DDW-2025-000052

Division of Drinking Water
Checklist for New Public Drinking Water Wells
(per Utah Administrative Code, Rule R309-Jl5-O
Well Name & Description:
1. Approval to Drill the Well
dJroiect Notification Form (PNF)
dPreliminary Evaluation Report (PER) concurrence
( .w rtt drilling specifications and plans
dV*aSurt Card or authorization to drill letter from the Division of Water Rights
3 Operating Permit to Introduce the Well Water
d,Do"r..no,ion of valid water right(s)
d Recorded land use agreements, or documentation that the requirements for coverage
zunder the City/County source protection ordinance have been met
dlesign engineer's certification of conformance with plan approval conditions
d Oesisn engineer's certification of rule conformance for any deviation from approved
,plansd}.-brilt o. r.cord drawings
d I|uid"n"" of O&M manual delivery to system owner
C Satisfactory bacteriological results as evidence ofproper flushing and disinfection
DDW-Eng-0o9 Pate I of I Lasr update 4/22120t5
systemName:CaL.fllrfiax \lJc.b 7<Lr- systemNumber, ?51 3 7
2. Approval to Equip the WelI
tr PNF (if the well drilling and well equipping are desiped by different consultants)
EI Welt location data
/Certification of well seal
D )Mell driller's report (well log)
d Aquifer drawdown test results (step drawdown test & constant-rate test) for well yield
.determination
C Chemicalanalvses of the well water/-EI Plans gpd specifications for equipping the well
d Pump information (e.g., pump specifications, pump curve & operating point,
z,motor information, etc.)
EI Well head discharge piping
tr Well house desigt
Utah Division of Drinking Water - Checklist for Issuing Operating Permits
Water System Name:il,SysremNumber: pft S7- ilS@a2
Project Description ileNumber: t3Ol0
Items I through 8 below must be submitted to the Division and found to be acceptable prior to
operating permil issuance (unless a water line project meets the requirements ofR309-500-7 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 I and 4 below.
{,Certification of Rule Conformance by a professional engineer (P.E.) that all conditions of
Plan Approval were accomplished, and ifapplicable, changes made during constnrction
were in conformance with rules R309-500 through 550
As-built or record drawings incorporating all changes to approved plans and - --.
specifications (rnless no changes were made to the previously approved plans during
construction)
Confirmation that as-built or record drawings have been received by the water system
Satisfactory bacteriological samples as evidence of proper disinfection and flushing in
accordance with the appropriate ANSI/AWWA standards:
fl ANSVAWWA C65l-14 AWWA Standard for Disinfecting Water Mains
Two consecutive sample sets at least 16 hours apart, none positive (e.g., every
1,200 feet, end-ofJine, each branch)
fl ANSVAWWA C652- I I AWWA Standard for Disinfection of Water-Storage Facilities
One or more samples, none positive
tr ANSVAWWA C653-13 AWWA Standard for Disinfection of Water Treatrnent
Plants
{,
{,
to
Two consecutive samples per unit, none positive, no less than 30 minutes apart
ANSVAWWA C654-13 AWWA Standard for Disinfection of Wells
Two consecutive samples, none positive, no less than 30 minutes apart
!6
Water quality data, where appropriate [For example, include raw and finished water data that
demonstrate satisfactory performance of the treatment facility; sample should be taken from a
storage tank for residual volatile organic compounds after tank interior re-coating; etc.J
Ifapplicable, all other documentation that may have been required during the plan review
process
If applicable, confirmation that the water system owner has received the O&M manual
for the new facility
Ifapplicable, location data ofnew storage tank, treatment facility, or source
{
5
8
It Chemtech-Ford Laboratories
S€rving the lnlemounlain West Since 1953
CHEMTECH.FORD
Certificate of Analysis
Cedar Hills
Attn: TJ A3ton
10246 North Canyon Road
Cedar Hill., UT E4062
Itibd( ord6c 24x0{r90
Phono: (8Ol) 420{650
Fex:
Email: publlc{ork3@c€darillla.org
Semde lD: Hrrycy WaI
Sampled: 1111$4 13tili2
Sys,en *j UTAH25137
Pa6nntaa l{ama
Colltonn, ToLl
E. Coll
R@ort to Srate.' No
Sarrpred Byi TJ Aston
Sampre Source. WS002
Unib ethod Test Str(.d
Org/100 mL EPAS223B 11t1312O21 15.30
OrgL/100 mL EPA9223B 1111312021 15i30
Lab #r 24Km9041
Sam ple Type : lnve3ligativs
Field Res. Chtorine: tlot Piovidsd
Sampre Poirt WS002
To.t Ended FhSs
111142021 11:30
1111,,12021 11:30
Result
&
Melissa Connolly. P.oject Manager
Sandy. Utah 84070 866.792.0093 Fax wwyy. Ch ern tec h F o rd. co m801 262.7299 Main9632 Soulh 500 West
SeNing the lntermountain West since 1953
Page 1 ol 2
/'Vt,z-4a2 '<-
d.Chemtech-Ford Laboratories
SeNing lhe lnlefinountain West Since 1953
CHEMTECH.FORD
Certificate of Analysis
Cedar Hills
Attn: TJ Aston
102146 t{orth Cenyon Road
C6dar Hills, UT 84062
Wo* Ord€r: 2ax1l26
Phone: (8Ol) a20{6i)
Email: [e-mail]
Sample lD: Harvoy WGll
S a m pled : 11 l'l 1t21 12152
Syster, #j UTAH25i37
Colitorm. Total
E. Coti
Lab *:
Sample fype:
Field R$. Chlorine:
Sampla Poiat:
T.3t Ended
11t1512O21 11.00
11115t2O21 11tO0
21K112641
lnvestigative
t{ot Provi&d
ws002
Flags
Rryor, ,o SraG.' No
Sarrpred Ayi TJ Arton
Sarrpro Source,- WS002
R63ult Unlta
Orgfioo mL
O.gflm rnL
Method
EPA 92234
EPA 92238
T.st St rt d
1111t'12O21 15:15
111142024 15:15
*/'ll-z-24
Melissa Connolly. Projecr Manager
Sandy, Ul,ah 84070 866.792.0093 Fax wwNt - C h e mtec h F otd. com801.262.7299 Main9632 Soulh 500 West
SeNing the lnte,mountain West since 1953
Page 1 of 2