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Home My WebLink AboutDDW-2025-0029673/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…1/12 Public Drinking Water System Information This is information related to the location Holiday Hills holidayhillshoatreasurer@gmail.com 719-684-5305 3 miles up left for Hobble Creek Canyon, across from Pole Heaven/Khyv Peak Road, on the east side of canyon road New Public Water System Information Form This form identifies information typically related to a new public water system (PWS). Note that some of the information requested may not apply to your system. Visit the Division of Drinking Water (DDW) website (drinkingwater.utah.gov) for additional information. Drinking Water System Name * System Email * Business Phone Number * Physical Address (Where is the system located, if there is no address, please describe the location as best you can using local landmarks) * 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…2/12 Springville 84663 Yes No 204 Hobble Creek Canyon Rd, Springville, UT, 84663 City * If does not have an address list the city nearest the system. Zip Code * If no address list the zip code the system is located in County * Utah Is the physical address also the mailing address? * If the system's mailing address is different than the physical address, please provide the water system's mailing address, city, state & zip code 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…3/12 Yes No MM / DD / YYYY Administrative Contact Information The Administrative Contact is the person who is responsible for all communication from the Utah Division of Drinking Water and to whom all correspondence regarding compliance and safety will go to. Krista Hiatt kristajhiatt@gmail.com 719-684-5305 Is this system actively serving water now?* If "YES" when approximately did this system begin operation If "NO" what is the anticipated start date for serving water? * 01 01 1962 Name * Email * Business Phone Number * 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…4/12 719-684-5305 2054 Blue Grouse Cir Springville UT 84663 Owner PWS Manager PWS Operator Other:Treasurer Cell Phone Mailing Address * City * State * Zip Code * Additional Responsibilities Type 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…5/12 HOA, Domestic Non-Profit System Population and Connections 27 27 MM / DD / YYYY Legal Owner Please describe the ownership group of the water system if it is an LLC or a single individual. Please provide the name and contact information for the registered agent below if it is different from the Administrative Contact information. If the legal owner is not in Utah, please provide the Utah registered agent information. Current number of service connections * If your system is currently constructed and serving water to the public please list how many connections are currently active. Number of service connections at full build-out * This would include for developments the total number of platted If you are not at full build out for SERVICE CONNECTIONS when do you anticipate reaching full build out? 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…6/12 Residential Commercial Industrial Agricultural Combined (this is multi-use connection or a connection that doesn't otherwise fit the above connections types) 27 Residential 90 90 Check the types of service connections the system has or will have * Please list the number of each type of connection If combined connections please describe in more detail the type of connection. What is your current population * The state estimates population based on service connections as 3.13 people per connection, you may also use an occupancy rating from the local housing or fire authority as the estimated population. What is the projected population served at full build out * The state estimates population based on service connections as 3.13 people per connection, you may also use an occupancy rating from the local housing or fire authority as the estimated population. 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…7/12 MM / DD / YYYY Community Non-transient non-community Transient non-community Unsure Full and part time residential, people who live and visit here will be consuming the water When do you estimate your POPULATION reach full build out population? System Type * Select which best represents your system, this is often the most confusing and in the description question please describe your system's population as best you can and we can assist in correctly identifying your system type. The Division of Drinking Water will make the final determination on system type based on the best available and supplied information. A community water system serves residents full time or could be occupied full time as residence. A non-transient non-community water system serves the same people daily, but it is not their full time residence (think of a job site or a school). A transient non-community water system serves a rotating or seasonal population (like a restaurant, church, or campground). System Description * Describe your system's operation, what type of business or development it is and who will be consuming the water. 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…8/12 Yes No System Facilities Storage Tank Pump Station Treatment Plant Chlorinator None of the Above The system receives water by connecting into the city's water system. The city valve and meter are located just outside of the neighborhood bounds. Is this system open year round?* Does the system have any of the following check all that apply. Please provide a description of any of these facilities. Including storage capacity for tanks, the type of treatment for treatment plants, and whether chlorinators are gaseous or tablet chlorination. As well as the number of facilities for each type 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…9/12 Own source Connect to or purchase water from an existing system Other: Source Spring Well Surface Water Does this system have or will develop its own source or receive water from an existing public water system? * What type of source(s) will your system use or develop * Number of sources if more than one Source Name * Source Latitude and Longitude (NAD83 preferred)* 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0…10/12 Purchased Water Source Springville City 25005 Seasonal Operation MM / DD / YYYY MM / DD / YYYY Submission Supplying water system name Supplying water system public water system identification number Begin Date System begin date must begin on the first of the month. End Date System end date must end on the last day of the month. 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0-…11/12 Yes No This form was created inside of State of Utah. I certify that the submitted information is correct to the best of my knowledge.* Forms 3/7/24, 9:08 AM New Public Water System Information Form https://docs.google.com/forms/d/1XRXD3j9vUBDNNJECLGiGjvs4y646afsRecme4yWRshw/edit#response=ACYDBNg7v7rY08LTs0IyS9rgAx8Y5u0…12/12