DDW-2024-014691

December 23, 2024
Tim Gough
Indian Hollow Creek Water Company
8186 South 1300 West
Jordan, Utah 84088
Subject:Plan Approval, Well Equipping, Country Haven Well #1 and Chlorinator (WS001, TP001); Indian Hollow Creek Water Company, System #22150, File #11191
Dear Tim Gough:The Division of Drinking Water (the Division) received the plans and specifications for equipping the Country Haven Well #1 from your consultant, Fred Duberow, P.E. with
Ensign Engineering, on November 14, 2024. Review comments were provided on November 21, 2024, and revised plans were received on December 12, 2024. The Division issued Plan Approval
for drilling Country Haven Well #1 (formerly called Indian Hollow Well) on November 5, 2018.
Our understanding of the project is equipping the Country Haven Well #1 (identified as WS001 in the Division’s database) with a Grundfos submersible pump at a design discharge rate of
139 gallons per minute (gpm), a 15 horsepower (HP) motor and construction of a new well house. The well house will include a gas chlorination facility (TP001) housed in a separate room.

The plan review of the proposed Country Haven Well #1 Chlorinator (TP001) has been completed according to the following:
The proposed Country Haven Well #1 Chlorinator (TP001) is a gas chlorinator.
This chlorinator will add chlorine to the water from Country Haven Well #1 (WS001).
This chlorinator is intended to provide secondary disinfection in the distribution system.
The chlorinated water will go to the Country Haven 250K Storage Tank (ST001) through a dedicated 4-inch supply line.
The proposed gas chlorine for disinfection meets the ANSI/NSF 60 standard.
The proposed design target dose of 1.0 mg/L or ppm (measured as free chlorine) is based on a typical flow of 139 gpm from Country Haven Well #1 (WS001).
The chlorine dose will be adjusted by manually adjusted rotometer set for the constant flow from Country Haven Well #1 (WS001).
The Point of Entry (POE) sampling location will be a continuous analyzer on the well discharge piping leaving the well house.
We have received the following information for Country Haven Well #1 (WS001) and Chlorinator (TP001):
Certification of well seal.
Well driller’s report (well log).
Aquifer drawdown test results (step drawdown test and constant-rate test).
New Source Chemical Analyses of the well water.
Plans and specifications for equipping the well.
Pump information
Well head discharge piping.
Well house design
Chlorinator design
We have completed our review of the plans and specifications, stamped, and signed by Fred Duberow, P. E., and dated December 8, 2021, and find they basically comply with the applicable
portions of Utah’s Administrative Rules for Public Drinking Water Systems in R309. On this basis, the plans for equipping Country Haven Well #1, construction of a well house and installation
of a gas chlorination facility are hereby approved.
This approval pertains to construction only. An Operating Permit must be obtained from the Director before the well and chlorinator may be put into service. A checklist outlining the
well approval process, including the items required for issuing an operating permit for this well is enclosed for your information. Enclosed please also find an Operating permit Checklist
for other components of this project.Approvals or permits from the local authority or county may be necessary before beginning construction of this project. As the project proceeds,
notice of any changes in the approved design, as well as any change affecting the quantity or quality of the delivered water, must be submitted to the Division. We may also conduct interim
and final inspections of this project. Please notify us when actual construction begins so that these inspections can be scheduled.
This approval must be renewed if construction has not begun or if substantial equipment has not been ordered within one year of the date of this letter.
Secondary Disinfection Requirements
The Indian Hollow Creek Water Companyis not required to disinfect the Country Haven Well #1 (WS001) based on bacteriological source sample results currently available as this is a new
source. The water system is electing to install the Country Haven Well #1 Chlorinator (TP001) to provide a detectable disinfectant residual in the distribution system for secondary disinfection.
The plan review of the proposed Country Haven Well #1 Chlorinator (TP001) is based on providing secondary disinfection. When this chlorinator is installed and placed in operation after
the Operating Permit issuance, the Indian Hollow Creek Water Company will be required to demonstrate ongoing compliance with the secondary disinfection requirements that are outlined
in Addendum 1 to this letter.
The Division shall be informed by telephone within 8 hours by a water supplier ofthe malfunction of any disinfection facility such that a detectable residual cannot be maintained at
all points in the distribution system per R309-105-18(1)(a).
Please be aware if the Country Haven Well #1 (WS001) is found to requireadditionaldisinfection in the future per R309-200-5(7)(a)(i), further regulations will apply. For example, if
primary disinfection is required this will include submitting disinfection CT information showing compliance with 4-log virus inactivation in accordance with the Ground Water Rule in
R309-215-16.
New Source Chemical Analyses
Radionuclide results were not received as part of the new source chemical analysis. Prior to the issuance of an operating permit please submit a radionuclide sample from the Country
Haven Well #1 (WS001). Please contact David Kruse at [e-mail] or 385-566-7789 with any questions regarding this system's source monitoring and reporting requirements.
If you have any questions regarding this approval, please contact Julie Cobleigh, P.E., of this office, at [phone], or me at [phone].
Sincerely,
Michael Newberry, P.E.
Permitting and Engineering Support Manager
JJC/mrn/mdbEnclosures─ Well Approval Checklist; Operating Permit Checklist cc:Nathan Brooks, Summit County Health Department, [e-mail] Duberow, P.E, Ensign, [e-mail]
Gough, Indian Hollow Water Company, [e-mail]

Julie Cobleigh, P.E.,Division of Drinking Water, [e-mail]
Luke Treutel, Division of Drinking Water, [e-mail]
David Kruse, Division of Drinking Water, [e-mail]
John Steffan, Division of Drinking Water, [e-mail]
Dylan Martinez, Division of Drinking Water, [e-mail]
Sitara Federico, Division of Drinking Water, [e-mail]
Deidre Beck, P.G.,- Division of Drinking Water, [e-mail] 22150 11191 WS001 TP001 PADivision of Drinking WaterChecklist for New Public Drinking Water Wells
(Per Utah Administrative Code, Rule R309-515-6)
System Name:System Number:Well Name & Description:1.Approval to Drill the Well
☐Project Notification Form (PNF)
☐Preliminary Evaluation Report (PER) concurrence
☐Well drilling specifications and plans
☐Valid Start Card or authorization to drill letter from the Division of Water Rights2.Approval to Equip the Well
☐PNF (if the well drilling and well equipping are designed by different consultants)
☐Well location data
☐Certification of well seal
☐Well driller’s report (well log)
☐Aquifer drawdown test results (step drawdown test & constant-rate test) for well yield determination
☐Chemical analyses of the well water
☐Plans and specifications for equipping the well
☐Pump information (e.g., pump specifications, pump curve & operating point, motor information, etc.)
☐Well head discharge piping
☐Well house design3.Operating Permit to Introduce the Well Water
☐Documentation of valid water right(s)
☐Recorded land use agreements, or documentation that the requirements for coverage under the City/County source protection ordinance have been met
☐Design engineer’s certification of conformance with plan approval conditions
☐Design engineer’s certification of rule conformance for any deviation from approved plans
☐As-built or record drawings
☐Evidence of O&M manual delivery to system owner☐Satisfactory bacteriological results as evidence of proper flushing and disinfection
Utah Division of Drinking Water ― Checklist for Issuing Operating PermitsWater System Name:System Number: Project Description:File Number:
Items 1 through 8 below must be submitted to the Division and found to be acceptable prior to operating permit issuance (unless a water line project meets the requirements of R309-500-7
and is not required to obtain an Operating Permit).
Distribution lines (not including in-line booster pump stations) requiring Plan Approval may be placed into service prior to submitting all of the following items and receipt of Operating
Permit if the water system has received items 1 and 4 below.☐1.Certification of Rule Conformance by a professional engineer (P.E.) that all conditions of Plan Approval were 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 approved plans during construction)☐3.Confirmation that as-built or record drawings have been received by the water system☐4.Satisfactory
bacteriological samples as evidence of proper disinfection and flushing in accordance with the appropriate ANSI/AWWA standards:
☐ANSI/AWWA C651-14 AWWA Standard for Disinfecting Water MainsTwo 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 FacilitiesOne or more samples, none positive☐ANSI/AWWA C653-13 AWWA Standard for Disinfection of Water Treatment PlantsTwo consecutive
samples per unit, none positive, no less than 30 minutes apart☐ANSI/AWWA C654-13 AWWA Standard for Disinfection of WellsTwo consecutive samples, none positive, no less than 30 minutes
apart☐5.Radionuclides☐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
Addendum 1
Future Elective Monitoring and Reporting Requirements
Chlorine Monitoring & Reporting Requirements
The water system will be required to meet elective disinfection requirements once this facility is installed and operating. As a part of these requirements, the water system will need
to continuously maintain a minimum free chlorine residual at each chlorinator Point of Entry (POE) into the system and demonstrate a detectable chlorine residual in the distribution
system.
Elective Disinfection Requirements and Reporting
Chlorine Residual ‒ Point of Entry (POE) to Distribution System
The POE sampling location will be identified in the Division’s database. The location will be identified during the plan approval process. Maintain a minimum of 0.2 mg/L residual (measured
as free chlorine) at the POE sampling location. [R309-215-16(3)(b)(iii)(A)(I) and (II)]
The chlorine residual concentration measured at the POE sampling location shall not exceed the maximum residual disinfectant level (MRDL) of 4.0 mg/L (measured as free chlorine). [R309-200-5(3)(c)(iv)]Record
and report the lowest daily value of chlorine residual measured as free chlorine at the POE sampling location (EP001). [R309-215-10(1)]Our records show that your water system will serve
approximately 200 people. Please be aware that R309-215-16(3)(b)(iii)(A)(II) requires water systems serving 3,300 people or fewer to monitor the POE chlorine residuals and take daily
grab sample(s). Alternatively, instead of taking daily grab samples, a groundwater system serving 3,300 or fewer people may choose to use an online analyzer to continuously monitor the
POE chlorine residuals entering the distribution system.
Chlorine Residual ‒ Distribution System (DS001)
This water system must maintain a detectable residualthroughout the distribution system. It is recommended to maintain the chlorine residual above 0.1 ppm in the distribution system.
[R309-520-5]

The chlorine residual measured in the distribution system shall not exceed the maximum residual disinfectant level (MRDL) of 4.0 mg/L (measured as free chlorine). [R309-200-5(3)(c)(iv)]
This water system must take a minimum of three (3) chlorine residual samples per weekat varying locations throughout its distribution system (DS001). [R309-105-10(1)(c)]
Distribution system chlorine residuals must be taken in conjunction with total coliform sampling. [R309-215-10(3)]
Disinfection Report Submission
To demonstrate ongoing compliance with elective disinfection requirements, the water system must complete monthly operational reports for each active chlorinator using a template approved
by the Division.
The monthly operational reports are submitted quarterly. The reports are due to the Division by the 10th day following the end of each reporting quarter (i.e., January 10th, April 10th,
July 10th and October 10th). The reports can be submitted by hardcopy, fax, or by uploading them to the Division’s chlorine residual reporting form which can be found at MRDL.utah.gov.
Please contact Luke Treutel at [phone] or [e-mail] to schedule training regarding proper reporting.
In addition to monthly disinfection reporting, this water system must submit the monthly average of chlorine residual samples taken in the distribution system. Distribution system chlorine
residual monitoring results are due quarterly by the same compliance dates as the monthly disinfection report and can be submitted via an online form found at mrdl.utah.gov.
Records must be maintained for a minimum of 5 years. [R309-105-17(1)]
Disinfection Byproducts Monitoring & Reporting Requirements
In addition to the chlorine monitoring and reporting described above, the system will be required to monitor disinfection byproducts as a result of introducing disinfection to the system.
According to our records, the water system will serve a population of approximately 200 people and serve groundwater from the system’s source. Based on this information, the water system
will be required to collect samples from two (2) Disinfection Byproduct (DBP) sampling sites every year during the July 1 - September 30 monitoring period. Each disinfection byproduct
sample should be a paired sample of Total Trihalomethanes (TTHM) and Haloacetic Acids (HAA5).
Water system staff will need to select two (2) sites to be sampled for DBPs. A sampling plan form will be enclosed with the operating permit letter and will need to be completed and
submitted to the Division within 30 days from the date of the operating permit letter. The specifics relating to the number and frequency of required samples will be provided in the
operating permit letter.
Source Bacteriological Monitoring 
The operating permit will include requirements for monthly Escherichia Coli (E. Coli) sampling at Country Haven Well #1 (WS001), prior to any treatment, for the months the well is in
operation or accessible for a minimum of two operating seasons. This monitoring is required to evaluate the quality of the water coming from Country Haven Well #1 (WS001) to determine
whether primary disinfection treatment is required or not. Additional monitoring and/or disinfection requirements may be assigned depending on the results of the assessment monitoring.
Source Assessment Monitoring
The source sampling requirement shall begin once the operating permit has been issued and extended to cover the duration of at least 18 months, sufficient to span two (spring/summer
or peak season) cycles. 
The sampling location of the source water bacteriological samples needs to be labeled as WS001. 
The source bacteriological sampling is in addition to the monthly total coliform sampling in the distribution system (DS001) that has been in place for your water system.
In the result of an E. coli positive sample, please contact Sitara Federico at [e-mail] or [phone] within 24 hours of notification.