DDW-2025-005917

COMPLETE FORM IN ITS ENTIRETY. IF IT DOES NOT APPLY, WRITE N/A.
I.GENERAL INFORMATION
A. PWS Information
PWSID:
UTAH27114
PWS Name:
Black Desert Resort
PWS Address:
1500 E. Black Desert Dr.
City:
Ivins
State:
UT
Zip:
84738
System Type:
Source Water Type:
Buying/Selling Relationships:
CommunityNTNCPopulation:2500
Subpart H
Ground
Consecutive System
Wholesale System
Neither
C. PWS Operations
Disinfectant Type:
Chlorine
Chloramines
Chlorine Dioxide
Ozone
Other
# of Disinfected Sources:
      Surface
      GWUDI
      Ground
1 Purchased
D. Contact Person
Name:
GregFarmer
Title:
Complex Director of Engineering
Phone:
435-357-5112
Fax:
Email:
[e-mail]
II. STAGE 2 DBPR REQUIREMENTS
A. Number of Compliance Monitoring Sites
B. Compliance Monitoring Frequency
Highest TTHM:
DBPR#1 (1 dual sample)
During peak historical month
(1-monitoring period)
Highest HAA5:
DBPR#2 (1 dual sample)
Existing Stage 1
Every 90 days (4 monitoring periods)
TOTAL:
4 samples 2 dual samples
III. MONITORING SITES

Stage 2 Compliance Monitoring Site ID
Site Type
Justification
DBPR#1
Highest TTHM
Highest HAA5
Stage 1 DBPR
Furthest point of systemTerrace Building A
DBPR#2
Highest TTHM
Highest HAA5
Stage 1 DBPR
Mid point of systemClub 73 Kitchen
IV. PEAK HISTORICAL MONTH AND PROPOSED STAGE 2 DBPR COMPLIANCE MONITORING SCHEDULE
A. Peak Historical Month
B. Proposed Stage 2 DBPR Compliance Monitoring Schedule
Stage 2 Compliance Monitoring Site ID
Projected Sampling Date (date or week)1
Period 1
Period 2
Period 3
Period 4
DBPR#1
March
June
September
December
DBPR#2
March
June
September
December

1period = monitoring period. Complete for the number of monitoring periods from Section II.B.
V. DISTRIBUTION SYSTEM SCHEMATIC
ATTACH a schematic of your distribution system showing locations of system facilities including sources, treatment plant, storage, pump stations, disinfectant applicators (e.g. chlorinators),
and proposed sample sites.
Name:
Crystal Moses
Date: 05/01/2025
Title:
Nalco Water regulatory specialist
Phone:
702-232-9193
Fax:
Signature: