DNR Form 542-0459 "Stage 2 Disinfectants and Disinfection Byproduct Rule Monitoring Plan - Groundwater Systems Serving at Least 10,000 People and Using Chlorine or Chloramines" - Iowa

What Is DNR Form 542-0459?

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

Form Details:

  • Released on November 1, 2016;
  • The latest edition provided by the Iowa Department of Natural Resources;
  • 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 DNR Form 542-0459 by clicking the link below or browse more documents and templates provided by the Iowa Department of Natural Resources.

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Download DNR Form 542-0459 "Stage 2 Disinfectants and Disinfection Byproduct Rule Monitoring Plan - Groundwater Systems Serving at Least 10,000 People and Using Chlorine or Chloramines" - Iowa

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Iowa Department of Natural Resources
Stage 2 Disinfectants and Disinfection Byproduct Rule
Monitoring Plan*
Groundwater systems serving at least 10,000 people and using chlorine or chloramines
Name of Public Water Supply:
City:
Date Plan Prepared:
The plan must be reviewed every three (3) years and updated as needed.
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Table of Contents
1. General Water System Information
2. Plant Description and Summary of Normal Operating Characteristics
3. Sampling Plan
4. Calculations for Determining Compliance
5. Reporting Requirements and Forms
6. Violations
*Note: This plan replaces the Disinfectants/Disinfection Byproducts Monitoring Plan (Stage 1)
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DNR Form 542-0459
Iowa Department of Natural Resources
Stage 2 Disinfectants and Disinfection Byproduct Rule
Monitoring Plan*
Groundwater systems serving at least 10,000 people and using chlorine or chloramines
Name of Public Water Supply:
City:
Date Plan Prepared:
The plan must be reviewed every three (3) years and updated as needed.
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Table of Contents
1. General Water System Information
2. Plant Description and Summary of Normal Operating Characteristics
3. Sampling Plan
4. Calculations for Determining Compliance
5. Reporting Requirements and Forms
6. Violations
*Note: This plan replaces the Disinfectants/Disinfection Byproducts Monitoring Plan (Stage 1)
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DNR Form 542-0459
1. General Water System Information
PWS Name:
PWSID: IA
Mailing Address:
City:
State:
Zip Code:
Population Served:
Source Water Type:
Groundwater
System Type:
Community
Nontransient Noncommunity
Contact Name:
Title:
Phone Number:
E-mail:
Fax Number:
Residual Disinfectant:
Chlorine
Chloramines
Relationship to another PWS:
Consecutive (buys from)*
Wholesale (sells to)
Neither
*If you are a consecutive system, list name of producing system:
Source Entry Point ID & Name:
Source Entry Point ID & Name:
Source Entry Point ID & Name:
Source Entry Point ID & Name:
(include all source entry points if system has more than one)
2. Plant Description & Summary of Normal Operating Characteristics
Briefly describe the normal operating conditions including all chemicals and treatment, source rotation, alternative
sources, storage, seasonal operation, etc. Consecutive systems must list any additional treatment provided within its
system, such as booster chlorination.
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3. Sampling Plan
Sampling is required in the distribution system for the disinfection byproducts (DBPs) of total trihalomethanes (TTHM)
and haloacetic acids (HAA5), and the chlorine disinfectant residual.
A. Disinfection Byproducts (TTHM & HAA5)
Disinfection byproducts form in the treatment plant and distribution system through contact between organic
compounds in the water and the disinfectant. Two types of byproducts must be monitored:
Total Trihalomethanes (TTHM), which is the sum of these four compounds:
Chloroform, bromoform, chlorodibromomethane, bromodichloromethane
Haloacetic Acids (HAA5), which is the sum of these five compounds:
Monochloro-, dichloro-, trichloro-, monobromo-, and dibromo- acetic acid
Peak Month:
This is the month with the warmest water temperature or highest TTHM results. The sample(s) must be collected this
month, as listed in your operation permit.
Complete both the ROUTINE and REDUCED sampling sections:
ROUTINE sampling requirement: The routine sampling requirement is two samples each year during the chosen
sampling month. Each sample is analyzed for both TTHM and HAA5.
High TTHM location:
Sample Point ID: DB01
This is the maximum residence time location, where the water is in contact with the disinfectant for the longest period of
time in the system before it’s consumed. This is likely the same location that’s been used in the past for DBP sampling
(MRT location). List the street address or unique site identifier. Use this address, the sample point ID DB01, and the
distribution system Facility ID (three-digit, starting with 9, usually 950 for most systems) for the facility code to identify
the sample when submitting it to the lab.
High HAA5 location:
Sample Point ID: DB02
This is usually an average residence time location, where the water is in contact with the disinfectant for an average
period of time in the system before it’s consumed. List the street address or unique site identifier. Use this address, the
sample point ID DB02, and the distribution system Facility ID (three-digit, starting with 9, usually 950 for most systems)
for the facility code to identify the sample when submitting it to the lab.
High TTHM location:
Sample Point ID: DB03
This is another maximum residence time location, where the water is in contact with the disinfectant for the longest
period of time in the system before it’s consumed List the street address or unique site identifier. Use this address, the
sample point ID DB03, and the distribution system Facility ID (three-digit, starting with 9, usually 950 for most systems)
for the facility code to identify the sample when submitting it to the lab.
High HAA5 location:
Sample Point ID: DB04
This is another average residence time location, where the water is in contact with the disinfectant for an average period
of time in the system before it’s consumed. List the street address or unique site identifier. Use this address, the sample
point ID DB04, and the distribution system Facility ID (three-digit, starting with 9, usually 950 for most systems) for the
facility code to identify the sample when submitting it to the lab.
st
nd
rd
The quarterly samples must be collected in the same month each quarter (1
, 2
, or 3
month of the specific quarter).
Use the peak sampling month selected above to select the series and check the appropriate box. This is your sampling
schedule. Collect the sample(s) on any day in that month.
Example: The peak sampling month for a system is July. The “First month of each quarter” is selected because that series
contains the month of July. The routine sampling schedule for the system is January, April, July, and October.
First month of each quarter: January, April, July, October
Second month of each quarter: February, May, August, November
Third month of each quarter: March, June, September, December
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REDUCED sampling requirement: Your system may qualify for reduced monitoring, based on previous DBP sampling
results that are at or below half of the MCL (LRAA). You’ll be notified of this status change by the DNR if your system
meets the criteria and your operation permit will list the appropriate sampling frequency for your system.
The reduced sampling requirement is two samples each year, one at the location and during the quarter with the highest
TTHM single measurement and one at the location and during the quarter with the highest HAA5 single measurement.
Each DBP sample is analyzed for both TTHM and HAA5.
Reduced high TTHM location:
Sample Point ID: DB0
Sample Month:
Reduced high HAA5 location:
Sample Point ID: DB0
Sample Month:
RETURN TO ROUTINE sampling requirement:
The system must return to Routine quarterly sampling beginning the next quarter if the annual sample result at any
location is at or above 0.060 mg/L for TTHM or 0.045 mg/L for HAA5.
Your operation permit will be revised to require the quarterly sampling. The quarterly samples must be collected as
st
nd
rd
described in the Routine sampling requirement, in the same month each quarter (1
, 2
, 3
month of the specific
quarter).
CHANGE OF SAMPLING SITE: If you need to change a sampling site, the replacement site must meet the same targeting
criteria as the original site (either high TTHM or high HAA5). Complete the “Change of Sampling Site for DBPs” form
located at this website: Send a copy to DNR, and attach the form to this plan:
http://www.iowadnr.gov/Environmental-
Protection/Water-Quality/Drinking-Water-Compliance/Forms
LAB INFORMATION: All samples must be collected in the bottles provided by the laboratory and as directed by the
laboratory. Samples must be placed in coolers and shipped to the certified laboratory as soon as practical. The laboratory
currently used for analysis of your system’s DBP samples is:
Lab Name:
Shipping Address:
City:
State:
Zip Code:
Lab Phone Number:
Contact Person:
A. General Sampling Procedure for TTHM and HAA5
Samples for TTHM and HAA5 must be collected at the appropriate sample location(s) previously listed. The laboratory
instructions should be followed for each sample. These samples are collected in 40 or 60 mL vials with no headspace (no
air bubble). These bottles will contain a preservative which may appear as a drop of liquid, powder, or may not be
apparent. Some labs may require additional preservative to be added after collection.
General sample collection instructions:
1. Run water for at least two minutes or until water is cool.
2. Carefully fill each vial by allowing the water to slowly run down the inside of the vial.
3. Overfill each vial so that a bead of water forms above the lip of the vial and there are no air bubbles in the sample
vial.
4. Add preservative if required.
5. Carefully screw on the cap.
6. Tip the vials upside down to check that no air bubble remains in the vial. If an air bubble does appear, unscrew the
cap and add more water (DO NOT DUMP out the sample and start over).
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7. Fill out the sample information forms. List the street address or unique site identifier for the sample.
8. Carefully pack the samples and ship or deliver to the lab.
B. Maximum Residual Disinfectant Level (Residual Chlorine)
Because this system uses chlorine or chloramines for oxidation and/or disinfection, the compliance with the Maximum
Residual Disinfectant Level or MRDL is based on the total chlorine residual measured in the distribution system. Systems
must measure the total chlorine residual to determine compliance with the MRDL. At a minimum, the total residual
chlorine level must be measured when coliform bacteria samples are collected at the locations specified by the
bacterial sampling plan. This includes any additional repeat or routine coliform bacteria samples required by the DNR.
These chlorine residual results must be reported on the laboratory sheet with the bacteria sample. These are the results
that you will use to calculate compliance with the MRDL.
Some systems switch between chlorine and chloramines throughout the year. You must record which disinfectant is
being used on any particular day. The calculation for the running annual average includes all chlorine and chloramine
data collected during the year according to your monitoring plan.
Usually a system will only use the total chlorine residual levels measured when the routine and repeat coliform samples
are collected for determining compliance with the MRDL. For Community Water Supply systems (CWS) serving 10,000 –
99,999 people, this ranges from 11 to 100 samples each month.
Note: A system is allowed to use its daily total chlorine distribution samples in the MRDL calculation, too, but that
decision must be delineated in this sampling plan and the failure to collect even a single total chlorine sample will trigger
a monitoring violation.
4. Calculations for Determining Compliance
A. Disinfection Byproducts (TTHM & HAA5) MCL
The compliance calculations for TTHM and HAA5 are shown below. The DNR will normally calculate the locational
running annual average (LRAA) for each site from the data reported directly to it by the laboratory. The LRAA will be
compared to the MCL value and compliance determined.
TTHM Maximum Contaminant Level: 0.080 mg/L
HAA5 Maximum Contaminant Level: 0.060 mg/L
For systems on annual sampling frequency, (collecting one sample at either one or two locations each year), the
locational running annual average (LRAA) is the value of the single sample at each location. If a single sample
result is at or above the maximum contaminant level (MCL) of 0.080 mg/L for TTHM or 0.060 mg/L for HAA5, it is
not an MCL violation but the system must now sample every quarter for at least one year.
For systems collecting a quarterly sample, the locational running annual average is calculated each quarter by
adding the results of each of the four most recent quarters at a single location and dividing the sum by four. This
value is the LRAA for that specific sampling site. For each new quarter, the oldest quarterly value is dropped and
the most recent quarterly value is included in the sum. If a sample was not collected in one quarter, the data for
the most recent three quarters is used and the sum divided by 3. If the analytical result is “less than” or “not
detected,” a zero is used in the calculation.
For example: At a single location, add each quarterly result and divide by 4.
(Q1 + Q2 + Q3 + Q4)
= LRAA
4
Next quarter:
(Q2 + Q3 + Q4 + Q1)
= LRAA
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