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Home My WebLink AboutDDW-2024-006643 BACTERIOLOGICAL SAMPLE SITE PLAN As part of the Revised Total Coliform Rule, the location from which samples are taken is to be varied. All water systems are required to maintain a current bacteriological sample siting plan. The plan shows the locations of all sample sites from which bacteriological tests are taken. Sample sites are to be representative of all pressure zones and each water source of the distribution system. The sample plan should be revised regularly and following any major construction project impacting the distribution system. WATER SYSTEM INFORMATION System Name: _______________________________________________ System #: UTAH[ ][ ][ ][ ][ ] Street Address: ______________________________________________ Phone #: _________________ Mailing Address: ____________________________________________ Email: ___________________ Service Connections: ___________ Population Served: _________ SAMPLE COLLECTION Samples collected by: __________________________________________________________________ Name of Laboratory: ____________________________________________________________________ Mailing Address: _______________________________________________________________________ State Lab Code: ______________ Phone #: ____________________ Fax #: ____________________ The Laboratory was sent a copy of this plan on: _______________________________________________ Utah Division of Drinking Water was sent a copy of this plan on:___________________________________ Seasonal Systems Is the water operated seasonally? [ ] YES [ ] NO Dates of operation: Open:________________________ Close:______________________________________ Systems, which operate seasonally, are required to take an investigative sample prior to opening to the public. Where will that sample be taken? Location_______________________________________ Date sampled: _____________________________ MAP OF SYSTEM Have you enclosed\attached a map of the distribution system showing the source (well, spring, etc.), storage tanks, treatment facilities, distribution piping, routine sample locations, and follow-up (repeat) map? [ ] Yes [ ] No PO Box 144830 Salt Lake City, UT 84114-4830 Phone: (801) 536-4100 Fax: (801) 536-4211 Email: ddwreports@utah.gov www.drinkingwater.utah.gov SAMPLE LOCATIONS The following describes each routine sample location, what months the location will be sampled, and where follow-up (repeat) samples will be taken in the event of a “positive” routine sample. Routine Sample Location: Follow-up (repeat) Sample Locations: 1. ____________________________________ (location name or address) 1. ______________________________________ (routine sample location name or address) Description: ____________________________ (hose bib, sink faucet, etc.) 2. ______________________________________ (location name or address up-stream) Water samples will be collected from this location during the months of (circle): 3. ______________________________________ (location name or address down-stream) 1st Qtr: Jan. Feb. Mar. 4. ______________________________________ 2nd Qtr: Apr. May Jun. 3rd Qtr: Jul. Aug. Sep. (source) 4th Qtr: Oct. Nov. Dec. Routine Sample Location: Follow-up (repeat) Sample Locations: 1. ____________________________________ (location name or address) 1. ______________________________________ (routine sample location name or address) Description: ____________________________ (hose bib, sink faucet, etc.) 2. ______________________________________ (location name or address up-stream) Water samples will be collected from this location during the months of (circle): 3. ______________________________________ (location name or address down-stream) 1st Qtr: Jan. Feb. Mar. 4. ______________________________________ 2nd Qtr: Apr. May Jun. 3rd Qtr: Jul. Aug. Sep. (source) 4th Qtr: Oct. Nov. Dec. Routine Sample Location: Follow-up (repeat) Sample Locations: 1. ____________________________________ (location name or address) 1. ______________________________________ (routine sample location name or address) Description: ____________________________ (hose bib, sink faucet, etc.) 2. ______________________________________ (location name or address up-stream) Water samples will be collected from this location during the months of (circle): 3. ______________________________________ (location name or address down-stream) 1st Qtr: Jan. Feb. Mar. 4. ______________________________________ 2nd Qtr: Apr. May Jun. 3rd Qtr: Jul. Aug. Sep. (source) 4th Qtr: Oct. Nov. Dec. Report Prepared by: ___________________________________________________________________ Signature and Title: ______________________________________________ Date: ______________ SAMPLE LOCATIONS The following describes each routine sample location, what months the location will be sampled, and where follow-up (repeat) samples will be taken in the event of a “positive” routine sample. Routine Sample Location: Follow-up (repeat) Sample Locations: 1. ____________________________________ (location name or address) 1. ______________________________________ (routine sample location name or address) Description: ____________________________ (hose bib, sink faucet, etc.) 2. ______________________________________ (location name or address up-stream) Water samples will be collected from this location during the months of (circle): 3. ______________________________________ (location name or address down-stream) 1st Qtr: Jan. Feb. Mar. 4. ______________________________________ 2nd Qtr: Apr. May Jun. 3rd Qtr: Jul. Aug. Sep. (source) 4th Qtr: Oct. Nov. Dec. Routine Sample Location: Follow-up (repeat) Sample Locations: 1. ____________________________________ (location name or address) 1. ______________________________________ (routine sample location name or address) Description: ____________________________ (hose bib, sink faucet, etc.) 2. ______________________________________ (location name or address up-stream) Water samples will be collected from this location during the months of (circle): 3. ______________________________________ (location name or address down-stream) 1st Qtr: Jan. Feb. Mar. 4. ______________________________________ 2nd Qtr: Apr. May Jun. 3rd Qtr: Jul. Aug. Sep. (source) 4th Qtr: Oct. Nov. Dec. Routine Sample Location: Follow-up (repeat) Sample Locations: 1. ____________________________________ (location name or address) 1. ______________________________________ (routine sample location name or address) Description: ____________________________ (hose bib, sink faucet, etc.) 2. ______________________________________ (location name or address up-stream) Water samples will be collected from this location during the months of (circle): 3. ______________________________________ (location name or address down-stream) 1st Qtr: Jan. Feb. Mar. 4. ______________________________________ 2nd Qtr: Apr. May Jun. 3rd Qtr: Jul. Aug. Sep. (source) 4th Qtr: Oct. Nov. Dec. SAMPLE LOCATIONS The following describes each routine sample location, what months the location will be sampled, and where follow-up (repeat) samples will be taken in the event of a “positive” routine sample. Routine Sample Location: Follow-up (repeat) Sample Locations: 1. ____________________________________ (location name or address) 1. ______________________________________ (routine sample location name or address) Description: ____________________________ (hose bib, sink faucet, etc.) 2. ______________________________________ (location name or address up-stream) Water samples will be collected from this location during the months of (circle): 3. ______________________________________ (location name or address down-stream) 1st Qtr: Jan. Feb. Mar. 4. ______________________________________ 2nd Qtr: Apr. May Jun. 3rd Qtr: Jul. Aug. Sep. (source) 4th Qtr: Oct. Nov. Dec. Routine Sample Location: Follow-up (repeat) Sample Locations: 1. ____________________________________ (location name or address) 1. ______________________________________ (routine sample location name or address) Description: ____________________________ (hose bib, sink faucet, etc.) 2. ______________________________________ (location name or address up-stream) Water samples will be collected from this location during the months of (circle): 3. ______________________________________ (location name or address down-stream) 1st Qtr: Jan. Feb. Mar. 4. ______________________________________ 2nd Qtr: Apr. May Jun. 3rd Qtr: Jul. Aug. Sep. (source) 4th Qtr: Oct. Nov. Dec. Routine Sample Location: Follow-up (repeat) Sample Locations: 1. ____________________________________ (location name or address) 1. ______________________________________ (routine sample location name or address) Description: ____________________________ (hose bib, sink faucet, etc.) 2. ______________________________________ (location name or address up-stream) Water samples will be collected from this location during the months of (circle): 3. ______________________________________ (location name or address down-stream) 1st Qtr: Jan. Feb. Mar. 4. ______________________________________ 2nd Qtr: Apr. May Jun. 3rd Qtr: Jul. Aug. Sep. (source) 4th Qtr: Oct. Nov. Dec. 4" - 2" Ø - WATERLINE 6" Ø - WATERLINE 8" Ø - WATERLINE 10" Ø - WATERLINE 12" Ø - WATERLINE LEGEND GROUNDWATER SOURCE WATER STORAGE TANK WATER VALVE N 9 5 W E S T 1 0 0 S O U T H , S T E . 1 1 5 , L O G A N , U T 8 4 3 2 1 PH: 435.227.0333 FAX: 435.227.0334 SHEET ID: DATE: SEPTEMBER 2017 EXHIBIT #1 CITY OF MENDON - DRINKING WATER DISTRIBUTION SYSTEM MAP SS#1 - DS001: POST OFFICE -120 N 100 W- UPSTREAM: 100 W (100 N - 200 N) DOWNSTREAM: 100 N (100 W - MAIN) SS#2 - DS001: CITY HALL & LIBRARY -15 N MAIN- UPSTREAM: CENTER (MAIN - 100W) DOWNSTREAM: CENTER (MAIN - 100E) SS#4 - DS001: MENDON STATION -95 N MAIN- UPSTREAM: 100 N (MAIN - 100W) DOWNSTREAM: 100 N (MAIN - 100E) SS#3 - DS001: MOUNTAINSIDE ELEMENTARY -235 E 125 N- UPSTREAM: 100 E (100N - 200 N) DOWNSTREAM: FONNESBECKS FEED LOT YARD HYDRANT CENTER MA I N 100 NORTH 100 SOUTH 200 NORTH 10 0 W E S T 10 0 E A S T 20 0 W E S T 125 NORTH STOO2 LOWER STORAGE STOO3 LOWER STORAGE STOO1 UPPER STORAGE TPOO1 UPPER SPRING CHLORINATOR WS002 LOWER SPRING WS001 UPPER SPRING WS005 BOOSTER STATION WELL WS003 COBBLESTONE WELL TP003 COBBLESTONE WELL CHLORINATOR ST004 COBBLESTONE STORAGE MR001 200 SOUTH 300 SOUTH 400 SOUTH 300 NORTH 400 NORTH GRAPHIC SCALE ( IN FEET ) 1 INCH = 300 FT S H - 2 3 CO B B L E S T O N E 500 NORTH 600 NORTH