DDW-2025-007156

Utah Department Of Environmental Quality
Division Of Drinking Water Sanitary Survey
Sanitary Survey
General System Information
Site Visit Date Surveyor Name
07/17/2025 Luke Treutel
GLEN CANYON NRA - LONE
ROCK CAMPGROUND
PWS ID: UTAH13053 Rating: Approved 08/15/2002 Active
1 Admin Contact (AC) [ eMail address is REQUIRED ]
MIN | 15pts | SM | G004 | R309-100-4(5) | Rule requires a person or organization be
designated as the owner of the system and name, address and phone number of such
be supplied to the Division.
*First Name: KY
*Last Name: MACKTIMA-BORHAUER
*Organization:
*Address: Redacted
*City: PAGE
*State: AZ
*Zip: 86040
*Email: [e-mail]
*Phone: [phone]
2 Legal Contact (LC) [ if no eMail address is available, enter [e-mail] ]
MIN | 15pts | SM | G004 | R309-100-4(5) | Rule requires a person or organization be
designated as the owner of the system and name, address and phone number of such
be supplied to the Division.
*First Name:
*Last Name:
*Organization: NPS - GLEN CANYON NRA
*Address: 130 NPS Maintenance Road
*City: PAGE
*State: AZ
*Zip: 86040
*Email: [e-mail]
*Phone: [phone]
Emergency Phone: [phone]
DEQ | Drinking Water
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3 Owner Contact (OW) [ if no eMail address is available, enter [e-mail] ]
MIN | 15pts | SM | G004 | R309-100-4(5) | Rule requires a person or organization be
designated as the owner of the system and name, address and phone number of such
be supplied to the Division.
*First Name:
*Last Name:
*Organization: NPS - GLEN CANYON NRA
*Address: 130 NPS Maintenance Road
*City: PAGE
*State: AZ
*Zip: 86040
*Email: [e-mail]
*Phone: [phone]
Emergency Phone: [phone]
4 Direct Operator in Charge (DO) [ if no eMail address is available, enter
[e-mail] ]
MIN | 15pts | SM | G004 | R309-100-4(5) | Rule requires a person or organization be
designated as the owner of the system and name, address and phone number of such
be supplied to the Division.
*First Name: JONATHAN EDWARD
*Last Name: COUCH
*Organization:
*Address: P.O. BOX 2845
*City: PAGE
*State: AZ
*Zip: 86040
*Email: [e-mail]
*Phone: [phone]
5 Does the system serve a Residential population?N
6 Does the system serve a Transient population? (A transient population is a rotating
population that is served by a water system that does not remain in the jurisdiction of
the water system for long periods of time. Examples of a transient population include,
but are not limited to, campers at a campground, users of a highway rest stop, skiers
at a ski resort, guests at a hotel, or patrons of a restaurant or a shopping center.)
Y
6A Population - Transient 100
6B Operating Period (Start Date) - Transient 04/01
6C Operating Period (End Date) - Transient 10/31
7 Does the system serve a Non-Transient population? (A non-transient population is a
population served by a water system that is the same population being served by the
system for at least six months of the year, but is not a resident in the system.
Examples of a non-transient population include, but are not limited to, employees of a
restaurant, shop, or ski resort; teachers and students at a school, day-care center, or
church; doctors, nurses, and other employees at a hospital or healthcare clinic.)
Y
7A Population - Non-Transient 4
7B Operating Period (Start Date) - Non-Transient 04/01
7C Operating Period (End Date) - Non-Transient 10/31
8 Population - Wholesale :0
9 Residential Connections:0
DEQ | Drinking Water
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Site Visit Info
Management and Operations
10 Commercial Connections:0
11 Industrial Connections:0
12 Agricultural Connections:0
13 Date of Survey (First Day of Field Work)07/17/2025
14 Date of Survey (Last Day of Field Work) ** this should match the Date of Survey in the
header **
07/17/2025
15 Date final report sent to system (questionnaire, deficiency report and capacity
spreadsheet)
08/05/2025
16 Water system representative present during the survey:KY MACKTIMA-BORHAUER (Notes: Aaron
and Jon also present.)
17 How much time was spent to prepare survey documents prior to field survey? (Round
up to nearest quarter hour)
1
18 How much time was spent to complete the field survey (arrival to completion; include
travel time between water system facilities)? (Round up to nearest quarter hour)
1.5
19 How much time was spent traveling from the primary workplace to the system and
back again at the end of the field survey? (Round up to nearest quarter hour)
2.5
20 How much time did it take to finish the Survey Report? (Round up to nearest quarter
hour)
1
21 Did you survey multiple water systems in one trip? ... if yes, answer the following
question(s)
N
22 For a community water system with water sources that require power to produce
sufficient flow, system is equipped with standby power option.
SIG | 25pts | SO | S033 | R309-515-6(2)(a) | Rule requires a community water system
without naturally flowing water sources, such as springs or flowing wells, to have one
or more of the system's sources equipped for operation during power outages. To
ensure continuous service when the primary power has been interrupted, a redundant
power supply is required. A redundant power supply may include a transfer switch for
auxiliary power such as a generator or a power supply service with coverage from two
independent substations. This significant deficiency must be corrected within 120 days
of notification or have a corrective action plan approved by DDW.
NA (Notes: N/A - TNC system.)
23 There are no undocumented drinking water facilities (i.e. tanks, pump stations,
treatment facilities, etc.) or recent modifications that have not gone through or in
process of DDW review [LIST UNDOCUMENTED FACILITIES OR DESCRIBE
MODIFICATIONS, IF APPLICABLE] [undocumented sources are covered in a
different question]
SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2)
and (3) | Rule requires complete plans & specification for all public drinking water
projects to be approved in writing by the Director. Any facility found that has not
started DDW review shall be considered unapproved. This significant deficiency must
be corrected within 120 days of notification or have a corrective action plan approved
by DDW.
C
24 Are there any individual home booster pumps installed in the distribution system (not
for fire suppression)?
SIG | 50pts | SM | M008 | R309-550-11(3) | R309-550-11(3)
C
25 Does the system haul water?N
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Cross Connection and Operator Certification
26 For a community system serving 100 or more connections, at least 2 water sources
are available.
SIG | 50pts | SO | TGR7 | R309-515-4(3) | Rule requires Community Water Systems
serving more than 100 connections to have a minimum of two sources except where
served by a water treatment plant. This significant deficiency must be corrected within
120 days of notification or have a corrective action plan approved by DDW.
NA (Notes: N/A - TNC system.)
27 Does system have a consecutive connection to another water system not listed in the
SOURCE section of Waterlink Report? If yes, answer the following question(s)
N
28 Does the system have a deficiency meeting the required source capacity? (USE
SPREADSHEET FOR CALCULATIONS) *IF YES, SELECT CORRECT STATEMENT
FROM THE FOLLOWING AND MARK "YES"; MARK ALL OTHER STATEMENTS
"NO."
N
29 Does the system have a deficiency meeting the required storage capacity DUE
SOLELY TO FIRE SUPPRESSION NEEDS? (USE SPREADSHEET FOR
CALCULATIONS) *IF YES, SELECT CORRECT STATEMENT FROM THE
FOLLOWING AND MARK "YES"; MARK ALL OTHER STATEMENTS "NO."
N
30 Does the system have a deficiency meeting the required equalization storage capacity
for indoor/outdoor demands (but not because of fire suppression needs)? (USE
SPREADSHEET FOR CALCULATIONS) *IF YES, SELECT CORRECT STATEMENT
FROM THE FOLLOWING AND MARK "YES"; MARK ALL OTHER STATEMENTS
"NO."
N
31 Does your water system have an Emergency Response Plan?
REC | 0pts | SM | M001 | R309-105-18 | All suppliers are advised to develop
contingency plans to cope with possible emergency situations. In many areas of the
state the possibility of earthquake damage shall be realistically considered.
Y
32 Does your Emergency Response Plan address cybersecurity? (only required for
systems over 3,300 population, otherwise mark NA)
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
NA (Notes: N/A - System serves a
population <3,300.)
33 Does your water system use SCADA? e.g. computers, laptops, phones, tablets, or any
other computer systems to manage, operate, or maintain the PWS?
N
34 Does your water system use any computer systems in regular business operations
such as accounting, billing, payroll, human resources, or management?
Y
35 For a community water system or a non-transient non-community water system, did
you make your initial service line inventory available to the public? (if a transient
system, enter NA)
REC | 0pts | MR | R006 | 40 CFR 141.84 | (a)(8)The rule requires that the service line
materials inventory be publicly accessible. (a)(8)(ii) The rule requires that water
systems serving greater than 50,000 persons make the publicly accessible inventory
available online. (a)(9) The rule requires that when a water system has no lead,
galvanized requiring replacement, or lead status unknown service lines (regardless of
ownership) in its inventory, it may comply with the requirements using a written
statement, in lieu of the inventory, declaring that the distribution system has no lead
service lines or galvanized requiring replacement service lines. The statement must
include a general description of all applicable sources used to make this
determination.
NA (Notes: N/A - TNC system.)
36 Legally adopted authority statement
MIN | 15pts | SM | M003 | R309-105-12(2) | Rule requires each public water system to
have a cross connection control program that includes a legally adopted and functional
local authority to enforce the program (i.e., ordinance, bylaw, or policy).
C
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General Maintenance and Environment
37 Documentation of annual public awareness and/or employee training
MIN | 15pts | SM | M004 | R309-105-12(2) | Rule requires each public water system to
have a cross connection control program that includes providing public education or
awareness material or presentations.
C
38 Documentation of personnel trained to manage the program (ALL COMUNITY
WATER SYSTEMS REQUIRE A DDW CERTIFIED CCC PROGRAM
ADMINISTRATOR. ALL OTHER WATER SYSTEMS REQUIRE AT A MINIMUM
BACKFLOW 101 OR EQUIVALENT/ GREATER CCC TRAINING)
MIN | 15pts | SM | M005 | R309-105-12(2) | Rule requires each public water system to
have a cross connection control program that includes an operator with adequate
training in the area of cross connection control or backflow prevention.
C
39 Does the water system have detailed records of cross connection control activities?
(inventories of backflow assemblies, devices, and air gaps installed within the system)
MIN | 15pts | SM | M006 | R309-105-12(2) | Rule requires each public water system to
have a cross connection control program that includes written records of cross
connection control activities.
C
40 Does the water system have records of on-going enforcement activities? (test history,
enforcement activities, hazard assessments)
MIN | 15pts | SM | M007 | R309-105-12(2) | Rule requires each public water system to
have a cross connection control program that includes test history and documentation
of on-going enforcement activities.
C
41 Operator meets required level of certification for water system. ( IF NO CERTIFIED
OPERATOR IS REQUIRED MARK COMPLIANT )
SIG | 50pts | OC | C001 | R309-105-11, R309-300-5(3) | Rule requires every
community and NTNC water system and public water systems that utilize
treatment/filtration to have at least one operator certified at the classified grade of the
water system. Certification must be appropriate for the type of system operated
(treatment and/or distribution). This significant deficiency must be corrected within 120
days of notification or have a corrective action plan approved by DDW.
C
42 Certified operator is within 1 hour travel time of water system. ( IF NO CERTIFIED
OPERATOR IS REQUIRED MARK COMPLIANT )
MIN | 0pts | OC | C002 | R309-300-5(14) | Rule requires the operator to be within 1
hour travel time, under normal work and home conditions, of each drinking water
system for which he is considered in direct responsible charge.
C
DEQ | Drinking Water
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Distribution
General Disinfection
43 Are there any visual indications of unsanitary conditions?
SIG | 50pts | SM | M017 | R309-200-6, R309-105-18, R309-215-4(3) | R309-200-6 The
Secondary Maximum Contaminant Levels for public water systems deals with
substances which affect the aesthetic quality of drinking water. They are presented
here as recommended limits or ranges and are not grounds for rejection. The taste of
water may be unpleasant and the usefulness of the water may be impaired if these
standards are significantly exceeded.
R309-105-18 The Director or the local health department shall be informed by
telephone by a water supplier of any "emergency situation". The term "emergency
situation...
R309-215-4(3) If the water fails to meet minimum standards, then certain public
notification procedures shall be carried out, as outlined in R309-220. Water suppliers
shall also keep analytical records in their possession, for a required length of time, as
outlined in R309-105-17.
C
44 No unprotected connection between the distribution system and a source of
contamination. (If there is an unprotected connection, describe the location in detail.)
SIG | 50pts | DS | D009 | R309-550-5(11) | R309-550-5(11)
C
45 Are air release/vacuum valves in the distribution system? ... if yes, answer the
following question(s)
N
46 Water system has a program to maintain, operate, or control the use of fire hydrants.
REC | 0pts | DS | D012 | N/A | Fire hydrants provide a direct access to the water in the
distribution system. In order to protect the quality and integrity of the water, fire
hydrant access should be controlled.
NA (Notes: N/A - No fire hydrants.)
47 Blow offs or air release valves are not directly connected to a sanitary sewer line.
SIG | 50pts | DS | D013 | R309-550-6(5)(a), R309-550-6(6)(c) and (7)(a) | Rule states
blow-offs or air relief valves shall not be connected directly to a sewer. This significant
deficiency must be corrected within 120 days of notification or have a corrective action
plan approved by DDW.
C
48 Blow offs or air release valves do not discharge below flood level in ditches or
streams.
SIG | 50pts | DS | D016 | R309-550-9(1) and (2), R309-550-13(2) | R309-550-9(1 & 3)
C
49 All water mains installed after 1995 that provide fire flow are at least 8 inches in
diameter.
MIN | 15pts | DS | D019 | R309-550-5(4) & (5) | Rule states that the minimum line size
serving a fire hydrant lateral shall be 8-inch diameter unless a hydraulic analysis
indicates that required flow and pressures can be maintained by 6-inch lines.
NA (Notes: N/A - No fire flow.)
50 Distribution system capable of providing minimum pressure of 20 psi at all service
connections.
SIG | 50pts | DS | D003 | R309-105-9, R309-550-5(1) | Rule states the distribution
system shall maintain minimum pressures as required by R309-105-9 at all points of
connection under all flow conditions. This significant deficiency must be corrected
within 120 days of notification or have a corrective action plan approved by DDW.
C
51 Was the water system constructed or new portions added after January 1, 2007? ... if
yes, answer the following question(s)
N
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WS001 - LONE ROCK WELL 1 - Active
52 Water system follows AWWA disinfection procedures for new, repaired, or
depressurized seasonal water mains and tanks.
SIG | 25pts | MR | D018 | R309-550-8(10) | All new and repaired water mains and
appurtenances shall be disinfected in accordance with AWWA Standard C651. This
significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
C
53 How often do you periodically disinfect any or all parts of your water system (i.e. batch
disinfection) other than for repairs or maintenance?
SIG | 50pts | SM | G006 | R309-105-6(1)(a), R309-500-6 | R309-105-6(1) Approval of
Engineering Plans and Specifications
R309-500-6 Plan Approval Procedure.
C
54 Is this facility Active or Inactive?A
55 Operating Period (Start Date)04/01
56 Operating Period (Ending Date)10/31
57 Undocumented sources shall not be physically connected to the drinking water
system. (IF SOURCE IS NOT IN SYSTEM INVENTORY MARK "DEFICIENT")
SIG | 200pts | SO | S001 | R309-515-6(5), R309-515-7(4), R309-500-9(2) and (3) |
R309-105-6(1) requires plans and specifications for all public drinking water projects to
be approved in writing by the Director prior to the commencement of construction. This
significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
C
58 Well casing is at least 18 inches above finished ground surface and 12 inches above
well house floor.
SIG | 25pts | SO | S003 | R309-515-6(6)(b)(vi), R309-515-6(12)(c)(ii), R309-515-
6(13)(a) | Rule requires the permanent well casing to project at least 18 inches above
the final ground surface and 12 inches above the pump house floor; at sites subject to
flooding, the top of the casing must terminate at least 3 feet above the 100-year flood
level or highest known flood elevation, whichever is higher. This significant deficiency
must be corrected within 120 days of notification or have a corrective action plan
approved by DDW.
C
59 Wellhead is sealed to prevent contamination.
SIG | 50pts | SO | S013 | R309-515-6(6)(i) | R309-515-6(6)(i) and R309-515-
6(12)(b,c,d)require a sanitary seal be installed and maintained at the wellhead and
discharge piping. This significant deficiency should be corrected within 120 days of
notification or have a corrective action plan approved by
C
60 Is the well casing vented? ... if yes, answer the following question(s)Y
60A Vent screened with #14 mesh screen
SIG | 25pts | SO | S006 | R309-515-6(12)(d)(iii) | Guidance states provisions should be
made for venting the well casing, however if vented R309-515-6(12)(d)(iii) and R309-
550-6(6)(a)require vents be fitted with a #14 mesh or finer non-corrodible screen.
C
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60B Vent down-turned
SIG | 25pts | SO | S007 | R309-515-6(12)(d)(iii) | Guidance states provisions should be
made for venting the well casing, however if vented R309-515-6(12)(d)(iii) and R309-
550-6(6)(b) requires vents be downturned or shielded to prevent the entrance of
surface water or rainwater.
C
60C Vent has adequate clearance to prevent contamination from entering the well
SIG | 25pts | SO | S008 | R309-515-6(12)(d)(iii) | Guidance states provisions should be
made for venting the well casing, however if vented R309-515-6(12)(d)(iii) and R309-
550-6(6)(b) requires vents be terminated with a discharge with an appropriate air gap.
C
61 Does the well have a pump to waste line? ... if yes, answer the following question(s)N
62 Water level is measured and recorded periodically
MIN | 5pts | SO | S015 | R309-515-6(12)(e ), R309-515-6(12)(c)(vi) | Rule requires
provisions be made to permit periodic measurement of water levels in the completed
well.
C
63 Wellhead secured to protect quality water
SIG | 25pts | SO | S002 | R309-105-10(5) | All water system facilities shall be secure.
This significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
D (Notes: No fence or other security
measures in place. Advise water system to
install fence.)
64 Well head or well house and equipment protected from flooding
SIG | 25pts | SO | S020 | R309-515-6(6)(b)(vi), R309-515-6(12)(d)(iii), R309-515-
6(13)(a) to (d) | Top of well casing shall terminate at least 18” above ground level or
12” above well house floor and for sites that flood at least 3’ above 100-year flood
level or highest known flood elevation. Well casing terminating in underground vault
shall have a drain to daylight and surface runoff directed away from vault access. Well
house floor shall be sloped for drainage, and have a drain to daylight unless highly
impractical. This significant deficiency must be corrected within 120 days of notification
or have a corrective action plan approved by DDW.
C
65 There are no unprotected cross-connections in well discharge piping.
SIG | 50pts | SO | S021 | R309-105-12(1), R309-515-6(12)(d)(iii) | Rule requires the
well discharge piping to be protected against the entrance of contamination. This
significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
C
66 Hose connections are equipped with a backflow prevention device
MIN | 15pts | SM | M007 | R309-105-12(2) | Rule requires each public water system to
have a cross connection control program that includes test history and documentation
of on-going enforcement activities.
C
67 No toxic chemicals, hazardous or flammable materials, or lubricants inside the well
house or near well head?
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C
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ST001 - STORAGE FACILITY ST001 - Active
68 Well discharge line has a smooth-nosed sampling tap, which samples the well water
before any chemical injection. (first item from the wellhead).
MIN | 5pts | SO | S023 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to
be equipped with a smooth nosed sampling tap, a check valve, a pressure gauge, a
means of measuring flow, and a shutoff valve. (smooth nosed sampling tap being the
first item from the well head and the shut-off valve as the last item)
C
69 Well discharge line has a check valve.
MIN | 5pts | SO | S024 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to
be equipped with (in order of placement from the wellhead) a smooth nosed sampling
tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve.
C
70 Well discharge line has a pressure gauge.
MIN | 5pts | SO | S025 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to
be equipped with (in order of placement from the wellhead) a smooth nosed sampling
tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve.
C
71 Well discharge line has a means to measure flow.
MIN | 5pts | SO | S026 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to
be equipped with (in order of placement from the wellhead) a smooth nosed sampling
tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve.
C
72 Well discharge line has a shut-off valve (last item from the well head).
MIN | 5pts | SO | S027 | R309-515-6(12)(d)(iv) | Rule requires the discharge piping to
be equipped with (in order of placement from the wellhead) a smooth nosed sampling
tap, a check valve, a pressure gauge, a means of measuring flow, and a shutoff valve.
C
73 Is there an air/vac valve on the well discharge line? If yes, answer the following
question(s)
N
74 Wells that pump directly into a distribution system have means to release trapped air
from pump discharge piping (for example, pumps directly to a tank, has an air release
valve or pump to waste line)
MIN | 5pts | SO | SL01 | R309-515-6(12)(d)(v) | Rule requires a well that pumps
directly into the distribution system be equipped with an air release/vacuum relief valve
located upstream of the check valve, unless the wellhead valve and piping provide for
pumping to waste all trapped air before water is introduced into the distribution
system.
C
75 Does well require oil-lubrication?N
76 Is this facility Active or Inactive?A
77 Storage tank capacity in gallons (from SDWIS; if different explain why in the
comments)
1500
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78 There are no undocumented drinking water facilities (i.e. tanks, pump stations,
treatment facilities, etc.) or recent modifications that have not gone through DDW
review
SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2)
and (3) | Rule requires complete plans & specification for all public drinking water
projects to be approved in writing by the Director. Any facility found that has not
started DDW review shall be considered unapproved. This significant deficiency must
be corrected within 120 days of notification or have a corrective action plan approved
by DDW.
C
79 Ladders, ladder guards, platform railings, or safely located entrance hatches are
provided where applicable.
MIN | 15pts | FW | V004 | R309-545-18 | Rule requires ladders, ladder guards,
platform railings, and safely located entrance hatches where applicable for water
storage tanks and requires safety practices to conform to pertinent laws and
regulations of the Utah Occupational Safety and Health Division.
C
80 Tank is vented.
SIG | 25pts | FW | VL02 | R309-545-15 | Rule requires drinking water storage tanks to
be vented. Overflows cannot be considered or used as vents. This significant
deficiency must be corrected within 120 days of notification or have a corrective action
plan approved by DDW.
C
81 Are air vents present? ... if yes, answer the following question(s)Y
81A Vent is either down-turned or shielded from contaminants (at least 2 inches below the
bottom of the opening)
SIG | 25pts | FW | V005 | R309-545-15(1) | Rule requires inverted vents on water
storage tanks to be down-turned a minimum of 2 inches below any opening and
shielded to prevent the entrance of contaminants. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
C
81B End of vent terminates at least 24 inches above earthen cover (buried tank) and is
located and sized to avoid blockage during winter.
MIN | 15pts | FW | V006 | R309-545-15(2) | For buried structures, the rule requires the
end of the vent discharge to be a minimum of 24 inches above the earthen covering.
C
81C Vent covered with #14 or finer non-corrodible mesh screen.
SIG | 25pts | FW | V007 | R309-545-15(4) | Rule requires a water storage tank vent to
be fitted with #14 mesh or finer non-corrodible screen and vents 6-inches or greater in
diameter to be fitted with additional heavy gauge screen or substantial covering to
protect the #14 mesh screen from vandalism or damage. This significant deficiency
must be corrected within 120 days of notification or have a compliance action plan
approved by DDW.
C
81D Vent 6-inch diameter and larger protected with additional heavy-gauge screen or
substantial covering.
MIN | 5pts | FW | V035 | R309-545-15(5) | Rule requires vents that are 6-inch diameter
or greater to be fitted with additional heavy gauge screen or substantial covering,
which will protect the No. 14 mesh screen against vandalism or damage.
C
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82 Are access openings present? ... if yes, answer the following question(s)
MIN | 15pts | FW | VL03 | R309-545-14 and 14(1) | Rule requires drinking water
storage tanks to be designed with reasonably convenient access to the interior for
cleaning and maintenance.
Y
82A Access opening framed at least 4 inches above roof surface or 18 inches above
earthen cover.
MIN | 15pts | FW | V008 | R309-545-14(1) | Rule requires tank access opening to be
framed at least 4 inches above the surface of the roof, or on a buried tank, to be at
least 18 inches above any earthen cover over the tank.
C
82B Access opening shoe box type with at least 2 inches of overlap
SIG | 25pts | FW | V010 | R309-545-14(2) | Rule requires the frame of an access
opening to be provided with a close fitting solid shoebox type cover which extends
down around the frame at least two inches and is furnished with a gasket(s) between
the lid and frame. This significant deficiency must be corrected within 120 days of
notification or have a corrective action plan approved by DDW.
C
82C Access opening lid properly gasketed
SIG | 25pts | FW | V009 | R309-545-14(2) | Rule requires the access opening to a tank
to be furnished with a gasket between the lid and frame. This significant deficiency
must be corrected within 120 days of notification or have a corrective action plan
approved by DDW.
C
83 Access opening locked
SIG | 25pts | FW | V029 | R309-545-14(3) | Rule requires the lid to any access
opening to have a locking device. This significant deficiency must be corrected within
120 days of notification or have a corrective action plan approved by DDW.
C
84 Roof or wall penetrations sealed
SIG | 100pts | FW | V017 | R309-545-6(1) and 545-9 | Rule requires openings in a
storage tank roof or top, designed to accommodate control apparatus or pump
columns, to be welded, gasketed, or curbed and sleeved and to have additional proper
shielding to prevent vandalism. This significant deficiency must be corrected within
120 days of notification or have a corrective action plan approved by DDW.
C
85 Area surrounding ground-level or buried storage tank is graded to prevent surface
water from standing within 50 feet.
SIG | 25pts | TR | V001 | R309-545-7(4) | Rule requires the area surrounding a
ground-level or buried water storage tank be graded in a manner to prevent surface
water from standing within 50 feet of the tank. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
C
86 Storage tank roof is sloped to prevent ponding
MIN | 15pts | FW | V003 | R309-545-9(4) | Rule requires drainage of storage tank roofs
to eliminate water ponding.
C
87 Are there cracks in the walls or roof of the storage tank? (if yes, select only one of the
following options)
N
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HD001 - HYDROPNEUMATIC TANK SET - 2 TANKS -- Hydropneumatic Tanks - Active
88 Is a tank overflow present? ... if yes, answer the following question(s)
SIG | 25pts | FW | VL01 | R309-545-13 | Rule requires all storage tanks to be provided
with an overflow that discharges at an an elevation between 12 and 24 inches above
the ground surface or the rim of the receiving basin. This significant deficiency must
be corrected within 120 days of notification or have a corrective action plan approved
by DDW.
Y
88A Overflow line discharges at least 12 inches above ground or the flood rim of receiving
basin?
SIG | 25pts | FW | V011 | R309-545-13 | Rule requires all water storage tanks to be
provided with an overflow that discharges at an elevation between 12 and 24 inches
above the ground surface or the rim of the receiving basin.
C
88B Overflow line covered with #4 mesh non-corrodible screen
SIG | 25pts | FW | V012 | R309-545-13(3) | Rule requires overflow pipes to be
screened with #4 mesh non-corrodible screens installed at a location least susceptible
to damage by vandalism. This significant deficiency must be corrected within 120 days
of notification or have a corrective action plan approved by DDW.
C
88C Overflow line connected or discharges to a sanitary sewer drain?
SIG | 50pts | FW | V013 | R309-545-13(5) | Rule prohibits overflow pipes from
connecting to, or discharging into, a sanitary sewer system. This significant deficiency
must be corrected within 120 days of notification or have a corrective action plan
approved by DDW.
NA (Notes: N/A - No sewer present.)
89 Are the drain line and overflow combined?Y
90 There are no undocumented drinking water facilities (i.e. tanks, pump stations,
treatment facilities, etc.) or recent modifications that have not gone through DDW
review
SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2)
and (3) | Rule requires complete plans & specification for all public drinking water
projects to be approved in writing by the Director. Any facility found that has not
started DDW review shall be considered unapproved. This significant deficiency must
be corrected within 120 days of notification or have a corrective action plan approved
by DDW.
C
91 A tank located below ground allows for adequate drainage, ventilation, maintenance,
and flood protection.
MIN | 15pts | PU | PT14 | R309-540-6(2) | Rule requires diaphragm or air tanks and
appurtenances located below ground to have adequate provisions for drainage,
ventilation, maintenance, and flood protection.
NA (Notes: N/A - Tank is above ground.)
92 Is there a means to measure pressure to verify the tank is pressurizing properly?
MIN | 15pts | PU | PT08 | R309-540-6(3) | A pressure gauge shall be installed on the
pressure tank inlet line.
C
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PF001 - LONE ROCK PUMP STATION -- Pump Stations - Active
93 Pump station/Hydropneumatic tank and controls not protected against hazard?
SIG | 25pts | PU | PT13 | R309-540-5(1)(a)(i) | The pump station site meets the
requirements for sanitary protection of water quality, hydraulics of the system, and
protection against interruption of service by fire, flood, or any other hazard. This
significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
C
94 Is this facility Active or Inactive?A
95 There are no undocumented drinking water facilities (i.e. tanks, pump stations,
treatment facilities, etc.) or recent modifications that have not gone through DDW
review
SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2)
and (3) | Rule requires complete plans & specification for all public drinking water
projects to be approved in writing by the Director. Any facility found that has not
started DDW review shall be considered unapproved. This significant deficiency must
be corrected within 120 days of notification or have a corrective action plan approved
by DDW.
C
96 Pump Type (Centrifugal, Hand pump, Jet, Positive Displacement, Screw, Submersible,
Vertical turbine)
Centrifugal
97 If the pump station is used to pressurize the distribution system, does it have at least
two functioning pumping units? ... if yes, answer the following question(s)
SIG | 25pts | PU | PS18 | R309-540-5(4)(b) | Rule states inline booster pumps,
withdrawing water directly from distribution lines without storage and feeding water
directly into distribution lines, shall have at least two pumping units. This significant
deficiency must be corrected within 120 days of notification or have a corrective action
plan approved by DDW.
NA (Notes: N/A - Pump station is not used
to pressurize DS.)
98 Pump station building and equipment are protected from flooding.
MIN | 15pts | PU | PS13 | R309-540-5(1)(a)(ii), R309-540-5(2)(a)(iii) | Pump station
access shall be 6" above surrounding ground and located at least 3’ above 100-year
flood elevation or highest recorded flood elevation; station is accessible at all times
unless it can be taken out of service when inaccessible.
C
99 There are no unprotected cross-connections in the pump station.
SIG | 50pts | PU | PS15 | R309-105-12(1) | Cross connections are not allowed unless
controlled by an approved and properly operating backflow prevention assembly or
device. This significant deficiency must be corrected within 120 days of notification or
have a corrective action plan approved by DDW.
C
100 Hose connections are equipped with a backflow prevention device
MIN | 15pts | SM | M007 | R309-105-12(2) | Rule requires each public water system to
have a cross connection control program that includes test history and documentation
of on-going enforcement activities.
C
101 Discharge piping has a pressure gauge.
MIN | 15pts | PU | PS03 | R309-540-5 (6)(c)(i) | Rule requires that a standard pressure
gauge be installed on the pump discharge line.
C
102 Does the pumping facility have an air relief valve located on the discharge piping? ... if
yes, answer the following question(s)
N
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TP002 - PRE FILTER AND CARTRIDGE FILTER -- Treatment General - Active
103 Pump station properly secured
MIN | 15pts | PU | PS33 | R309-540-5(1)(a)(v) | The pump station is protected to
prevent vandalism and entrance by animals or unauthorized persons.
C
104 Is this facility Active or Inactive?A
105 There are no undocumented drinking water facilities (i.e. tanks, pump stations,
treatment facilities, etc.) or recent modifications that have not gone through DDW
review
SIG | 50pts | SM | G001 | R309-100-5(2), R309-500-6, R309-500-9, R309-500-9(2)
and (3) | Rule requires complete plans & specification for all public drinking water
projects to be approved in writing by the Director. Any facility found that has not
started DDW review shall be considered unapproved. This significant deficiency must
be corrected within 120 days of notification or have a corrective action plan approved
by DDW.
C
106 Operating Period (Start Date)04/01
107 Operating Period (Ending Date)10/31
108 What is the objective of the treatment process and how do you know it is working?
(e.g., surface water treatment, disinfection, arsenic removal, TDS removal etc.)
Sediment removal
109 Walk me through the different process steps of your treatment plant. What is the
purpose of each step? Show me how you determine you are meeting your Treatment
Requirements.
Discussed
110 What Chemicals are used? Why?NA (Notes: Chlorination is done by TP001.)
111 How is the chemical dose adjusted with flow and water quality? Prompts: What flow
rate is used for the adjustment (influent, effluent, CFE)? What water quality
parameters would make you change dose rate?
NA
112 Does influent flow rate vary?N
113 Process control testing is consistent with the specific treatment process
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C
114 There is a means to accurately measure the quantities of chemicals used.
SIG | 25pts | TR | TD99 | R309-525-11(7)(d)(iv) | Provisions shall be made for
measuring the quantities of chemicals used. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
C
115 Treatment plant properly secured to protect the quality of the treated water, R309-520-
7(2)(f)
SIG | 25pts | SM | A050 | R309-400-11 | If the water system does not comply with the
directive, the Director may assess 25 to 200 points to the water system. Points shall
be assessed based upon the severity of the non-compliance, the threat to public
health and the underlying basis for the original directive.
C
116 Are liquid chemicals used? ... if yes, answer the following question(s)N (Notes: Chlorination is done by TP001.)
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117 Treatment chemicals meet ANSI/NSF 60.
SIG | 50pts | TR | TD90 | R309-525-11(5), R309-520-6(2) | All chemicals added to
drinking water, including chlorine, chloramines and chemicals used to generate
hypochlorite solutions and chlorine dioxide, shall be certified as complying with
ANSI/NSF Standard 60. This significant deficiency must be corrected within 120 days
of notification or have a corrective action plan approved by DDW.
C
118 Are all chemical feeders properly verified for accuracy?
SIG | 25pts | TR | TG21 | R309-525-11(7)(a)(i) | Feeders shall supply, at all times, the
necessary amounts of chemicals at an accurately controlled rate, throughout the
anticipated range of feed. This significant deficiency must be corrected within 120
days of notification or have a corrective action plan approved by DDW.
NA (Notes: N/A - No chemical feed at
TP002. Chlorination is done by TP001.)
119 Spare parts are available for all chemical feeders
MIN | 15pts | TR | TX09 | R309-525-11(7)(b)(i) and (ii) | R308-525-11(8)(b)(i) states
that a means consistent with the nature of the chemical solution shall be provided in a
solution tank to maintain a uniform strength of solution. Continuous agitation shall be
provided to maintain slurries in suspension. 2 dem
NA (Notes: Chlorination is done by TP001.)
120 Incompatible chemicals stored separately
SIG | 25pts | TR | TG19 | R309-525-11(7)(a)(iv) | Rule prohibits chemicals that are
incompatible from being fed, stored, or handled together. This significant deficiency
must be corrected within 120 days of notification or have a corrective action plan
approved by DDW.
C
121 Daily operating records reflect chemical dosages and total quantities used
SIG | 25pts | MR | TG20 | R309-105-14(3)(a) | Rule requires all water system using
chemical addition or specialized equipment for the treatment of drinking water to
regularly complete operational reports. This significant deficiency must be corrected
within 120 days of notification or have a corrective action plan approved by DDW.
NA (Notes: Chlorination is done by TP001.)
122 Raw water compliance samples are collected before any treatment. R309-215-4(4)
SIG | 25pts | TR | T006 | R309-525-15(10)(a)(i) | R309-525-15(10)(a)(i)
Y

122A If yes, was location shown?Yes
123 Where are finished water quality monitoring samples collected?First connection from facility.
124 Does water system have a DEQ/DWQ (UPDES permit) discharge permit for the
proper disposal of treatment plant waste to land or water?
MIN | 15pts | SM | TGR3 | R309-105-6 | R309-105-6
NA (Notes: N/A - no waste.)
125 Which parameters are watched when running treatment plant?Flow rate
126 What type of alarm system is used?Unknown
127 Does treatment plant have a SCADA system?N
128 Proper lab equipment on site to support required operations & maintenance of the
plant?
SIG | 25pts | TR | T019 | R309-525-17(1) | Sufficient laboratory equipment shall be
provided to assure proper operation and monitoring of the water plant. This significant
deficiency must be corrected within 120 days of notification or have a corrective action
plan approved by DDW.
NA (Notes: N/A - Not a treatment plant.)
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TP001 - LONE ROCK WELL 1 CHLORINATOR -- Treatment - Chlorination General - Active
129 Is this facility Active or Inactive?A
130 Is system required to provide primary disinfection? Prompt - If system knows they are
required to chlorinate based on water quality issues and/or knows they are required to
provide a minimum CT then follow-up by DDW is needed.
N
131 When chlorination is required, disinfection has operated uninterrupted during the past
year while supplying drinking water.
SIG | 50pts | TR | TD25 | R309-520-6 | Rule requires continuous disinfection of
groundwater sources that do not consistently meet bacteriological quality standards,
all surface water sources, and groundwater sources under the direct influence of
surface water. This significant deficiency must be corrected within 120 days of
notification or have a corrective action plan approved by DDW.
NA (Notes: N/A - Chlorination is not
required.)
132 Chlorine (gas & hypochlorite solution, tablets, granules, ) and chemicals used to
generate chlorine solutions and chlorine dioxide meet ANSI/NSF 60.
SIG | 50pts | TR | TD90 | R309-525-11(5), R309-520-6(2) | All chemicals added to
drinking water, including chlorine, chloramines and chemicals used to generate
hypochlorite solutions and chlorine dioxide, shall be certified as complying with
ANSI/NSF Standard 60. This significant deficiency must be corrected within 120 days
of notification or have a corrective action plan approved by DDW.
C
133 If chemical dilution or dissolution is needed, cross-connection control is provided on
water lines feeding solution tanks.
SIG | 50pts | TR | TX07 | R309-525-11(2)(c), R309-525-11(9)(b)(i) to (iv) | Cross
connection control shall be provided on make-up water lines feeding solution tanks.
This significant deficiency must be corrected within 120 days of notification or have a
corrective action plan approved by DDW.
C
134 Water flow rate is measured to control chemical feed?
SIG | 25pts | TR | TD79 | R309-525-11(7)(d)(ii) and (iii), R309-525-11(7)(a)(i) |
Chemical feed rates shall be proportional to flows and a means to measure water flow
rate shall be provided. This significant deficiency must be corrected within 120 days of
notification or have a corrective action plan approved by DDW.
C
135 Solution tanks and tank refilling line entry points are properly labeled to identify the
chemicals
MIN | 15pts | TR | TG03 | R309-525-11(8)(c)(vii) | Rule requires tanks to be properly
labeled to designate the chemical contained.
C
136 Free chlorine residual test equipment on-site or available?
MIN | 15pts | TR | TD78 | R309-520-7(1)(j) | Rule requires chlorine residual test
equipment available capable of measuring residuals to the nearest 0.1 mg/l in the
range below 0.5 mg/l, to the nearest 0.3 mg/l between 0.5 mg/l and 1.0 mg/l and to the
nearest 0.5 mg/l above 1.0 mg/l.
C
137 Spare parts are available to replace parts subject to wear and breakage
MIN | 15pts | TR | TD75 | Standard Method 334.0 Determination of Residual Chlorine
in Drinking Water Using an Online Chlorine Analyzer. [EPA 815-B-09-013 September
2009 11.1.1.2 Page 13] | Spare parts shall be provided and maintained for all
chlorinators to repair parts subject to wear and breakage.
C
138 Is chlorine chemical dose rate adjusted due to different water demand flow rates
and/or changing water quality?
Y
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TP001 - LONE ROCK WELL 1 CHLORINATOR -- Liquid Hypochlorination - Active

138A If yes, which water flow rate is used? e.g. influent flow, effluent flow, filter flow.Filter flow
139 Is there a designated chlorine Point of Entry (POE) sample location?
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C
140 POE is before first connection/customer?
SIG | 25pts | TR | T028 | R309-215 | R309-215 & R309-520-6(4)(d)
C
141 Chlorine residual records are maintained and available... if yes answer following
SIG | 25pts | TR | T028 | R309-215 | R309-215 & R309-520-6(4)(d)
Y

141A System is sampling distribution residuals throughout entire distribution system
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C

141B Distribution chlorine residuals meet minimum concentration requirement
SIG | 25pts | TR | T028 | R309-215 | R309-215 & R309-520-6(4)(d)
C

141C "What is the maximum free chlorine residual measure? This value never exceeds 4.0
mg/L? "
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C

141D System collects at least three distribution chlorine residual samples a week?
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C

141E System is sampling distribution residuals in accordance with monitoring schedule
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C
142 Treatment plant properly secured to protect the quality of the treated water. R309-520-
7(2)(f)
SIG | 25pts | SM | A050 | R309-400-11 | If the water system does not comply with the
directive, the Director may assess 25 to 200 points to the water system. Points shall
be assessed based upon the severity of the non-compliance, the threat to public
health and the underlying basis for the original directive.
D (Notes: Fence needed to secure facility
from vandalism.)
143 Daily operating records reflect chemical dosages and total quantities used
SIG | 25pts | MR | TG20 | R309-105-14(3)(a) | Rule requires all water system using
chemical addition or specialized equipment for the treatment of drinking water to
regularly complete operational reports. This significant deficiency must be corrected
within 120 days of notification or have a corrective action plan approved by DDW.
C
144 Is this facility Active or Inactive?A
145 Operational means provided to avoid injection of significantly decayed hypochlorite,
such as solution strength testing and delivery records
MIN | 5pts | TR | TD68 | R309-520-7(3)(b) | Rule requires the water system to provide
an operational means, such as keeping records of the delivery date of the hypochlorite
solution, to avoid the injection of significantly decayed hypochlorite solutions.
C
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TP002 - PRE FILTER AND CARTRIDGE FILTER -- Filtration - General
146 Solution tank is covered to minimize corrosive vapors
MIN | 5pts | TR | TD64 | R309-525-11(8)(b)(iii) | Chemical solutions shall be kept
covered.
C
147 Where concentrated hypochlorite solutions (5% or greater) are handled in containers
LARGER than 55 gallons: emergency eyewash station and a safety shower present
SIG | 25pts | TR | TD66 | R309-520-7(3)(a)(i) | Where hypochlorite solutions are used
at remote locations or in quantities of 55 gallons or less on site, safety showers are not
required and alternative emergency eyewash may be provided. This significant
deficiency must be corrected within 120 days of notification or have a corrective action
plan approved by DDW.
NA (Notes: N/A - containers are <55
gallons.)
148 Where concentrated hypochlorite solutions are handled in containers of 55 gallons or
LESS: some method of emergency eyewash provided (a full eyewash station and
shower is not required)
SIG | 25pts | TR | TD66 | R309-520-7(3)(a)(i) | Where hypochlorite solutions are used
at remote locations or in quantities of 55 gallons or less on site, safety showers are not
required and alternative emergency eyewash may be provided. This significant
deficiency must be corrected within 120 days of notification or have a corrective action
plan approved by DDW.
C
149 Hypochlorite solution storage area is protected from excessive heat and direct sunlight
MIN | 5pts | TR | TD67 | R309-520-7(3)(a)(ii) | States Storage and injection areas shall
be designed to minimize the decay in strength of concentrated hypochlorite solutions
from excessive heat or direct sunlight.
C
150 Records are kept to minimize the use of decayed hypochlorite solution
MIN | 5pts | TR | TD68 | R309-520-7(3)(b) | Rule requires the water system to provide
an operational means, such as keeping records of the delivery date of the hypochlorite
solution, to avoid the injection of significantly decayed hypochlorite solutions.
C
151 There are adequate spill containment provisions for acid and caustic liquids.
MIN | 15pts | TR | TG59 | R309-525-11(6)(a)(iv)(B), R309-525-11(8)(b)(viii) | Rule
requires liquid chemical storage tanks to have an overflow and receiving basin or drain
capable of receiving accidental spills or overflows, and meeting all the requirements of
R309-525-23.
C
152 Instrumentation and controls for the process are operational, and in service
SIG | 25pts | TR | T021 | R309-100 - R309-600 | All instrumentation needed to verify
that treatment processes are sufficient shall be properly calibrated and maintained. At
a minimum, this shall include turbidimeters. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
NA (Notes: N/A - Treatment consists of filter
and chlorinator. No instrumentation
present.)
153 Is turbidity monitoring required? ... if yes, answer the following question(s)N
154 What is the maximum filtration rate throughout the year (in gpm/sf)?Unknown
155 What criteria are used to determine when a filter backwash is needed?H
156 What criteria are used to determine filtration is functioning properly? (PSI, Turbidity,
Headloss, Flow rate, water quality parameter)
Flow rate
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TP002 - PRE FILTER AND CARTRIDGE FILTER -- Cartridge Filtration
157 Criteria is used to determine filter loading rate meets the manufacturers
recommendations? R309-525-15(2) Explain in comments...
MIN | 15pts | TR | TGR9 | R309-105-7, 8 & 18, R309-100 through 605 | Trigger for
regulatory followup to address concerns.
C
158 What criteria are used to determine if filter media needs to be replaced?Flow rate and time
159 Is backwash flow rate verified to determine it meets minimum requirements?
MIN | 15pts | TR | T076 | R309-525-15(7) | Rule requires that backwash systems be
designed and operated to
provide for adequate backwash with minimum media loss.
NA (Notes: N/A- System replaces filters
completely instead of backwashing.)
160 If system filters by Direct Filtration, the plant is configured to shut down automatically
when a source water exceeds 20 NTU for longer than 3 hours, or when the source
water turbidity exceeds 30 NTU at any time? R309-530-5(3)(g)
SIG | 25pts | TR | T021 | R309-100 - R309-600 | All instrumentation needed to verify
that treatment processes are sufficient shall be properly calibrated and maintained. At
a minimum, this shall include turbidimeters. This significant deficiency must be
corrected within 120 days of notification or have a corrective action plan approved by
DDW.
NA (Notes: N/A - Not a treatment plant.)
161 What filter is used in the cartridge?O (Notes: Paper)
162 Is filter used for Surface Water/UDI log removal credits?N
163 What criteria is used to determine the filter is functioning according to manufacturer's
specifications?
Head loss
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