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HomeMy WebLinkAboutDDW-2024-010049Utah Department Of Environmental Quality Division Of Drinking Water Sanitary Survey Sanitary Survey General System Information Exception Granted: R309-550-5(4), | waterline having less dia than mandated 8inch dia pipe Exception Granted: R309-550-5(1) | lack of distribution system pressure in the water line Exception Granted: R309-550-5(8) | Sufficient valves not provided on water mains Exception Granted: R309-550-5(b), | less number of fire hydrants in the distribution system Site Visit Date Surveyor Name 07/19/2024 Deidre Beck PINE MOUNTAIN MUTUAL PWS ID: UTAH22014 Rating: Approved 04/09/1996 Active 1 Admin Contact (AC) [ eMail address is REQUIRED ] MIN | 15pts | SM | G004 | R309-100-4(5) | Rule requires a person or organization be designated as the owner of the system and name, address and phone number of such be supplied to the Division. *First Name: ROBERT S *Last Name: HART *Organization: *Address: Redacted *City: WEST VALLEY CITY *State: UT *Zip: 84120 *Email: maybob38@gmail.com *Phone: 501-598-3757 Emergency Phone: 801-969-6709 2 Legal Contact (LC) [ if no eMail address is available, enter NoeMail@utah.gov ] MIN | 15pts | SM | G004 | R309-100-4(5) | Rule requires a person or organization be designated as the owner of the system and name, address and phone number of such be supplied to the Division. *First Name: *Last Name: *Organization: PINE MOUNTAIN MUTUAL *Address: 9197 TRIMBLE CREEK DR *City: WEST JORDAN *State: UT *Zip: 84088 *Email: MAYBOB38@GMAIL.COM *Phone: 801-969-6709 Emergency Phone: 801-597-0440 DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 1 of 25 3 Owner Contact (OW) [ if no eMail address is available, enter NoeMail@utah.gov ] MIN | 15pts | SM | G004 | R309-100-4(5) | Rule requires a person or organization be designated as the owner of the system and name, address and phone number of such be supplied to the Division. *First Name: *Last Name: *Organization: PINE MOUNTAIN MUTUAL *Address: 9197 TRIMBLE CREEK DR *City: WEST JORDAN *State: UT *Zip: 84088 *Email: MAYBOB38@GMAIL.COM *Phone: 801-969-6709 Emergency Phone: 801-597-0440 4 Direct Operator in Charge (DO) [ if no eMail address is available, enter NoeMail@utah.gov ] MIN | 15pts | SM | G004 | R309-100-4(5) | Rule requires a person or organization be designated as the owner of the system and name, address and phone number of such be supplied to the Division. *First Name: ROBERT S *Last Name: HART *Organization: *Address: 4708 WESTPOINT DR *City: WEST VALLEY CITY *State: UT *Zip: 84120 *Email: maybob38@gmail.com *Phone: 501-598-3757 Emergency Phone: 801-969-6709 5 Does the system serve a Residential population?Y 5A Population - Residential 21 5B Operating Period (Start Date) - Residential 01/01 5C Operating Period (End Date) - Residential 12/31 6 Does the system serve a Transient population? (A transient population is a rotating population that is served by a water system that does not remain in the jurisdiction of the water system for long periods of time. Examples of a transient population include, but are not limited to, campers at a campground, users of a highway rest stop, skiers at a ski resort, guests at a hotel, or patrons of a restaurant or a shopping center.) Y 6A Population - Transient 339 6B Operating Period (Start Date) - Transient 01/01 6C Operating Period (End Date) - Transient 12/31 7 Does the system serve a Non-Transient population? (A non-transient population is a population served by a water system that is the same population being served by the system for at least six months of the year, but is not a resident in the system. Examples of a non-transient population include, but are not limited to, employees of a restaurant, shop, or ski resort; teachers and students at a school, day-care center, or church; doctors, nurses, and other employees at a hospital or healthcare clinic.) N 8 Population - Wholesale :0 DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 2 of 25 Site Visit Info Management and Operations 9 Residential Connections:354 10 Commercial Connections:0 11 Industrial Connections:0 12 Agricultural Connections:0 13 Date of Survey (First Day of Field Work)07/19/2024 14 Date of Survey (Last Day of Field Work) ** this should match the Date of Survey in the header ** 07/19/2024 15 Date final report sent to system (questionnaire, deficiency report and capacity spreadsheet) 08/15/2024 16 Water system representative present during the survey:DARIN ROSS 17 How much time was spent to prepare survey documents prior to field survey? (Round up to nearest quarter hour) 1 18 How much time was spent to complete the field survey (arrival to completion; include travel time between water system facilities)? (Round up to nearest quarter hour) 5 19 How much time was spent traveling from the office to system and back again at the end of the field survey? (Round up to nearest quarter hour) 2.5 20 How much time did it take to finish the Survey Report? (Round up to nearest quarter hour) 3 21 Did you survey multiple water systems in one trip? ... if yes, answer the following question(s) N 22 For a community water system with water sources that require power to produce sufficient flow, system is equipped with standby power option. SIG | 25pts | SO | S033 | R309-515-6(2)(a) | Rule requires a community water system without naturally flowing water sources, such as springs or flowing wells, to have one or more of the system's sources equipped for operation during power outages. To ensure continuous service when the primary power has been interrupted, a redundant power supply is required. A redundant power supply may include a transfer switch for auxiliary power such as a generator or a power supply service with coverage from two independent substations. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. NA (Notes: Not a community system.) 23 There are no undocumented drinking water facilities (i.e. tanks, pump stations, treatment facilities, etc.) or recent modifications that have not gone through or in process of DDW review [LIST UNDOCUMENTED FACILITIES OR DESCRIBE MODIFICATIONS, IF APPLICABLE] [undocumented sources are covered in a different question] SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2) and (3) | Rule requires complete plans & specification for all public drinking water projects to be approved in writing by the Director. Any facility found that has not started DDW review shall be considered unapproved. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 24 Are there any individual home booster pumps installed in the distribution system (not for fire suppression)? SIG | 50pts | SM | M008 | R309-550-11(3) | R309-550-11(3) C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 3 of 25 Cross Connection and Operator Certification 25 Does the system haul water?N 26 For a community system serving 100 or more connections, at least 2 water sources are available. SIG | 50pts | SO | TGR7 | R309-515-4(3) | Rule requires Community Water Systems serving more than 100 connections to have a minimum of two sources except where served by a water treatment plant. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. NA (Notes: Not a community system.) 27 Does system have a consecutive connection to another water system not listed in the SOURCE section of Waterlink Report? If yes, answer the following question(s) N 28 Does the system have a deficiency meeting the required source capacity? (USE SPREADSHEET FOR CALCULATIONS) *IF YES, SELECT CORRECT STATEMENT FROM THE FOLLOWING AND MARK "YES"; MARK ALL OTHER STATEMENTS "NO." N 29 Does the system have a deficiency meeting the required storage capacity DUE SOLELY TO FIRE SUPPRESSION NEEDS? (USE SPREADSHEET FOR CALCULATIONS) *IF YES, SELECT CORRECT STATEMENT FROM THE FOLLOWING AND MARK "YES"; MARK ALL OTHER STATEMENTS "NO." N 30 Does the system have a deficiency meeting the required equalization storage capacity for indoor/outdoor demands (but not because of fire suppression needs)? (USE SPREADSHEET FOR CALCULATIONS) *IF YES, SELECT CORRECT STATEMENT FROM THE FOLLOWING AND MARK "YES"; MARK ALL OTHER STATEMENTS "NO." N 31 Does your water system have an Emergency Response Plan? REC | 0pts | SM | M001 | R309-105-18 | All suppliers are advised to develop contingency plans to cope with possible emergency situations. In many areas of the state the possibility of earthquake damage shall be realistically considered. Y 32 Does your Emergency Response Plan address cybersecurity? (required for systems over 3,300 population) MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for regulatory followup to address concerns. NA (Notes: System does not serve over 3,300 people.) 33 Does your water system use any computers, laptops, phones, tablets, or any other computer systems to manage, operate, or maintain the PWS (SCADA or Industrial Control Systems)? This includes any water sources, treatment, distribution or any process related to operation function Y (Notes: Only 2 people have access to the network.) 34 Does your water system use any computer systems in regular business operations such as accounting, billing, payroll, human resources, or management? N 35 Legally adopted authority statement MIN | 15pts | SM | M003 | R309-105-12(2) | Rule requires each public water system to have a cross connection control program that includes a legally adopted and functional local authority to enforce the program (i.e., ordinance, bylaw, or policy). C 36 Documentation of annual public awareness and/or employee training MIN | 15pts | SM | M004 | R309-105-12(2) | Rule requires each public water system to have a cross connection control program that includes providing public education or awareness material or presentations. C 37 Documentation of personnel trained to manage the program (ALL COMUNITY WATER SYSTEMS REQUIRE A DDW CERTIFIED CCC PROGRAM ADMINISTRATOR. ALL OTHER WATER SYSTEMS REQUIRE AT A MINIMUM BACKFLOW 101 OR EQUIVALENT/ GREATER CCC TRAINING) MIN | 15pts | SM | M005 | R309-105-12(2) | Rule requires each public water system to have a cross connection control program that includes an operator with adequate training in the area of cross connection control or backflow prevention. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 4 of 25 General Maintenance and Environment Distribution 38 Does the water system have detailed records of cross connection control activities? (inventories of backflow assemblies, devices, and air gaps installed within the system) MIN | 15pts | SM | M006 | R309-105-12(2) | Rule requires each public water system to have a cross connection control program that includes written records of cross connection control activities. C 39 Does the water system have records of on-going enforcement activities? (test history, enforcement activities, hazard assessments) MIN | 15pts | SM | M007 | R309-105-12(2) | Rule requires each public water system to have a cross connection control program that includes test history and documentation of on-going enforcement activities. C 40 Operator meets required level of certification for water system. ( IF NO CERTIFIED OPERATOR IS REQUIRED MARK COMPLIANT ) SIG | 50pts | OC | C001 | R309-105-11, R309-300-5(3) | Rule requires every community and NTNC water system and public water systems that utilize treatment/filtration to have at least one operator certified at the classified grade of the water system. Certification must be appropriate for the type of system operated (treatment and/or distribution). This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 41 Certified operator is within 1 hour travel time of water system. ( IF NO CERTIFIED OPERATOR IS REQUIRED MARK COMPLIANT ) MIN | 0pts | OC | C002 | R309-300-5(14) | Rule requires the operator to be within 1 hour travel time, under normal work and home conditions, of each drinking water system for which he is considered in direct responsible charge. C 42 Are there any visual indications of unsanitary conditions? SIG | 50pts | SM | M017 | R309-200-6, R309-105-18, R309-215-4(3) | R309-200-6 The Secondary Maximum Contaminant Levels for public water systems deals with substances which affect the aesthetic quality of drinking water. They are presented here as recommended limits or ranges and are not grounds for rejection. The taste of water may be unpleasant and the usefulness of the water may be impaired if these standards are significantly exceeded. R309-105-18 The Director or the local health department shall be informed by telephone by a water supplier of any "emergency situation". The term "emergency situation... R309-215-4(3) If the water fails to meet minimum standards, then certain public notification procedures shall be carried out, as outlined in R309-220. Water suppliers shall also keep analytical records in their possession, for a required length of time, as outlined in R309-105-17. C 43 No unprotected connection between the distribution system and a source of contamination. (If there is an unprotected connection, describe the location in detail.) SIG | 50pts | DS | D009 | R309-550-5(11) | R309-550-5(11) C 44 Are air release/vacuum valves in the distribution system? ... if yes, answer the following question(s) Y DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 5 of 25 44A Open end of vent line covered with #14 mesh screen SIG | 25pts | DS | D004 | R309-550-6(6)(b) | Rule states the open end of the air relief vent pipe from automatic valves shall be provided with a #14 mesh, non-corrodible screen and a downward elbow, and where possible, be extended to at least one foot above grade. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 44B For a valve in a chamber, open end of vent pipe is at least 12 inches above grade or one foot above distribution line in a chamber that does not flood. SIG | 25pts | DS | D006 | R309-550-6(6)(b) | Rule states the open end of the air relief vent pipe from automatic valves shall be provided with a #14 mesh, non-corrodible screen and a downward elbow, and where possible, be extended to at least one foot above grade. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 44C Chamber has drain to daylight, gravel-filled adsorption pit if not subject to flooding, or sump pump. SIG | 25pts | DS | D007 | R309-550-6(6)(b) and (7)(b) | Rule states chambers shall be provided with a drain to daylight, if possible. Where this is not possible, underground gravel-filled absorption pits may be used if the site is not subject to flooding and conditions will assure adequate drainage. Sump pumps may also be considered if a drain to daylight or absorption pit is not feasible. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 44D Open end of vent line down-turned. SIG | 25pts | DS | D006 | R309-550-6(6)(b) | Rule states the open end of the air relief vent pipe from automatic valves shall be provided with a #14 mesh, non-corrodible screen and a downward elbow, and where possible, be extended to at least one foot above grade. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 45 Water system has a program to maintain, operate, or control the use of fire hydrants. REC | 0pts | DS | D012 | N/A | Fire hydrants provide a direct access to the water in the distribution system. In order to protect the quality and integrity of the water, fire hydrant access should be controlled. C 46 Blow offs or air release valves are not directly connected to a sanitary sewer line. SIG | 50pts | DS | D013 | R309-550-6(5)(a), R309-550-6(6)(c) and (7)(a) | Rule states blow-offs or air relief valves shall not be connected directly to a sewer. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 47 Blow offs or air release valves do not discharge below flood level in ditches or streams. SIG | 50pts | DS | D016 | R309-550-9(1) and (2), R309-550-13(2) | R309-550-9(1 & 3) C 48 All water mains installed after 1995 that provide fire flow are at least 8 inches in diameter. MIN | 15pts | DS | D019 | R309-550-5(4) & (5) | Rule states that the minimum line size serving a fire hydrant lateral shall be 8-inch diameter unless a hydraulic analysis indicates that required flow and pressures can be maintained by 6-inch lines. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 6 of 25 General Disinfection WS003 - PINE MTN SPRING - 49 Distribution system capable of providing minimum pressure of 20 psi at all service connections. SIG | 50pts | DS | D003 | R309-105-9, R309-550-5(1) | Rule states the distribution system shall maintain minimum pressures as required by R309-105-9 at all points of connection under all flow conditions. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 50 Was the water system constructed or new portions added after January 1, 2007? ... if yes, answer the following question(s) N 51 Water system follows AWWA disinfection procedures for new, repaired, or seasonal water mains and tanks. SIG | 25pts | MR | D018 | R309-550-8(10) | All new and repaired water mains and appurtenances shall be disinfected in accordance with AWWA Standard C651. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 52 How often do you periodically disinfect any or all parts of your water system (i.e. batch disinfection) other than for repairs or maintenance? SIG | 50pts | SM | G006 | R309-105-6(1)(a), R309-500-6 | R309-105-6(1) Approval of Engineering Plans and Specifications R309-500-6 Plan Approval Procedure. C 53 Is this facility Active or Inactive? (Active status means used on a routine/seasonal basis without long periods of inactivity and water quality samples are routinely collected)) I (Notes: This source is not being used because of low flow.) 53A Explain why this facility is Inactive (Is this facility in stand-by mode and not used regularly, has not been used for multiple years, does it have known water quality concerns?) This source is not being used because of low flow. 54 Operating Period (Start Date)01/01 55 Operating Period (End Date)12/31 56 Undocumented sources shall not be physically connected to the drinking water system. (IF SOURCE IS NOT IN SYSTEM INVENTORY MARK "DEFICIENT") SIG | 200pts | SO | S001 | R309-515-6(5), R309-515-7(4), R309-500-9(2) and (3) | R309-105-6(1) requires plans and specifications for all public drinking water projects to be approved in writing by the Director prior to the commencement of construction. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 57 Area of equal or higher elevation within 50 feet of spring collection devices is fenced. MIN | 15pts | SO | SS02 | R309-515-7(7)(e) | Rule requires a stock-tight fence around the spring collection area. C 58 Surface water runoff diverted away from spring by diversion channel or berm. MIN | 15pts | SO | SS03 | R309-515-7(7)(g) | Rule requires a diversion channel or berm, constructed immediately inside the fenced area, capable of diverting all anticipated surface water runoff away from the spring collection area. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 7 of 25 59 Spring box has a means to release overflow? MIN | 15pts | SO | SS23 | R309-515-7(7)(d), R309-545-13(1) | All junction boxes and collection boxes, must comply with R309-545 with respect to access openings, venting, and tank overflow. Lids for these spring boxes shall be gasketed and the box adequately vented. Y 59A Overflow screened with #4 mesh screen SIG | 25pts | SO | SS04 | R309-515-7(7)(d), R309-545-13(3) | Overflow pipes on junction and collection boxes shall comply with R309-545 and be screened with No. 4 mesh non-corrodible screens. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 59B Overflow has a minimum of 12 inch clearance above flood rim of receiving basin SIG | 25pts | SO | SS14 | R309-515-7(7)(d), R309-545 | Overflow pipes on junction and collection boxes shall comply with R309-545 and discharge a minimum of 12 inches above the ground surface or rim of the receiving basin. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 60 Drain has minimum of 12 inch clearance above flood rim of receiving basin SIG | 25pts | SO | SS14 | R309-515-7(7)(d), R309-545 | Overflow pipes on junction and collection boxes shall comply with R309-545 and discharge a minimum of 12 inches above the ground surface or rim of the receiving basin. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 61 Spring collection area graded and no evidence of water ponding or flow on surface? SIG | 25pts | SO | SS06 | R309-515-7(7)(i) | Rule requires the spring to be developed as thoroughly as possible to minimize the possibility of excess water ponding within the collection area. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 62 If a liner is present, spring liner integrity is maintained. SIG | 50pts | SO | SS19 | R309-515-7(7)(b)(iv) | If a liner is present, it shall be installed to assure its integrity. No sharp-edged stones or stones two inches or larger shall be located within two inches of the liner. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 63 No deep-rooted vegetation is within the 50 ft collection area. SIG | 25pts | SO | SS07 | R309-515-7(7)(f) | All deep-rooted vegetation within the fenced collection area shall be removed by a means not negatively affecting water quality. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 64 No roots seen in collection boxes and junctions. SIG | 25pts | SO | SS08 | R309-105-10(4)(a), R309-515-8(1)(a) | Spring collection areas shall be periodically (preferably annually) cleared of deep-rooted vegetation to prevent root growth from clogging collection lines. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 8 of 25 65 Is a spring collection box present? ... if yes, answer the following question(s) MIN | 5pts | SO | L014 | R309-515-7(7)(c) | Rule requires each spring collection area to be provided with at least one collection box to permit spring inspection and testing. Y 65A Spring box has shoe box type lid with 2 inch overlap around frame SIG | 25pts | SO | SS09 | R309-515-7(7)(d), R309-545-14 (2) | Access openings shall comply with R309-545 and be provided with a close-fitting, solid shoebox-type cover that extends down around the frame at least 2 inches. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 65B Spring box lid is gasketed SIG | 25pts | SO | SS10 | R309-515-7(7)(d), R309-545-14 (2) | Access openings shall comply with R309-545 and be provided with a cover furnished with a gasket between the lid and frame. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. D (Notes: There are areas missing on the gasket.) 65C Spring box lid does not show evidence of a vacuum. MIN | 5pts | SO | SS11 | R309-515-7(7)(d), R309-545-15 | Rule requires junction boxes and collection boxes to comply with R309-545 with respect to venting. Therefore, a junction or collection box requires a vent to be fitted with #14 mesh or finer non-corrodible screen, be fitted with a protective heavy-gauge screen or covering if 6 inches in diameter or greater, be down-turned and shielded to prevent the entrance of contaminants, be located and sized to avoid blockage during winter, and have the end of the vent discharge a minimum of 24 inches above the earth on buried structures. C 65D Spring box opening is at least 4 inches above the surface of the box or 18 inches above an earthen cover if the box is buried. MIN | 15pts | SO | SS12 | R309-515-7(7)(d), R309-545-14 (1), | Access openings shall comply with R309-545 and be framed at least 4 inches above the surface of the spring box roof at the opening or 18 inches above the ground surface on a buried spring box. C 65E Spring box lid is locked SIG | 25pts | SO | SS13 | R309-515-7(7)(d), R309-545-14 (3) | Access openings shall comply with R309-545 and the lids to the openings shall be locked. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 65F All openings/penetrations in the spring collection box are sealed. SIG | 50pts | SO | SS20 | R309-515-7(7)(d), R309-545-9(1) and (2) | All junction and collection boxes shall comply with R309-545 and shall have suitable watertight roofs and sidewalls that exclude birds, animals, insects, and excessive dust. All openings shall be kept to a minimum and be watertight. Pipes that may contain water of lesser quality than drinking water shall not penetrate the spring box. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. D (Notes: The spring box has penetrations in the seal where moss is growing.) DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 9 of 25 WS001 - WELL NO. 1 - Active Exception Granted: R309-515-7(7)(b)(vi)(e) | N/A 66 Is a spring box vent present? ... if yes, answer the following question(s) MIN | 5pts | SO | SS11 | R309-515-7(7)(d), R309-545-15 | Rule requires junction boxes and collection boxes to comply with R309-545 with respect to venting. Therefore, a junction or collection box requires a vent to be fitted with #14 mesh or finer non-corrodible screen, be fitted with a protective heavy-gauge screen or covering if 6 inches in diameter or greater, be down-turned and shielded to prevent the entrance of contaminants, be located and sized to avoid blockage during winter, and have the end of the vent discharge a minimum of 24 inches above the earth on buried structures. N 67 Spring has a permanent flow-measuring device. MIN | 5pts | SO | SS01 | R309-515-7(7)(h) | Rule requires a spring to have a permanent flow measuring device. C 68 Is this facility Active or Inactive?A 69 Operating Period (Start Date)01/01 70 Operating Period (Ending Date)12/31 71 Undocumented sources shall not be physically connected to the drinking water system. (IF SOURCE IS NOT IN SYSTEM INVENTORY MARK "DEFICIENT") SIG | 200pts | SO | S001 | R309-515-6(5), R309-515-7(4), R309-500-9(2) and (3) | R309-105-6(1) requires plans and specifications for all public drinking water projects to be approved in writing by the Director prior to the commencement of construction. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 72 Well casing is at least 18 inches above finished ground surface and 12 inches above well house floor. SIG | 25pts | SO | S003 | R309-515-6(6)(b)(vi), R309-515-6(12)(c)(ii), R309-515- 6(13)(a) | Rule requires the permanent well casing to project at least 18 inches above the final ground surface and 12 inches above the pump house floor; at sites subject to flooding, the top of the casing must terminate at least 3 feet above the 100-year flood level or highest known flood elevation, whichever is higher. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 73 Wellhead is sealed to prevent contamination. SIG | 50pts | SO | S013 | R309-515-6(6)(i) | R309-515-6(6)(i) and R309-515- 6(12)(b,c,d)require a sanitary seal be installed and maintained at the wellhead and discharge piping. This significant deficiency should be corrected within 120 days of notification or have a corrective action plan approved by C 74 Is the well casing vented? ... if yes, answer the following question(s)Y DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 10 of 25 74A Vent screened with #14 mesh screen SIG | 25pts | SO | S006 | R309-515-6(12)(d)(iii) | Guidance states provisions should be made for venting the well casing, however if vented R309-515-6(12)(d)(iii) and R309- 550-6(6)(a)require vents be fitted with a #14 mesh or finer non-corrodible screen. C 74B Vent down-turned SIG | 25pts | SO | S007 | R309-515-6(12)(d)(iii) | Guidance states provisions should be made for venting the well casing, however if vented R309-515-6(12)(d)(iii) and R309- 550-6(6)(b) requires vents be downturned or shielded to prevent the entrance of surface water or rainwater. C 74C Vent has adequate clearance to prevent contamination from entering the well SIG | 25pts | SO | S008 | R309-515-6(12)(d)(iii) | Guidance states provisions should be made for venting the well casing, however if vented R309-515-6(12)(d)(iii) and R309- 550-6(6)(b) requires vents be terminated with a discharge with an appropriate air gap. C 75 Does the well have a pump to waste line? ... if yes, answer the following question(s)Y 75A Pump to waste line discharges with a minimum of 12-inch clearance to flood rim SIG | 25pts | SO | S009 | R309-515-6(12)(d)(ix) | Rule requires a pump-to-waste line connected to a sewer/storm drain to have a minimum 12-inch clearance to the flood rim. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 75B Pump to waste line equipped with #4 non-corrodible mesh screen SIG | 25pts | SO | S010 | R309-515-6(12)(d)(ix) | The discharge end of the pump-to- waste line shall be covered with a No. 4 mesh corrosion-resistant screen. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 75C Pump to waste line downturned if it discharges to sewer/storm drain or allowing complete drainage if not downturned SIG | 25pts | SO | S011 | R309-515-6(12)(d)(ix) | The discharge end of the pump-to- waste line shall be downturned. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 76 Provisions available to periodically measure water levels MIN | 5pts | SO | S015 | R309-515-6(12)(e ), R309-515-6(12)(c)(vi) | Rule requires provisions be made to permit periodic measurement of water levels in the completed well. C 77 Wellhead secured to protect quality water SIG | 25pts | SO | S002 | R309-105-10(5) | All water system facilities shall be secure. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 11 of 25 78 Well head or well house and equipment protected from flooding SIG | 25pts | SO | S020 | R309-515-6(6)(b)(vi), R309-515-6(12)(d)(iii), R309-515- 6(13)(a) to (d) | Top of well casing shall terminate at least 18” above ground level or 12” above well house floor and for sites that flood at least 3’ above 100-year flood level or highest known flood elevation. Well casing terminating in underground vault shall have a drain to daylight and surface runoff directed away from vault access. Well house floor shall be sloped for drainage, and have a drain to daylight unless highly impractical. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 79 There are no unprotected cross-connections in well discharge piping. SIG | 50pts | SO | S021 | R309-105-12(1), R309-515-6(12)(d)(iii) | Rule requires the well discharge piping to be protected against the entrance of contamination. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 80 No toxic chemicals, hazardous or flammable materials, or lubricants inside the well house or near well head? MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for regulatory followup to address concerns. C 81 Well discharge line has a smooth-nosed sampling tap, which samples the well water before any chemical injection. (first item from the wellhead). MIN | 5pts | SO | S023 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. (smooth nosed sampling tap being the first item from the well head and the shut-off valve as the last item) D (Notes: There is no smooth-nosed sampling tap.) 82 Well discharge line has a check valve. MIN | 5pts | SO | S024 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with (in order of placement from the wellhead) a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. C 83 Well discharge line has a pressure gauge. MIN | 5pts | SO | S025 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with (in order of placement from the wellhead) a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. C 84 Well discharge line has a means to measure flow. MIN | 5pts | SO | S026 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with (in order of placement from the wellhead) a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. C 85 Well discharge line has a shut-off valve (last item from the well head). MIN | 5pts | SO | S027 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with (in order of placement from the wellhead) a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. C 86 Is there an air/vac valve on the well discharge line? If yes, answer the following question(s) Y DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 12 of 25 WS002 - WELL NO. 2 - Active 86A Air vacuum relief valve on well discharge piping downturned SIG | 25pts | SO | S028 | R309-515-6(12)(d)(v) | Rule requires the exhaust/relief piping on an air release/vacuum relief valve on the well discharge piping to be down-turned. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 86B Air vacuum relief valve on well discharge piping screened with #14 mesh screen SIG | 25pts | SO | S029 | R309-515-6(12)(d)(v) | Rule requires the exhaust/relief piping on an air release/vacuum relief valve on the well discharge piping to be covered with a #14 mesh corrosion-resistant screen. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 86C Air vacuum relief valve on well discharge piping has at least 6 inches of clearance above floor SIG | 25pts | SO | S030 | R309-515-6(12)(d)(v) | Rule requires the exhaust/relief piping on an air release/vacuum relief valve on the well discharge piping to be at least 6 inches above the well house floor. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 87 Wells that pump directly into a distribution system have means to release trapped air from pump discharge piping (for example, pumps directly to a tank, has an air release valve or pump to waste line) MIN | 5pts | SO | SL01 | R309-515-6(12)(d)(v) | Rule requires a well that pumps directly into the distribution system be equipped with an air release/vacuum relief valve located upstream of the check valve, unless the wellhead valve and piping provide for pumping to waste all trapped air before water is introduced into the distribution system. C 88 Does well require oil-lubrication?N 89 Is this facility Active or Inactive?A 90 Operating Period (Start Date)01/01 91 Operating Period (Ending Date)12/31 92 Undocumented sources shall not be physically connected to the drinking water system. (IF SOURCE IS NOT IN SYSTEM INVENTORY MARK "DEFICIENT") SIG | 200pts | SO | S001 | R309-515-6(5), R309-515-7(4), R309-500-9(2) and (3) | R309-105-6(1) requires plans and specifications for all public drinking water projects to be approved in writing by the Director prior to the commencement of construction. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 13 of 25 93 Well casing is at least 18 inches above finished ground surface and 12 inches above well house floor. SIG | 25pts | SO | S003 | R309-515-6(6)(b)(vi), R309-515-6(12)(c)(ii), R309-515- 6(13)(a) | Rule requires the permanent well casing to project at least 18 inches above the final ground surface and 12 inches above the pump house floor; at sites subject to flooding, the top of the casing must terminate at least 3 feet above the 100-year flood level or highest known flood elevation, whichever is higher. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 94 Wellhead is sealed to prevent contamination. SIG | 50pts | SO | S013 | R309-515-6(6)(i) | R309-515-6(6)(i) and R309-515- 6(12)(b,c,d)require a sanitary seal be installed and maintained at the wellhead and discharge piping. This significant deficiency should be corrected within 120 days of notification or have a corrective action plan approved by D (Notes: The wellhead seal has a portion that is not intact and needs to be fixed.) 95 Is the well casing vented? ... if yes, answer the following question(s)Y 95A Vent screened with #14 mesh screen SIG | 25pts | SO | S006 | R309-515-6(12)(d)(iii) | Guidance states provisions should be made for venting the well casing, however if vented R309-515-6(12)(d)(iii) and R309- 550-6(6)(a)require vents be fitted with a #14 mesh or finer non-corrodible screen. C 95B Vent down-turned SIG | 25pts | SO | S007 | R309-515-6(12)(d)(iii) | Guidance states provisions should be made for venting the well casing, however if vented R309-515-6(12)(d)(iii) and R309- 550-6(6)(b) requires vents be downturned or shielded to prevent the entrance of surface water or rainwater. C 95C Vent has adequate clearance to prevent contamination from entering the well SIG | 25pts | SO | S008 | R309-515-6(12)(d)(iii) | Guidance states provisions should be made for venting the well casing, however if vented R309-515-6(12)(d)(iii) and R309- 550-6(6)(b) requires vents be terminated with a discharge with an appropriate air gap. C 96 Does the well have a pump to waste line? ... if yes, answer the following question(s)N 97 Provisions available to periodically measure water levels MIN | 5pts | SO | S015 | R309-515-6(12)(e ), R309-515-6(12)(c)(vi) | Rule requires provisions be made to permit periodic measurement of water levels in the completed well. C 98 Wellhead secured to protect quality water SIG | 25pts | SO | S002 | R309-105-10(5) | All water system facilities shall be secure. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 14 of 25 99 Well head or well house and equipment protected from flooding SIG | 25pts | SO | S020 | R309-515-6(6)(b)(vi), R309-515-6(12)(d)(iii), R309-515- 6(13)(a) to (d) | Top of well casing shall terminate at least 18” above ground level or 12” above well house floor and for sites that flood at least 3’ above 100-year flood level or highest known flood elevation. Well casing terminating in underground vault shall have a drain to daylight and surface runoff directed away from vault access. Well house floor shall be sloped for drainage, and have a drain to daylight unless highly impractical. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 100 There are no unprotected cross-connections in well discharge piping. SIG | 50pts | SO | S021 | R309-105-12(1), R309-515-6(12)(d)(iii) | Rule requires the well discharge piping to be protected against the entrance of contamination. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 101 No toxic chemicals, hazardous or flammable materials, or lubricants inside the well house or near well head? MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for regulatory followup to address concerns. C 102 Well discharge line has a smooth-nosed sampling tap, which samples the well water before any chemical injection. (first item from the wellhead). MIN | 5pts | SO | S023 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. (smooth nosed sampling tap being the first item from the well head and the shut-off valve as the last item) D (Notes: There is no smooth-nosed sampling tap on the discharge piping.) 103 Well discharge line has a check valve. MIN | 5pts | SO | S024 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with (in order of placement from the wellhead) a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. C 104 Well discharge line has a pressure gauge. MIN | 5pts | SO | S025 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with (in order of placement from the wellhead) a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. C 105 Well discharge line has a means to measure flow. MIN | 5pts | SO | S026 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with (in order of placement from the wellhead) a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. C 106 Well discharge line has a shut-off valve (last item from the well head). MIN | 5pts | SO | S027 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to be equipped with (in order of placement from the wellhead) a smooth nosed sampling tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve. C 107 Is there an air/vac valve on the well discharge line? If yes, answer the following question(s) Y DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 15 of 25 ST001 - 365,000 GAL TANK - Active 107A Air vacuum relief valve on well discharge piping downturned SIG | 25pts | SO | S028 | R309-515-6(12)(d)(v) | Rule requires the exhaust/relief piping on an air release/vacuum relief valve on the well discharge piping to be down-turned. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 107B Air vacuum relief valve on well discharge piping screened with #14 mesh screen SIG | 25pts | SO | S029 | R309-515-6(12)(d)(v) | Rule requires the exhaust/relief piping on an air release/vacuum relief valve on the well discharge piping to be covered with a #14 mesh corrosion-resistant screen. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 107C Air vacuum relief valve on well discharge piping has at least 6 inches of clearance above floor SIG | 25pts | SO | S030 | R309-515-6(12)(d)(v) | Rule requires the exhaust/relief piping on an air release/vacuum relief valve on the well discharge piping to be at least 6 inches above the well house floor. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 108 Wells that pump directly into a distribution system have means to release trapped air from pump discharge piping (for example, pumps directly to a tank, has an air release valve or pump to waste line) MIN | 5pts | SO | SL01 | R309-515-6(12)(d)(v) | Rule requires a well that pumps directly into the distribution system be equipped with an air release/vacuum relief valve located upstream of the check valve, unless the wellhead valve and piping provide for pumping to waste all trapped air before water is introduced into the distribution system. C 109 Does well require oil-lubrication?N 110 Is this facility Active or Inactive?A 111 Storage tank capacity in gallons (from SDWIS; if different explain why in the comments) 365000 112 There are no undocumented drinking water facilities (i.e. tanks, pump stations, treatment facilities, etc.) or recent modifications that have not gone through DDW review SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2) and (3) | Rule requires complete plans & specification for all public drinking water projects to be approved in writing by the Director. Any facility found that has not started DDW review shall be considered unapproved. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 113 Ladders, ladder guards, platform railings, or safely located entrance hatches are provided. MIN | 15pts | FW | V004 | R309-545-18 | Rule requires ladders, ladder guards, platform railings, and safely located entrance hatches where applicable for water storage tanks and requires safety practices to conform to pertinent laws and regulations of the Utah Occupational Safety and Health Division. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 16 of 25 114 Tank is vented. SIG | 25pts | FW | VL02 | R309-545-15 | Rule requires drinking water storage tanks to be vented. Overflows cannot be considered or used as vents. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 115 Are air vents present? ... if yes, answer the following question(s)Y 115A Vent is either down-turned or shielded from contaminants (at least 2 inches below the bottom of the opening) SIG | 25pts | FW | V005 | R309-545-15(1) | Rule requires inverted vents on water storage tanks to be down-turned a minimum of 2 inches below any opening and shielded to prevent the entrance of contaminants. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 115B End of vent terminates at least 24 inches above earthen cover (buried tank) and is located and sized to avoid blockage during winter. MIN | 15pts | FW | V006 | R309-545-15(2) | For buried structures, the rule requires the end of the vent discharge to be a minimum of 24 inches above the earthen covering. C 115C Vent covered with #14 or finer non-corrodible mesh screen. SIG | 25pts | FW | V007 | R309-545-15(4) | Rule requires a water storage tank vent to be fitted with #14 mesh or finer non-corrodible screen and vents 6-inches or greater in diameter to be fitted with additional heavy gauge screen or substantial covering to protect the #14 mesh screen from vandalism or damage. This significant deficiency must be corrected within 120 days of notification or have a compliance action plan approved by DDW. C 115D Vent 6-inch diameter and larger protected with additional heavy-gauge screen or substantial covering. MIN | 5pts | FW | V035 | R309-545-15(5) | Rule requires vents that are 6-inch diameter or greater to be fitted with additional heavy gauge screen or substantial covering, which will protect the No. 14 mesh screen against vandalism or damage. C 116 Are access openings present? ... if yes, answer the following question(s) MIN | 15pts | FW | VL03 | R309-545-14 and 14(1) | Rule requires drinking water storage tanks to be designed with reasonably convenient access to the interior for cleaning and maintenance. Y 116A Access opening framed at least 4 inches above roof surface or 18 inches above earthen cover. MIN | 15pts | FW | V008 | R309-545-14(1) | Rule requires tank access opening to be framed at least 4 inches above the surface of the roof, or on a buried tank, to be at least 18 inches above any earthen cover over the tank. C 116B Access opening shoe box type with at least 2 inches of overlap SIG | 25pts | FW | V010 | R309-545-14(2) | Rule requires the frame of an access opening to be provided with a close fitting solid shoebox type cover which extends down around the frame at least two inches and is furnished with a gasket(s) between the lid and frame. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 17 of 25 116C Access opening lid properly gasketed SIG | 25pts | FW | V009 | R309-545-14(2) | Rule requires the access opening to a tank to be furnished with a gasket between the lid and frame. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 117 Access opening locked SIG | 25pts | FW | V029 | R309-545-14(3) | Rule requires the lid to any access opening to have a locking device. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 118 Roof or wall penetrations sealed SIG | 100pts | FW | V017 | R309-545-6(1) and 545-9 | Rule requires openings in a storage tank roof or top, designed to accommodate control apparatus or pump columns, to be welded, gasketed, or curbed and sleeved and to have additional proper shielding to prevent vandalism. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 119 Area surrounding ground-level or buried storage tank is graded to prevent surface water from standing within 50 feet. SIG | 25pts | TR | V001 | R309-545-7(4) | Rule requires the area surrounding a ground-level or buried water storage tank be graded in a manner to prevent surface water from standing within 50 feet of the tank. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 120 Storage tank roof is sloped to prevent ponding MIN | 15pts | FW | V003 | R309-545-9(4) | Rule requires drainage of storage tank roofs to eliminate water ponding. C 121 Are there cracks in the walls or roof of the storage tank? (if yes, select only one of the following options) N 122 Is a tank overflow present? ... if yes, answer the following question(s) SIG | 25pts | FW | VL01 | R309-545-13 | Rule requires all storage tanks to be provided with an overflow that discharges at an an elevation between 12 and 24 inches above the ground surface or the rim of the receiving basin. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. Y 122A Overflow line discharges at least 12 inches above ground or the flood rim of receiving basin? SIG | 25pts | FW | V011 | R309-545-13 | Rule requires all water storage tanks to be provided with an overflow that discharges at an elevation between 12 and 24 inches above the ground surface or the rim of the receiving basin. C 122B Overflow line covered with #4 mesh non-corrodible screen SIG | 25pts | FW | V012 | R309-545-13(3) | Rule requires overflow pipes to be screened with #4 mesh non-corrodible screens installed at a location least susceptible to damage by vandalism. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 18 of 25 ST002 - 85,000 GAL TANK - Active 122C Overflow line connected or discharges to a sanitary sewer drain? SIG | 50pts | FW | V013 | R309-545-13(5) | Rule prohibits overflow pipes from connecting to, or discharging into, a sanitary sewer system. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 123 Are the drain line and overflow combined?Y 124 Is this facility Active or Inactive?A 125 Storage tank capacity in gallons (from SDWIS; if different explain why in the comments) 85000 126 There are no undocumented drinking water facilities (i.e. tanks, pump stations, treatment facilities, etc.) or recent modifications that have not gone through DDW review SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2) and (3) | Rule requires complete plans & specification for all public drinking water projects to be approved in writing by the Director. Any facility found that has not started DDW review shall be considered unapproved. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 127 Ladders, ladder guards, platform railings, or safely located entrance hatches are provided. MIN | 15pts | FW | V004 | R309-545-18 | Rule requires ladders, ladder guards, platform railings, and safely located entrance hatches where applicable for water storage tanks and requires safety practices to conform to pertinent laws and regulations of the Utah Occupational Safety and Health Division. C 128 Tank is vented. SIG | 25pts | FW | VL02 | R309-545-15 | Rule requires drinking water storage tanks to be vented. Overflows cannot be considered or used as vents. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 129 Are air vents present? ... if yes, answer the following question(s)Y 129A Vent is either down-turned or shielded from contaminants (at least 2 inches below the bottom of the opening) SIG | 25pts | FW | V005 | R309-545-15(1) | Rule requires inverted vents on water storage tanks to be down-turned a minimum of 2 inches below any opening and shielded to prevent the entrance of contaminants. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 129B End of vent terminates at least 24 inches above earthen cover (buried tank) and is located and sized to avoid blockage during winter. MIN | 15pts | FW | V006 | R309-545-15(2) | For buried structures, the rule requires the end of the vent discharge to be a minimum of 24 inches above the earthen covering. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 19 of 25 129C Vent covered with #14 or finer non-corrodible mesh screen. SIG | 25pts | FW | V007 | R309-545-15(4) | Rule requires a water storage tank vent to be fitted with #14 mesh or finer non-corrodible screen and vents 6-inches or greater in diameter to be fitted with additional heavy gauge screen or substantial covering to protect the #14 mesh screen from vandalism or damage. This significant deficiency must be corrected within 120 days of notification or have a compliance action plan approved by DDW. C 129D Vent 6-inch diameter and larger protected with additional heavy-gauge screen or substantial covering. MIN | 5pts | FW | V035 | R309-545-15(5) | Rule requires vents that are 6-inch diameter or greater to be fitted with additional heavy gauge screen or substantial covering, which will protect the No. 14 mesh screen against vandalism or damage. C 130 Are access openings present? ... if yes, answer the following question(s) MIN | 15pts | FW | VL03 | R309-545-14 and 14(1) | Rule requires drinking water storage tanks to be designed with reasonably convenient access to the interior for cleaning and maintenance. Y 130A Access opening framed at least 4 inches above roof surface or 18 inches above earthen cover. MIN | 15pts | FW | V008 | R309-545-14(1) | Rule requires tank access opening to be framed at least 4 inches above the surface of the roof, or on a buried tank, to be at least 18 inches above any earthen cover over the tank. C 130B Access opening shoe box type with at least 2 inches of overlap SIG | 25pts | FW | V010 | R309-545-14(2) | Rule requires the frame of an access opening to be provided with a close fitting solid shoebox type cover which extends down around the frame at least two inches and is furnished with a gasket(s) between the lid and frame. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 130C Access opening lid properly gasketed SIG | 25pts | FW | V009 | R309-545-14(2) | Rule requires the access opening to a tank to be furnished with a gasket between the lid and frame. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 131 Access opening locked SIG | 25pts | FW | V029 | R309-545-14(3) | Rule requires the lid to any access opening to have a locking device. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 132 Roof or wall penetrations sealed SIG | 100pts | FW | V017 | R309-545-6(1) and 545-9 | Rule requires openings in a storage tank roof or top, designed to accommodate control apparatus or pump columns, to be welded, gasketed, or curbed and sleeved and to have additional proper shielding to prevent vandalism. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 20 of 25 ST003 - 45,000 GAL TANK - Active 133 Area surrounding ground-level or buried storage tank is graded to prevent surface water from standing within 50 feet. SIG | 25pts | TR | V001 | R309-545-7(4) | Rule requires the area surrounding a ground-level or buried water storage tank be graded in a manner to prevent surface water from standing within 50 feet of the tank. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 134 Storage tank roof is sloped to prevent ponding MIN | 15pts | FW | V003 | R309-545-9(4) | Rule requires drainage of storage tank roofs to eliminate water ponding. C 135 Are there cracks in the walls or roof of the storage tank? (if yes, select only one of the following options) N 136 Is a tank overflow present? ... if yes, answer the following question(s) SIG | 25pts | FW | VL01 | R309-545-13 | Rule requires all storage tanks to be provided with an overflow that discharges at an an elevation between 12 and 24 inches above the ground surface or the rim of the receiving basin. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. Y 136A Overflow line discharges at least 12 inches above ground or the flood rim of receiving basin? SIG | 25pts | FW | V011 | R309-545-13 | Rule requires all water storage tanks to be provided with an overflow that discharges at an elevation between 12 and 24 inches above the ground surface or the rim of the receiving basin. C 136B Overflow line covered with #4 mesh non-corrodible screen SIG | 25pts | FW | V012 | R309-545-13(3) | Rule requires overflow pipes to be screened with #4 mesh non-corrodible screens installed at a location least susceptible to damage by vandalism. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 136C Overflow line connected or discharges to a sanitary sewer drain? SIG | 50pts | FW | V013 | R309-545-13(5) | Rule prohibits overflow pipes from connecting to, or discharging into, a sanitary sewer system. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 137 Are the drain line and overflow combined?Y 138 Is this facility Active or Inactive?A 139 Storage tank capacity in gallons (from SDWIS; if different explain why in the comments) 45000 DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 21 of 25 140 There are no undocumented drinking water facilities (i.e. tanks, pump stations, treatment facilities, etc.) or recent modifications that have not gone through DDW review SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2) and (3) | Rule requires complete plans & specification for all public drinking water projects to be approved in writing by the Director. Any facility found that has not started DDW review shall be considered unapproved. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 141 Ladders, ladder guards, platform railings, or safely located entrance hatches are provided. MIN | 15pts | FW | V004 | R309-545-18 | Rule requires ladders, ladder guards, platform railings, and safely located entrance hatches where applicable for water storage tanks and requires safety practices to conform to pertinent laws and regulations of the Utah Occupational Safety and Health Division. C 142 Tank is vented. SIG | 25pts | FW | VL02 | R309-545-15 | Rule requires drinking water storage tanks to be vented. Overflows cannot be considered or used as vents. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 143 Are air vents present? ... if yes, answer the following question(s)Y 143A Vent is either down-turned or shielded from contaminants (at least 2 inches below the bottom of the opening) SIG | 25pts | FW | V005 | R309-545-15(1) | Rule requires inverted vents on water storage tanks to be down-turned a minimum of 2 inches below any opening and shielded to prevent the entrance of contaminants. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 143B End of vent terminates at least 24 inches above earthen cover (buried tank) and is located and sized to avoid blockage during winter. MIN | 15pts | FW | V006 | R309-545-15(2) | For buried structures, the rule requires the end of the vent discharge to be a minimum of 24 inches above the earthen covering. C 143C Vent covered with #14 or finer non-corrodible mesh screen. SIG | 25pts | FW | V007 | R309-545-15(4) | Rule requires a water storage tank vent to be fitted with #14 mesh or finer non-corrodible screen and vents 6-inches or greater in diameter to be fitted with additional heavy gauge screen or substantial covering to protect the #14 mesh screen from vandalism or damage. This significant deficiency must be corrected within 120 days of notification or have a compliance action plan approved by DDW. C 143D Vent 6-inch diameter and larger protected with additional heavy-gauge screen or substantial covering. MIN | 5pts | FW | V035 | R309-545-15(5) | Rule requires vents that are 6-inch diameter or greater to be fitted with additional heavy gauge screen or substantial covering, which will protect the No. 14 mesh screen against vandalism or damage. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 22 of 25 144 Are access openings present? ... if yes, answer the following question(s) MIN | 15pts | FW | VL03 | R309-545-14 and 14(1) | Rule requires drinking water storage tanks to be designed with reasonably convenient access to the interior for cleaning and maintenance. Y 144A Access opening framed at least 4 inches above roof surface or 18 inches above earthen cover. MIN | 15pts | FW | V008 | R309-545-14(1) | Rule requires tank access opening to be framed at least 4 inches above the surface of the roof, or on a buried tank, to be at least 18 inches above any earthen cover over the tank. C 144B Access opening shoe box type with at least 2 inches of overlap SIG | 25pts | FW | V010 | R309-545-14(2) | Rule requires the frame of an access opening to be provided with a close fitting solid shoebox type cover which extends down around the frame at least two inches and is furnished with a gasket(s) between the lid and frame. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 144C Access opening lid properly gasketed SIG | 25pts | FW | V009 | R309-545-14(2) | Rule requires the access opening to a tank to be furnished with a gasket between the lid and frame. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 145 Access opening locked SIG | 25pts | FW | V029 | R309-545-14(3) | Rule requires the lid to any access opening to have a locking device. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 146 Roof or wall penetrations sealed SIG | 100pts | FW | V017 | R309-545-6(1) and 545-9 | Rule requires openings in a storage tank roof or top, designed to accommodate control apparatus or pump columns, to be welded, gasketed, or curbed and sleeved and to have additional proper shielding to prevent vandalism. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 147 Area surrounding ground-level or buried storage tank is graded to prevent surface water from standing within 50 feet. SIG | 25pts | TR | V001 | R309-545-7(4) | Rule requires the area surrounding a ground-level or buried water storage tank be graded in a manner to prevent surface water from standing within 50 feet of the tank. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 148 Storage tank roof is sloped to prevent ponding MIN | 15pts | FW | V003 | R309-545-9(4) | Rule requires drainage of storage tank roofs to eliminate water ponding. C 149 Are there cracks in the walls or roof of the storage tank? (if yes, select only one of the following options) N DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 23 of 25 PF001 - PUMP FACILITY -- Pump Stations - Active 150 Is a tank overflow present? ... if yes, answer the following question(s) SIG | 25pts | FW | VL01 | R309-545-13 | Rule requires all storage tanks to be provided with an overflow that discharges at an an elevation between 12 and 24 inches above the ground surface or the rim of the receiving basin. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. Y 150A Overflow line discharges at least 12 inches above ground or the flood rim of receiving basin? SIG | 25pts | FW | V011 | R309-545-13 | Rule requires all water storage tanks to be provided with an overflow that discharges at an elevation between 12 and 24 inches above the ground surface or the rim of the receiving basin. C 150B Overflow line covered with #4 mesh non-corrodible screen SIG | 25pts | FW | V012 | R309-545-13(3) | Rule requires overflow pipes to be screened with #4 mesh non-corrodible screens installed at a location least susceptible to damage by vandalism. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 150C Overflow line connected or discharges to a sanitary sewer drain? SIG | 50pts | FW | V013 | R309-545-13(5) | Rule prohibits overflow pipes from connecting to, or discharging into, a sanitary sewer system. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 151 Are the drain line and overflow combined?Y 152 Is this facility Active or Inactive?A 153 There are no undocumented drinking water facilities (i.e. tanks, pump stations, treatment facilities, etc.) or recent modifications that have not gone through DDW review SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2) and (3) | Rule requires complete plans & specification for all public drinking water projects to be approved in writing by the Director. Any facility found that has not started DDW review shall be considered unapproved. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 154 Pump Type (Centrifugal, Hand pump, Jet, Positive Displacement, Screw, Submersible, Vertical turbine) Centrifugal 155 If the pump station is used to pressurize the distribution system, does it have at least two functioning pumping units? ... if yes, answer the following question(s) SIG | 25pts | PU | PS18 | R309-540-5(4)(b) | Rule states inline booster pumps, withdrawing water directly from distribution lines without storage and feeding water directly into distribution lines, shall have at least two pumping units. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. Y DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 24 of 25 155A Demand is met by remaining pump(s) when largest pumping unit out of service SIG | 25pts | PU | PS19 | R309-540-3(a) | Inline booster pumps shall have at least two pumping units (such that with any one pump out of service, the remaining pump or pumps shall be capable of providing the peak day demand of the specific portion of the system serviced). This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 156 Pump station building and equipment are protected from flooding. MIN | 15pts | PU | PS13 | R309-540-5(1)(a)(ii), R309-540-5(2)(a)(iii) | Pump station access shall be 6" above surrounding ground and located at least 3’ above 100-year flood elevation or highest recorded flood elevation; station is accessible at all times unless it can be taken out of service when inaccessible. C 157 There are no unprotected cross-connections in the pump station. SIG | 50pts | PU | PS15 | R309-105-12(1) | Cross connections are not allowed unless controlled by an approved and properly operating backflow prevention assembly or device. This significant deficiency must be corrected within 120 days of notification or have a corrective action plan approved by DDW. C 158 Discharge piping has a pressure gauge. MIN | 15pts | PU | PS03 | R309-540-5 (6)(c)(i) | Rule requires that a standard pressure gauge be installed on the pump discharge line. C 159 Does the pumping facility have an air relief valve located on the discharge piping? ... if yes, answer the following question(s) N 160 Pump station properly secured MIN | 15pts | PU | PS33 | R309-540-5(1)(a)(v) | The pump station is protected to prevent vandalism and entrance by animals or unauthorized persons. C DEQ | Drinking Water Run Date: 08/15/2024 14:18:31 | Rating: Approved UTAH22014 PINE MOUNTAIN MUTUAL page 25 of 25