DDW-2024-011903

Utah Department Of Environmental Quality
Division Of Drinking Water Sanitary Survey
Sanitary Survey
General System Information
Exception Granted: R309-550-7 | West Bountiful City is planning to replace their water main along 560 West Street during the 2023 construction
season. The city is very flat with high groundwater noted during recent construction. The existing sanitary sewer was put into place in 1962, and is
an 8-inch diameter concrete pipe with gasketed bell and spigot joints. The sanitary sewer is gravity fed throughout West Bountiful City’s service
area. The basis for your request for an exception to R309-550-7 is that due to existing sanitary sewer depths, the proposed water main and water
lateral replacements will have a 6-inch vertical separation above the sanitary sewer laterals instead of the required 18-inches.
Exception Granted: R309-550-7(1) | Minimum Vertical Separation Requirements for Sewer Lateral Serving Highgate Subdivision not met
Exception Granted: R309-550-7 | Minimum separation requirements for water and sewer lines. West Bountiful is flat with a high water table.
Therefore, utilities have been burried shallow with the sewer mine only burried 2 feet at one end.
Exception Granted: R309-550 7 | Iinsufficient Water/Sewer Separation

Site Visit Date Surveyor Name
09/18/2024 Loren Allen
WEST BOUNTIFUL CITY
WATER SYSTEM
PWS ID: UTAH06014 Rating: Approved 03/11/1980 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: BLAKE BOYD
*Last Name: ANDERSON
*Organization:
*Address: Redacted
*City: WOODS CROSS
*State: UT
*Zip: 84087
*Email: [e-mail]
*Phone: [phone]
Emergency Phone: [phone]
DEQ | Drinking Water
Run Date: 10/08/2024 10:09:36 | Rating: Approved UTAH06014 WEST BOUNTIFUL CITY WATER SYSTEM page 1 of 29
2 Legal Contact (LC) [ if no eMail address is available, enter [e-mail] ]
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: WEST BOUNTIFUL WATER
SYS
*Address: 550 N 800 W
*City: WEST BOUNTIFUL
*State: UT
*Zip: 84087
*Email:
*Phone: [phone]
3 Owner Contact (OW) [ if no eMail address is available, enter [e-mail] ]
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: WEST BOUNTIFUL CITY
*Address: 550 N 800 W
*City: WOODS CROSS
*State: UT
*Zip: 84087
*Email:
*Phone:
4 Direct Operator in Charge (DO) [ if no eMail address is available, enter
[e-mail] ]
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: BLAKE BOYD
*Last Name: ANDERSON
*Organization:
*Address: 1001 S 1020 W
*City: WOODS CROSS
*State: UT
*Zip: 84087
*Email: [e-mail]
*Phone: [phone]
Emergency Phone: [phone]
5 Does the system serve a Residential population?Y
5A Population - Residential 5600
5B Operating Period (Start Date) - Residential 01/01
5C Operating Period (End Date) - Residential 12/31
DEQ | Drinking Water
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Site Visit Info
Management and Operations
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.)
N
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
9 Residential Connections:1799
10 Commercial Connections:91
11 Industrial Connections:0
12 Agricultural Connections:7
13 Date of Survey (First Day of Field Work)09/18/2024
14 Date of Survey (Last Day of Field Work) ** this should match the Date of Survey in the
header **
09/18/2024
15 Date final report sent to system (questionnaire, deficiency report and capacity
spreadsheet)
09/19/2024
16 Water system representative present during the survey:Y
17 How much time was spent to prepare survey documents prior to field survey? (Round
up to nearest quarter hour)
.3
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)
2.5
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)
1
20 How much time did it take to finish the Survey Report? (Round up to nearest quarter
hour)
1.5
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.
C
DEQ | Drinking Water
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Cross Connection and Operator Certification
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
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.
C
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.
Y
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
34 Does your water system use any computer systems in regular business operations
such as accounting, billing, payroll, human resources, or management?
Y
DEQ | Drinking Water
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General Maintenance and Environment
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
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
DEQ | Drinking Water
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Distribution
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
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
DEQ | Drinking Water
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General Disinfection
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
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)
Y
50A Distribution system capable of maintaining the following pressures at all service
connections: (a) 20 psi during fire flow and fire demand during peak day demand; (b)
30 psi during peak instantaneous demand; and (c) 40 psi during peak day demand.
SIG | 50pts | DS | D010 | R309-105-9, R309-550-5(1) | Rule states that unless
otherwise specifically approved by the Director, public water systems constructed after
January 1, 2007, shall be designed and shall meet the following minimum water
pressures at points of connection: (a) 20 psi during conditions of fire flow and fire
demand experienced during peak day demand; (b) 30 psi during peak instantaneous
demand; and (c) 40 psi during peak day demand. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
C
DEQ | Drinking Water
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WS005 - 400 NORTH WELL - Proposed Source
WS002 - CITY OFFICE WELL ABANDONED - Inactive (AB - ABANDONED)
WS004 - NEW CITY WELL - Inactive (AB - ABANDONED)
WS003 - STONE CREEK WELL -
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
55 Is this source in operation without an Operating Permit?
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.
N
55A When is the anticipated date to request an Operating Permit? Explain in comments...400 North Well is listed as WS007 - 400
NORTH WELL
53 Does the water system still have physical access to this facility? Y/N Guidance:
Answer NO if sold and no longer have security access or the facility is demolished and
can not be inspected.
N
54 Does the water system still have physical access to this facility? Y/N Guidance:
Answer NO if sold and no longer have security access or the facility is demolished and
can not be inspected.
N (Notes: Listed as WS007 - 400 North
Well)
56 Is this facility Active or Inactive?I
56A Explain why this facility is Inactive (Is this facility in stand-by mode?)replaced by WS007 West 400 north well
57 Operating Period (Start Date)01/01
58 Operating Period (Ending Date)12/31
59 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.
NA (Notes: Inactive)
DEQ | Drinking Water
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60 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.
NA (Notes: Inactive)
61 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
NA (Notes: Inactive)
62 Is the well casing vented? ... if yes, answer the following question(s)N
63 Does the well have a pump to waste line? ... if yes, answer the following question(s)N
64 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.
NA (Notes: Inactive)
65 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.
NA (Notes: Inactive)
66 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.
NA (Notes: Inactive)
67 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.
NA (Notes: Inactive)
68 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.
NA (Notes: Inactive)
DEQ | Drinking Water
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WS007 - WEST 400 NORTH WELL - Active
Exception Granted: R309-515-6(4)(a) | Sewer lines may not be located within zone one and zone two of a public Drinking Water Source Protection
(DWSP) zones.

69 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)
NA (Notes: Inactive)
70 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.
NA (Notes: Inactive)
71 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.
NA (Notes: Inactive)
72 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.
NA (Notes: Inactive)
73 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.
NA (Notes: Inactive)
74 Is there an air/vac valve on the well discharge line? If yes, answer the following
question(s)
N (Notes: inactive)
75 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.
NA (Notes: Inactive)
76 Does well require oil-lubrication?N (Notes: inactive)
77 Is this facility Active or Inactive?A
78 Operating Period (Start Date)01/01
79 Operating Period (Ending Date)12/31
DEQ | Drinking Water
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80 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
81 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
82 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
83 Is the well casing vented? ... if yes, answer the following question(s)Y
83A 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
83B 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
83C 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
84 Does the well have a pump to waste line? ... if yes, answer the following question(s)Y
84A 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
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84B 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
84C 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
85 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
86 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
87 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
88 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
89 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
90 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)
C
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91 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
92 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
93 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
94 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
95 Is there an air/vac valve on the well discharge line? If yes, answer the following
question(s)
Y
95A 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
95B 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
95C 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
96 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
97 Does well require oil-lubrication?Y
DEQ | Drinking Water
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ST001 - TANK #1 (OLD) ST001 - Active
97A Well shaft lubricants ANSI/NSF 60 certified
SIG | 25pts | SO | S031 | R309-105-10(7), R309-515-6(6)(a) | Rules require all oil-
lubricated pumps for drinking water wells to utilize food-grade mineral oil suitable for
human consumption as determined by the Director. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
<a href="https://www.youtube.com/watch?v=UABQMeeUz1g">Click here for addition
training</a>
C
98 Is this facility Active or Inactive?A
99 Storage tank capacity in gallons (from SDWIS; if different explain why in the
comments)
1000000
100 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
101 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
102 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
103 Are air vents present? ... if yes, answer the following question(s)Y

103A 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

103B 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
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103C 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

103D 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
104 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

104A 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

104B 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

104C 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
105 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
106 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
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ST002 - TANK #2 (NEW) ST002 - Active
107 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
108 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
109 Are there cracks in the walls or roof of the storage tank? (if yes, select only one of the
following options)
N
110 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

110A 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

110B 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

110C 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
111 Are the drain line and overflow combined?Y
112 Is this facility Active or Inactive?A
113 Storage tank capacity in gallons (from SDWIS; if different explain why in the
comments)
1500000
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114 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
115 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
116 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
117 Are air vents present? ... if yes, answer the following question(s)Y

117A 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

117B 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

117C 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

117D 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
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118 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

118A 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

118B 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

118C 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
119 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
120 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
121 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
122 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
123 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
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TP007 - WEST 400 NORTH CHLORINATOR-FLUORIDATOR -- Treatment - Chlorination General -
124 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

124A 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

124B 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

124C 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
125 Are the drain line and overflow combined?Y
126 Is this facility Active or Inactive?A
127 Is system required to provide primary disinfection? Prompt - If system knows they are
required to chlorinate based on water quality issues and/or knows they are required to
provide a minimum CT then follow-up by DDW is needed.
N
128 When chlorination is required, disinfection has operated uninterrupted during the past
year while supplying drinking water.
SIG | 50pts | TR | TD25 | R309-520-6 | Rule requires continuous disinfection of
groundwater sources that do not consistently meet bacteriological quality standards,
all surface water sources, and groundwater sources under the direct influence of
surface water. This significant deficiency must be corrected within 120 days of
notification or have a corrective action plan approved by DDW.
C
129 Chlorine (gas & hypochlorite solution, tablets, granules, ) and chemicals used to
generate chlorine solutions and chlorine dioxide meet ANSI/NSF 60.
SIG | 50pts | TR | TD90 | R309-525-11(5), R309-520-6(2) | All chemicals added to
drinking water, including chlorine, chloramines and chemicals used to generate
hypochlorite solutions and chlorine dioxide, shall be certified as complying with
ANSI/NSF Standard 60. This significant deficiency must be corrected within 120 days
of notification or have a corrective action plan approved by DDW.
C
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130 If chemical dilution or dissolution is needed, cross-connection control is provided on
water lines feeding solution tanks.
SIG | 50pts | TR | TX07 | R309-525-11(2)(c), R309-525-11(9)(b)(i) to (iv) | Cross
connection control shall be provided on make-up water lines feeding solution tanks.
This significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
C
131 Water flow rate is measured to control chemical feed?
SIG | 25pts | TR | TD79 | R309-525-11(7)(d)(ii) and (iii), R309-525-11(7)(a)(i) |
Chemical feed rates shall be proportional to flows and a means to measure water flow
rate shall be provided. This significant deficiency must be corrected within 120 days of
notification or have a corrective action plan approved by DDW.
C
132 Solution tanks and tank refilling line entry points are properly labeled to identify the
chemicals
MIN | 15pts | TR | TG03 | R309-525-11(8)(c)(vii) | Rule requires tanks to be properly
labeled to designate the chemical contained.
C
133 Free chlorine residual test equipment on-site or available?
MIN | 15pts | TR | TD78 | R309-520-7(1)(j) | Rule requires chlorine residual test
equipment available capable of measuring residuals to the nearest 0.1 mg/l in the
range below 0.5 mg/l, to the nearest 0.3 mg/l between 0.5 mg/l and 1.0 mg/l and to the
nearest 0.5 mg/l above 1.0 mg/l.
C
134 Spare parts are available to replace parts subject to wear and breakage
MIN | 15pts | TR | TD75 | Standard Method 334.0 Determination of Residual Chlorine
in Drinking Water Using an Online Chlorine Analyzer. [EPA 815-B-09-013 September
2009 11.1.1.2 Page 13] | Spare parts shall be provided and maintained for all
chlorinators to repair parts subject to wear and breakage.
C
135 Is chlorine chemical dose rate adjusted due to different water demand flow rates
and/or changing water quality?
N
136 Is there a designated chlorine Point of Entry (POE) sample location?
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C
137 POE is before first connection/customer?
SIG | 25pts | TR | T028 | R309-215 | R309-215 & R309-520-6(4)(d)
C
138 Chlorine residual records are maintained and available... if yes answer following
SIG | 25pts | TR | T028 | R309-215 | R309-215 & R309-520-6(4)(d)
Y

138A System is sampling distribution residuals throughout entire distribution system
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C

138B Distribution chlorine residuals meet minimum concentration requirement
SIG | 25pts | TR | T028 | R309-215 | R309-215 & R309-520-6(4)(d)
C

138C "What is the maximum free chlorine residual measure? This value never exceeds 4.0
mg/L? "
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C
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TP007 - WEST 400 NORTH CHLORINATOR-FLUORIDATOR -- Gaseous Chlorination -

138D System collects at least three distribution chlorine residual samples a week?
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C

138E System is sampling distribution residuals in accordance with monitoring schedule
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C
139 Treatment plant properly secured to protect the quality of the treated water. R309-520-
7(2)(f)
SIG | 25pts | SM | A050 | R309-400-11 | If the water system does not comply with the
directive, the Director may assess 25 to 200 points to the water system. Points shall
be assessed based upon the severity of the non-compliance, the threat to public
health and the underlying basis for the original directive.
C
140 Daily operating records reflect chemical dosages and total quantities used
SIG | 25pts | MR | TG20 | R309-105-14(3)(a) | Rule requires all water system using
chemical addition or specialized equipment for the treatment of drinking water to
regularly complete operational reports. This significant deficiency must be corrected
within 120 days of notification or have a corrective action plan approved by DDW.
C
141 Is this facility Active or Inactive?A
142 If disinfection is required, standby chlorination equipment of sufficient capacity is
available to replace the largest unit.
SIG | 25pts | TR | TD22 | R309-520-7(1)(k)(ii) | Where chlorination is required for
disinfection of the water supply, the rule requires standby equipment of sufficient
capacity to be available to replace the largest unit in the event of its failure. This
significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
C
143 Is the chlorinator room heated and has the ability to be protected from excessive heat?
MIN | 15pts | TR | TD08 | R309-520-7(1)(l) | Rule requires chlorinator buildings to be
heated, lighted, and ventilated as necessary to assure proper operation of the
equipment and safety of the operators.
C
144 If continuous disinfection is needed, automatic switch over of chlorine cylinders is
provided.
MIN | 15pts | TR | TD01 | R309-520-7(2)(a), R309-520-6(1) | Rule requires automatic
switch over of chlorine cylinders be provided if continuous disinfection is required.
C
145 Exhaust fan takes suction near the floor as far as practical from the door and air inlet,
and discharges outside away from air inlets.
MIN | 15pts | TR | TD09 | R309-520-7(2)(d)(iii) | Rule requires a chlorine room exhaust
fan to take suction inside the chlorine room near the floor, as far as practical from the
door and air inlet, and discharge air outside of the building away from air inlets.
C
146 Air inlets are located near the ceiling and fitted with louvers.
MIN | 15pts | TR | TD10 | R309-520-7(2)(d)(iv) | Rule requires chlorine room air inlets
to be through wall louvers near the ceiling.
C
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147 Chlorine vent line discharges outside and above grade and is screened with #14 mesh
screen.
SIG | 25pts | TR | TD13 | R309-520-7(2)(e) | Rule requires the chlorine vent line to
discharge outside, above grade, at a point least susceptible to vandalism, and to have
the end covered with a #14 mesh non-corrodible screen. This significant deficiency
must be corrected within 120 days of notification or have a corrective action plan
approved by DDW.
C
148 Separate switches for chlorine room fans and lights are located near the entrance to
the room (or are located outside the chlorine room if housed in a water treatment
plant).
MIN | 15pts | TR | TD12 | R309-520-7(2)(d)(v) | Rule requires separate switches for
the chlorine room fans and lights to be located near the entrance to the room and to
be protected from vandalism. The switches are required to be located outside the
chlorine room if housed in a water treatment plant.
C
149 Chlorine cylinder is restrained in position to prevent upset.
SIG | 25pts | TR | TD15 | R309-520-7(2)(h) | Rule requires chlorine cylinders to be
restrained in position to prevent upset. This significant deficiency must be corrected
within 120 days of notification or have a corrective action plan approved by DDW.
C
150 Chlorine cylinder is not stored in direct sunlight or exposed to excessive heat.
SIG | 25pts | TR | TD17 | R309-520-7(2)(f)(ii) | Rule prohibits chlorine cylinders from
being stored in direct sunlight or exposed to excessive heat. This significant deficiency
must be corrected within 120 days of notification or have a corrective action plan
approved by DDW.
C
151 Weight scale is provided for weighing chlorine gas cylinders/containers.
SIG | 25pts | TR | TD02 | R309-520-7(2)(i) | Rule requires scales to be provided for
determining chlorine cylinder weight. This significant deficiency must be corrected
within 120 days of notification or have a corrective action plan approved by DDW.
C
152 Is the chlorine cylinder 150 pounds in capacity? ... if yes, answer the following
question(s)
Y

152A Leak response/repair plan available
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C

152B Bottle of ammonium hydroxide (56 % ammonia solution) is available for chlorine leak
detection
MIN | 15pts | TR | TD14 | R309-520-7(2)(l)(i) | Rule requires a bottle of ammonium
hydroxide (56% ammonia solution) to be available for leak detection.
C

152C Immediate access to NIOSH respirator available
SIG | 25pts | TR | TD04 | R309-520-7(2)(k)(ii) | Where 150 pound chlorine cylinders
are used, a respirator recommended the National Institute of Occupational Safety and
Health must be available. This significant deficiency must be corrected within 120 days
of notification or have a corrective action plan approved by DDW.
C
153 Is the chlorine cylinder 1 ton in capacity? ... if yes, answer the following question(s)N
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TP003 - STONE CREEK FLUORIDATOR -- Fluoridation - Active
154 Is the (daily) scale weight or volume data recorded? Explain where in the comments...
SIG | 25pts | TR | TD02 | R309-520-7(2)(i) | Rule requires scales to be provided for
determining chlorine cylinder weight. This significant deficiency must be corrected
within 120 days of notification or have a corrective action plan approved by DDW.
C (Notes: In office)
155 Is this facility Active or Inactive?I (Notes: Inactive)

155A Explain why this facility is Inactive (Is this facility in stand-by mode?)TP007 is now used
156 Background fluoride level before adding fluoride (in ppm):0 (Notes: inactive)
157 Target dose of fluoride added (in ppm):0 (Notes: inactive)
158 Typical fluoride level after adding fluoride (in ppm):0 (Notes: Inactive)
159 Sampling location is present for measuring the final fluoride level (if compliant, answer
follow-up question)
MIN | 15pts | TR | TF44 | R309-535-5(2)(d)(iii) | A sampling point shall be provided
downstream of the fluoridation facility for measuring the fluoride level of treated water.
NA (Notes: Inactive)
160 There is a means to measure the flow of water to be treated
SIG | 25pts | TR | TF11 | R309-535-5(2)(d)(i) | A means to measure the flow of treated
water shall be provided. This significant deficiency must be corrected within 120 days
of notification or have a corrective action plan approved by DDW.
NA (Notes: Inactive)
161 Fluoride concentrations, including chemical dosage and total water quantity, are
calculated daily. Daily operating records reflect chemical dosages and total quantities
used.
MIN | 15pts | TR | TF20 | R309-105-14(3) | R309-105-14(3) requires all water system
using chemical addition or specialized equipment for the treatment of drinking water
shall regularly complete operational reports. For a fluoridation facility that does not
calculate fluoride concentrations, include field and lab fluoride results.
NA (Notes: Inactive)
162 Fluoride testing instruments are properly verified (zeroed & recorded split samples) or
calibrated
MIN | 15pts | TR | TF21 | R309-525-25(4) | R309-525-25(4) states all instrumentation
needed to verify that treatment processes are sufficient shall be properly calibrated
and maintained.
NA (Notes: Inactive)
163 Fluoride chemicals are stored in covered or unopened shipping containers inside a
building.
MIN | 15pts | TR | TF06 | R390-535-5(2)(b)(i) | Fluoride chemicals shall be stored in
covered or sealed containers, inside a building, and away from direct sunlight and a
source of heat.
NA (Notes: Inactive)
164 Fluoride injection point shall not be located upstream of lime-soda softening or ion
exchange softening process.
MIN | 15pts | TR | TF50 | R309-535-5(2)(g)(iii) | Added the following: The fluoride
injection point shall not be located upstream of lime softening, iron exchange, or other
processes that affect the fluoride level.
NA (Notes: Inactive)
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165 Chemicals used for fluoridation meet the NSF/ANSI 60 standard or applicable AWWA
standards
SIG | 25pts | TR | TF04 | R309-535-5(2)(a)(i) | All chemicals used for fluoridation shall
be certified to comply with ANSI/NSF Standard 60. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
NA (Notes: Inactive)
166 Electrical outlet and cord/plug for fluoride feed pump is a non-standard receptacle type
without using an adaptor and feed pump is interconnected with a well or a service
pump (to ensure that the fluoride feed pump is turned on only when the well or service
pump is on and water is flowing in the pipe)
SIG | 100pts | TR | TF22 | R309-535-5(2)(f) | Rule requires the electrical outlet used
for fluoride feed pump to have interlock protection by being wired with the well or
service pump, such that the feed pump is only activated when the well or service
pump is on. The rule also prohibits the feed pump from being plugged into a
continuously active ("hot") electrical outlet. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
NA (Notes: Inactive)
167 Acid-resistant secondary containment is provided and adequately sized for corrosive
fluoride solutions.
SIG | 25pts | TR | TF26 | R309-535-5(2)(c )(i), (ii) and (iii) | Rule requires secondary
containment: for tanks containing corrosive fluoride solutions, to be sized to contain
the maximum volume of solution handled, and to be designed to be acid resistant.
This significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
NA (Notes: Inactive)
168 Vent for the chemical storage, injection and operating areas vents to outside
atmosphere and away from air intakes.
MIN | 15pts | TR | TF24 | R309-535-5(2)(j)(iii) | The fluoride operating area shall be
vented to outside atmosphere and away from air intakes.
NA (Notes: Inactive)
169 Incompatible chemicals are not stored in fluoride storage or injection areas.
MIN | 15pts | TR | TF28 | R309-535-5(2)(b)(i) - (iv) | Fluoride chemicals shall be stored
in covered or sealed containers, inside a building, away from direct sunlight and a
source of heat, and not be stored with incompatible chemicals. Bags or other
containers for dry materials shall be stored on pallets. Containers for dry materials
shall be kept closed to keep out moisture.
NA (Notes: Inactive)
170 Has any electrical or SCADA work been done recently that could affect the original
design or fluoride control settings?"... If the answer is yes, answer the next question.
N (Notes: Inactive)
171 Is fluorosilicic acid used for fluoridation? ... if yes, answer the following questions N (Notes: Inactive)

171A Acid solution tank is mounted on a scale or has other means of measuring the quantity
of fluoride used each day (such as level indicator or loss-of-weight recorder).
SIG | 25pts | TR | TF14 | R309-535-5(2)(d)(ii) | A means shall be provided to measure
the solution level in a tank and the quantity of the chemical used. This significant
deficiency must be corrected within 120 days of notification or have a corrective action
plan approved by DDW.
C
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171B Solution tanks for fluorosilicic acid are vented to atmosphere outside the building
(away from air intake).
MIN | 15pts | TR | TF29 | R309-535-5(3)(b)(ii) | Rule requires solution tanks at
fluorosilicic acid installations to vent to the outside, above grade, away from air
intakes, and where least susceptible to contamination.
C

171C Neutralizing chemical is available for immediate use in case of acid spill
SIG | 25pts | TR | TF42 | R309-535-5(3)(e) | A neutralizing chemical shall be available
on site to handle small quantity accidental acid spills. This significant deficiency must
be corrected within 120 days of notification or have a corrective action plan approved
by DDW.
C

171D Deluge shower and eyewash station are provided. The emergency shower and eye
wash station should be located close to, but outside of, the fluorosilicic acid operating
area.
SIG | 25pts | TR | TF15 | R309-535-5(3)(d) | Emergency eyewash stations and
showers shall be provided. This significant deficiency must be corrected within 120
days of notification or have a corrective action plan approved by DDW.
C

171E Appropriate acid-resistant personal protective equipment provided for operators
(including eye or face protection gear for handling acid, acid resistant long rubber
gloves, apron or coverall, and boots)
SIG | 25pts | TR | TF13 | R309-535-5(3)(f), R309-535-5(4)(h), R309-535-5(5)(e) | The
use of personal protective equipment (PPE) is required when handling fluorisilicic acid
and dry chemicals. This significant deficiency must be corrected within 120 days of
notification or have a corrective action plan approved by DDW.
C

171F If acid bulk storage tank and day tank are present and there is a risk of solution
overflow from the bulk tank to the day tank, each tank is provided with separate vent.
MIN | 15pts | TR | TF31 | R309-535-5(3)(b)(iii) | Rule prohibits a bulk tank from sharing
a vent with a day tank if there is a risk of solution overflow from the bulk tank to the
day tank.
C

171G If there is a transfer pump between the acid bulk storage tank and the day tank, there
is a means to stop the transfer of acid in case of transfer pump failure.
REC | 0pts | TR | TF32 | recommendation | A means to stop the transfer pump will
protect the operator and minimize possible acid spill.
C

171H Emergency shutoff is near the entrance of the fluoride operating area to turn off the
transfer pump or injection pump in case of acid spill
REC | 0pts | TR | TF33 | recommendation | Having an emergency shutoff near the
entrance of the fluoride operating area will better protect the operator and minimize the
need of entering the operating area during acid spill.
C
171I Means provided to handle catastrophic failure of acid bulk storage tank.
REC | 0pts | TR | TF34 | recommendation | Water system should have an operation
plan in place and provide adequate training to the operators for responding to
catastrophic failure of acid bulk storage tank.
C
171J There is a seismic restraint system for the acid bulk storage tank.
REC | 0pts | TR | TF35 | recommendation | The acid bulk storage tank should be
adequately restrained to prevent catastrophic failure in case of seismic event.
C
172 Is a saturator used for fluoridation? ... if yes, answer the following question(s)N (Notes: Inactive)
173 Is fluoride dry feed equipment used?....if yes, answer the following questions N (Notes: inactive)
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TP007 - WEST 400 NORTH CHLORINATOR-FLUORIDATOR -- Fluoridation -
174 Appropriate personal protective equipment provided for operators (including NIOSH
approved respirator and chemical/dust-resistant safety goggles for saturators and dry
feeders, acid-resistant gloves, apron or coverall, and boots)
SIG | 25pts | TR | TF13 | R309-535-5(3)(f), R309-535-5(4)(h), R309-535-5(5)(e) | The
use of personal protective equipment (PPE) is required when handling fluorisilicic acid
and dry chemicals. This significant deficiency must be corrected within 120 days of
notification or have a corrective action plan approved by DDW.
NA (Notes: Inactive)
175 Is this facility Active or Inactive?A
176 Background fluoride level before adding fluoride (in ppm):0.2
177 Target dose of fluoride added (in ppm):0.7
178 Typical fluoride level after adding fluoride (in ppm):0.7
179 Sampling location is present for measuring the final fluoride level (if compliant, answer
follow-up question)
MIN | 15pts | TR | TF44 | R309-535-5(2)(d)(iii) | A sampling point shall be provided
downstream of the fluoridation facility for measuring the fluoride level of treated water.
C (Notes: Downstream of fluoride injection)

179A Identify the sampling location of the measured final fluoride level:Downstream of the fluorideation injection
(Notes: Smooth nose sampling tap)
180 There is a means to measure the flow of water to be treated
SIG | 25pts | TR | TF11 | R309-535-5(2)(d)(i) | A means to measure the flow of treated
water shall be provided. This significant deficiency must be corrected within 120 days
of notification or have a corrective action plan approved by DDW.
C
181 Fluoride concentrations, including chemical dosage and total water quantity, are
calculated daily. Daily operating records reflect chemical dosages and total quantities
used.
MIN | 15pts | TR | TF20 | R309-105-14(3) | R309-105-14(3) requires all water system
using chemical addition or specialized equipment for the treatment of drinking water
shall regularly complete operational reports. For a fluoridation facility that does not
calculate fluoride concentrations, include field and lab fluoride results.
C
182 Fluoride testing instruments are properly verified (zeroed & recorded split samples) or
calibrated
MIN | 15pts | TR | TF21 | R309-525-25(4) | R309-525-25(4) states all instrumentation
needed to verify that treatment processes are sufficient shall be properly calibrated
and maintained.
C
183 Fluoride chemicals are stored in covered or unopened shipping containers inside a
building.
MIN | 15pts | TR | TF06 | R390-535-5(2)(b)(i) | Fluoride chemicals shall be stored in
covered or sealed containers, inside a building, and away from direct sunlight and a
source of heat.
C
184 Fluoride injection point shall not be located upstream of lime-soda softening or ion
exchange softening process.
MIN | 15pts | TR | TF50 | R309-535-5(2)(g)(iii) | Added the following: The fluoride
injection point shall not be located upstream of lime softening, iron exchange, or other
processes that affect the fluoride level.
C
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185 Chemicals used for fluoridation meet the NSF/ANSI 60 standard or applicable AWWA
standards
SIG | 25pts | TR | TF04 | R309-535-5(2)(a)(i) | All chemicals used for fluoridation shall
be certified to comply with ANSI/NSF Standard 60. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
C
186 Electrical outlet and cord/plug for fluoride feed pump is a non-standard receptacle type
without using an adaptor and feed pump is interconnected with a well or a service
pump (to ensure that the fluoride feed pump is turned on only when the well or service
pump is on and water is flowing in the pipe)
SIG | 100pts | TR | TF22 | R309-535-5(2)(f) | Rule requires the electrical outlet used
for fluoride feed pump to have interlock protection by being wired with the well or
service pump, such that the feed pump is only activated when the well or service
pump is on. The rule also prohibits the feed pump from being plugged into a
continuously active ("hot") electrical outlet. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
C
187 Acid-resistant secondary containment is provided and adequately sized for corrosive
fluoride solutions.
SIG | 25pts | TR | TF26 | R309-535-5(2)(c )(i), (ii) and (iii) | Rule requires secondary
containment: for tanks containing corrosive fluoride solutions, to be sized to contain
the maximum volume of solution handled, and to be designed to be acid resistant.
This significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
C
188 Vent for the chemical storage, injection and operating areas vents to outside
atmosphere and away from air intakes.
MIN | 15pts | TR | TF24 | R309-535-5(2)(j)(iii) | The fluoride operating area shall be
vented to outside atmosphere and away from air intakes.
C
189 Incompatible chemicals are not stored in fluoride storage or injection areas.
MIN | 15pts | TR | TF28 | R309-535-5(2)(b)(i) - (iv) | Fluoride chemicals shall be stored
in covered or sealed containers, inside a building, away from direct sunlight and a
source of heat, and not be stored with incompatible chemicals. Bags or other
containers for dry materials shall be stored on pallets. Containers for dry materials
shall be kept closed to keep out moisture.
C
190 Has any electrical or SCADA work been done recently that could affect the original
design or fluoride control settings?"... If the answer is yes, answer the next question.
N (Notes: None)
191 Is fluorosilicic acid used for fluoridation? ... if yes, answer the following questions Y (Notes: Yes)

191A Acid solution tank is mounted on a scale or has other means of measuring the quantity
of fluoride used each day (such as level indicator or loss-of-weight recorder).
SIG | 25pts | TR | TF14 | R309-535-5(2)(d)(ii) | A means shall be provided to measure
the solution level in a tank and the quantity of the chemical used. This significant
deficiency must be corrected within 120 days of notification or have a corrective action
plan approved by DDW.
C
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191B Solution tanks for fluorosilicic acid are vented to atmosphere outside the building
(away from air intake).
MIN | 15pts | TR | TF29 | R309-535-5(3)(b)(ii) | Rule requires solution tanks at
fluorosilicic acid installations to vent to the outside, above grade, away from air
intakes, and where least susceptible to contamination.
C

191C Neutralizing chemical is available for immediate use in case of acid spill
SIG | 25pts | TR | TF42 | R309-535-5(3)(e) | A neutralizing chemical shall be available
on site to handle small quantity accidental acid spills. This significant deficiency must
be corrected within 120 days of notification or have a corrective action plan approved
by DDW.
C

191D Deluge shower and eyewash station are provided. The emergency shower and eye
wash station should be located close to, but outside of, the fluorosilicic acid operating
area.
SIG | 25pts | TR | TF15 | R309-535-5(3)(d) | Emergency eyewash stations and
showers shall be provided. This significant deficiency must be corrected within 120
days of notification or have a corrective action plan approved by DDW.
C

191E Appropriate acid-resistant personal protective equipment provided for operators
(including eye or face protection gear for handling acid, acid resistant long rubber
gloves, apron or coverall, and boots)
SIG | 25pts | TR | TF13 | R309-535-5(3)(f), R309-535-5(4)(h), R309-535-5(5)(e) | The
use of personal protective equipment (PPE) is required when handling fluorisilicic acid
and dry chemicals. This significant deficiency must be corrected within 120 days of
notification or have a corrective action plan approved by DDW.
C

191F If acid bulk storage tank and day tank are present and there is a risk of solution
overflow from the bulk tank to the day tank, each tank is provided with separate vent.
MIN | 15pts | TR | TF31 | R309-535-5(3)(b)(iii) | Rule prohibits a bulk tank from sharing
a vent with a day tank if there is a risk of solution overflow from the bulk tank to the
day tank.
C

191G If there is a transfer pump between the acid bulk storage tank and the day tank, there
is a means to stop the transfer of acid in case of transfer pump failure.
REC | 0pts | TR | TF32 | recommendation | A means to stop the transfer pump will
protect the operator and minimize possible acid spill.
C

191H Emergency shutoff is near the entrance of the fluoride operating area to turn off the
transfer pump or injection pump in case of acid spill
REC | 0pts | TR | TF33 | recommendation | Having an emergency shutoff near the
entrance of the fluoride operating area will better protect the operator and minimize the
need of entering the operating area during acid spill.
C
191I Means provided to handle catastrophic failure of acid bulk storage tank.
REC | 0pts | TR | TF34 | recommendation | Water system should have an operation
plan in place and provide adequate training to the operators for responding to
catastrophic failure of acid bulk storage tank.
C
191J There is a seismic restraint system for the acid bulk storage tank.
REC | 0pts | TR | TF35 | recommendation | The acid bulk storage tank should be
adequately restrained to prevent catastrophic failure in case of seismic event.
D (Notes: No restraint seen.)
192 Is a saturator used for fluoridation? ... if yes, answer the following question(s)N
193 Is fluoride dry feed equipment used?....if yes, answer the following questions N
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194 Appropriate personal protective equipment provided for operators (including NIOSH
approved respirator and chemical/dust-resistant safety goggles for saturators and dry
feeders, acid-resistant gloves, apron or coverall, and boots)
SIG | 25pts | TR | TF13 | R309-535-5(3)(f), R309-535-5(4)(h), R309-535-5(5)(e) | The
use of personal protective equipment (PPE) is required when handling fluorisilicic acid
and dry chemicals. This significant deficiency must be corrected within 120 days of
notification or have a corrective action plan approved by DDW.
C
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