DDW-2024-012378

A: Absence: R: Routine
P: Presence: I: Investigative
Page 1 of 1

JORDANELLE SPECIAL SERVICE DISTRICT

JORDANELLE LABORATORY

Po. Box 519 Phone: [phone]
Heber City Ut. 84032 Form: 28 Fax: [phone]

Microbiological Analysis of Water Samples
Standard Methods 20th, 9223B, Presence/ Absence (P/A), Colilert

MONTH: August 2022 CUSTOMER: Clawson General Contracting SYSTEM #:26086

DATE
COLLECTED ID CODE UNIQUE
LAB ID # SAMPLING POINT TIME R,I CL2 SAMPLER
INITIALS RESULT
Total
Coliform
s E.coli
8/3/2022 B4669 R004035 Water Tank 1
1600 I A.L. A A

Analyzed by: T.D.

Approved by: Date: 8/4/2022

Wade C. Webster
DDW-Eng-0010 Page 1 of 1 12/8/2015
Utah Division of Drinking Water ― Checklist for Issuing Operating Permits
(Per Utah Administrative Code, Rule R309-500-9)
Water System Name: Jordanelle SSD System Number: 26086
Project Description: Mayflower Tank #1 – 1.2 MG File Number: 16871
Items 1 through 8 below must be submitted to the Division and found to be acceptable prior to operating
permit issuance. However, distribution lines without booster pumps may be placed into service prior to
submitting all of the items if a professional engineer (PE) responsible for the entire water system has been
identified to the Director and has received items 1 through 4 below. [In this case, a public water system will
submit all items needed to obtain an Operating Permit for each distribution system project after the new water lines
have been placed into service as determined by the water system’s designated PE.]

☒ 1. Certification of Rule Conformance by a PE that all conditions of Plan Approval have been
accomplished, and if applicable, changes made during construction were in conformance with
rules R309-500 through 550
☒ 2. As-built or record drawings incorporating all changes to approved plans and specifications,
unless no changes were made to the previously submitted and approved pre-construction
drawings
☒ 3. Confirmation that as-built or record drawings have been received by the water system
☒ 4. Evidence that bacteriological samples have been collected to verify proper flushing and
disinfection in accordance with the appropriate ANSI/AWWA Standards:
☐ ANSI/AWWA C651-14 AWWA Standard for Disinfecting Water Mains
Two consecutive sample sets at least 16 hours apart, none positive (every 1200 feet, end-
of-line, each branch, etc.)
☒ ANSI/AWWA C652-11 AWWA Standard for Disinfection of Water-Storage Facilities
One or more samples, none positive
☐ ANSI/AWWA C653-13 AWWA Standard for Disinfection of Water Treatment Plants
Two consecutive samples per unit, none positive, no less than 30 minutes apart
☐ ANSI/AWWA C654-13 AWWA Standard for Disinfection of Wells
Two consecutive samples, none positive, no less than 30 minutes apart
☐ 5. Water quality data, where appropriate [Guidance: Include appropriate raw and finished water data
that demonstrate satisfactory performance of the new treatment facility. Storage tank water shall be
analyzed for residual volatile organic compounds after tank interior painting or re-coating.]
☒ 6. If applicable, all other documentation that may have been required during the plan review
process
☒ 7. If applicable, confirmation that the water system owner has received the O&M manual for the
new facility
☒ 8. If applicable, location data of new storage tank, treatment facility, or source