAGE INTENTIONALLY LEFT BLANK)
PWS NAME:
Date:
Regulation of
If Requirement Not Included in
WATER SUPPLY PLAN CONTENT REQUIREMENT
Requirement Location In Plan;
Connecticut
Supply Plan Document; EXPLAIN
(Pursuant to the Regulations of Connecticut State Agencies Section
(Page Number
State Agencies
(use separate sheet of paper if
25-32d-3)
Paragraph/Section)
Citation
necessary)
SUBSECTION (a) A description of the existing water supply system, including:
The legislative or franchise authority for the areas proposed to be
(a)(1)
served by the plan;
a list and description of: service areas; sources of supply, including
(a)(2)
active, emergency and inactive sources, with a description of what
portion of the service area is served by each source of supply; pump
stations; and storage and treatment facilities;
a map of: water company owned lands, service areas, sources of
(a)(3)
supply, interconnections, pumping stations, pressure zones, source
water protection area boundaries, storage, treatment facilities,
public or privately-owned protected lands.
a map and description of existing transmission and distribution
(a)(4)
facilities, including age, materials, capacity and condition, if
known;
a description of meter reading and testing program and extent of
(a)(5)
metering;
a schematic of the water supply system's hydraulic profile;
(a)(6)
a general discussion of the water supply system's fire flow
(a)(7)
capabilities;
the calculation of the safe yield of each source of supply in
(a)(8)
accordance with Section 25-32d-4 of the Regulations of
Connecticut State Agencies;
a summary of monthly system production data by sources of supply
(a)(9)
and a summary of system average daily demands, maximum month
demands and peak day demands for the previous five years;
a list, description, and map of existing interconnections, and the
(a)(10)
quantities of water sold to or purchased from other water companies
during the previous five years, and any limitations on their use;
a history of water quality violations in each water supply system for
(a)(11)
the previous five years and a trend analysis for water quality
parameters that may be approaching water quality standards;
DPH-DWS-WSPX
1 of 14
Rev. 5/23/2016
PWS NAME:
Date:
Regulation of
If Requirement Not Included in
WATER SUPPLY PLAN CONTENT REQUIREMENT
Requirement Location In Plan;
Connecticut
Supply Plan Document; EXPLAIN
(Pursuant to the Regulations of Connecticut State Agencies Section
(Page Number
State Agencies
(use separate sheet of paper if
25-32d-3)
Paragraph/Section)
Citation
necessary)
a description of the watershed inspection program required pursuant
(a)(12)
to subsection (b) of section 19-13-B102 of the Regulations of
Connecticut State Agencies and the cross connection inspection
program required pursuant to subsection (f) of section 19-13-B102
of
the
Regulations
of
Connecticut
State
Agencies,
and
demonstration of compliance with certification requirements
pursuant to sections 25-32-7a to 25-32-14, inclusive, of the
Regulations of Connecticut State Agencies;
SUBSECTION (b) An analysis of present and future water supply demands for the five, twenty, and fifty year planning periods, including:
A description of the present population distribution patterns and
(b)(1)
population served;
data and an evaluation of current and historic water use in each
(b)(2)
water supply system for the past five years of record, or since the
most recent submittal of a water supply plan, including average
daily, maximum month and peak day demands and sales to other
water companies. Water companies that have this data compiled by
user categories shall provide data in that form;
a description of local, state and regional land use plans, policies and
(b)(3)
zoning as related to projected water demands and future service
areas;
projected water demands for the five, twenty and fifty year planning
(b)(4)
periods, A 4 including sales to other water companies, based on user
categories if data is available, and local land use plans and zoning
regulations;
an assessment of population changes within existing and future
(b)(5)
service areas for the five, twenty, and fifty year planning periods
using the Office of Policy and Management's most current
population data and projections, including an explanation of any
deviations thereto and maps depicting the existing and future
service areas;
identification of any sources of supply that will no longer be used to
(b)(6)
meet system demands or any sources of supply to be abandoned;
DPH-DWS-WSPX
2 of 14
Rev. 5/23/2016
PWS NAME:
Date:
Regulation of
If Requirement Not Included in
WATER SUPPLY PLAN CONTENT REQUIREMENT
Requirement Location In Plan;
Connecticut
Supply Plan Document; EXPLAIN
(Pursuant to the Regulations of Connecticut State Agencies Section
(Page Number
State Agencies
(use separate sheet of paper if
25-32d-3)
Paragraph/Section)
Citation
necessary)
an analysis of the relationship between available water and average
(b)(7)
daily demand as determined for the most recent representative
period of record not affected by unusual demand conditions such as
drought or a significant temporary increase in demand, maximum
month demand and peak day demand and the margin of safety to be
maintained by the water company currently and for the five, twenty,
and fifty year planning periods;
demonstration that the margin of safety is sufficient to meet the
(b)(8)
water company's current and future needs considering factors such
as potential increases or decreases in demand, the time required to
bring new sources of supply on line, potential losses of sources of
supply or decreased capacities, land area available for development,
available interconnections and other factors which may increase or
reduce supply or demand;
an analysis of any treatment limitations, water quality concerns, or
(b)(9)
distribution system limitations and the ability to meet demands
currently and for the five, twenty and fifty year planning periods;
and
an analysis of any system improvements necessary to minimize the
(b)(10)
effect of a water supply emergency on critical system components
as identified in subdivision (1) of subsection (d) of this section.
SUBSECTION (c) An assessment of potential alternative sources of supply, including:
An analysis of alternatives to allow the use of inactive or emergency
(c)(1)
sources of supply and the safe yield of existing active sources of
supply beyond any current limitations in order to meet demands
currently and in the five, twenty and fifty year planning periods;
an evaluation of potential new sources of supply and a description
(c)(2)
of existing state, local and regional land use plans, policies,
classifications and zoning as they relate to source development;
identification of potential or historic pollution sources which may
(c)(3)
affect any new source of supply; and
a demonstration of the ability of the selected alternatives to meet
(c)(4)
future system demands, including a conceptual implementation
plan.
DPH-DWS-WSPX
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Rev. 5/23/2016