DDW-2025-004493

CCR Rule Implementation Guidance 38 Revised April 2013
April 2010
CCR Certification Form

CWS Name: Nordic Mountain Water, Inc.
PWSID No: Utah29009
The community water system named above hereby confirms that its consumer confidence report has
been distributed to customers (and appropriate notices of availability have been given). Further, the
system certifies that the information contained in the report is correct and consistent with the compliance
monitoring data previously submitted to the state/primacy agency.
Certified by:
Name: Bill D Green
Title: President, Nordic Mountain Water Board of Directors
Phone #: [phone] Date: March 28, 2025
Please check all items that apply.
☐ CCR was distributed by mail.
Date completed:
 CCR was distributed by other direct delivery method. Specify direct delivery methods:
Date completed: March 28, 2025
☐ Mail – notification that CCR is available on Web site via a direct uniform resource
locator (URL)
☐ E-mail – direct URL to CCR
 E-mail – CCR sent as an attachment to the e-mail
☐ E-mail – CCR sent embedded in the e-mail
☐ Other: ____________________________________
If the CCR was provided by a direct URL, please provide the direct URL Internet address:
www
If the CCR was provided electronically, please describe how a customer requests paper CCR
delivery:

 "Good faith" efforts were used to reach non-bill paying consumers. Those efforts included the
following methods as recommended by the state/primacy agency:
Date completed: March 28, 2025
☐ posting the CCR on the Internet at www._______________________________________
☐ mailing the CCR to postal patrons within the service area (attach a list of zip codes used)
☐ advertising availability of the CCR in news media (attach copy of announcement)
☐ publication of CCR in local newspaper (attach copy of newspaper announcement)
 posting the CCR in public places (attach a list of locations)
☐ delivery of multiple copies to single bill addresses serving several persons such as: apartments,
businesses, and large private employers
☐ delivery to community organizations (attach a list)
☐ electronic city newsletter or electronic community newsletter or listserv (attach a copy of the
article or notice)
☐ electronic announcement of CCR availability via social media outlets (attach list of social
media outlets utilized)
☐ (for systems serving at least 100,000 persons) Posted CCR on a publicly-accessible Internet site at
the address: www.__________________________________________________
Date completed:
☐ Delivered CCR to other agencies as required by the state/primacy agency (attach a list)
Date completed:

Certification:
Name: Bill D Green – President
Nordic Mountain Water Board of Directors

Signature: ________________________________ Date: March 28, 2025