Community Water System Survey 2006

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Overview

Cover
I
II
III
1-2
3-4
Fig 1
5
6A
6B
6C
7
T1 & T2
8
9
10
11
12
13-17
18-19
20
21
22-25
26-27b
27c-28

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Sheet 1: Cover

	Appendix C
	United States
	Environmental Protection Agency
	SURVEY OF COMMUNITY WATER SYSTEMS
	OMB No. XXXX-XXXX
	Expiration date: MM/DD/YY

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Sheet 2: I

Paper version:			Spreadsheet version:		Web site version:
			When you complete the survey, please visit our website at
Please return this questionnaire in the enclosed pre-paid Federal Express envelope.			www.UploadCWSSurvey.gov
			Follow instructions to upload your completed questionnaire. Please have your Response ID available		(There will be a cover sheet that welcomes the system to the web site, verifying its name and PWSID. It will include instructions for when
or mail to:					the system finishes the survey (e.g., click "done" and follow instructions to save a version of the completed questionnaire.
			If you prefer, you may return this questionnaire by emailing it as an attachment to:		it will also include the following text:)
EPA Community Water System Survey			CWSSurvey@cadmusgroup.com
c/o The Cadmus Group, Inc.
57 Water Street			You also may print a copy of the completed questionnaire and send it to us in the pre-paid Federal Express envelope provided.		Participation in the survey is voluntary. However, as a matter of policy, EPA will not disclose the identity of any respondent to this questionnaire, nor the
Watertown, MA 02472			(Please call XXX-XXX-XXXX if you need a Federal Express envelope.)		identity of any participating water system. While no respondent has ever claimed that the information asked for in this survey contains confidential business
					information (CBI), EPA will offer you the opportunity of claiming CBI in the event that we receive a Freedom of Information Act request for any data that
Participation in the survey is voluntary. However, as a matter of policy, EPA will not disclose the identity of any respondent to this questionnaire, nor the			Or you may mail your printed copy of the completed questionnaire to:		would identify you or your system. It should be noted, however, that EPA has never received a Freedom of Information Act request for such information
identity of any participating water system. While no respondent has ever claimed that the information asked for in this survey contains confidential business			EPA Community Water System Survey		in prior surveys.
information (CBI), EPA will offer you the opportunity of claiming CBI in the event that we receive a Freedom of Information Act request for any data that			c/o The Cadmus Group, Inc.
would identify you or your system. It should be noted, however, that EPA has never received a Freedom of Information Act request for such information			57 Water Street		The public reporting and record keeping burden for this collection of information is estimated to average 3.58 hours per response or to range from 1 hour to
in prior surveys.			Watertown, MA 02472		5 hours per respondent annually. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or
					provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and
The public reporting and record keeping burden for this collection of information is estimated to average 3.58 hours per response or to range from 1 hour to			Participation in the survey is voluntary. However, as a matter of policy, EPA will not disclose the identity of any respondent to this questionnaire, nor the		systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing
5 hours per respondent annually. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or			identity of any participating water system. While no respondent has ever claimed that the information asked for in this survey contains confidential business		information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a
provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and			information (CBI), EPA will offer you the opportunity of claiming CBI in the event that we receive a Freedom of Information Act request for any data that		collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An
systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing			would identify you or your system. It should be noted, however, that EPA has never received a Freedom of Information Act request for such information		agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a			in prior surveys.		number. The OMB control numbers for EPA's regulations are listed in 40 CFR Part 9 and 48 CFR Chapter 15.
collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control			The public reporting and record keeping burden for this collection of information is estimated to average 3.58 hours per response or to range from 1 hour to		If you wish, you may send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods
number. The OMB control numbers for EPA's regulations are listed in 40 CFR Part 9 and 48 CFR Chapter 15.			5 hours per respondent annually. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or		for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S.
			provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and		Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460; and to the Office of Information and Regulatory Affairs,
If you wish, you may send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods			systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing		Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk Officer for EPA. Include the EPA ICR number and OMB
for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S.			information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a		control number in any correspondence. Do not send the completed survey to this address.
Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460; and to the Office of Information and Regulatory Affairs,			collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An
Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk Officer for EPA. Include the EPA ICR number and OMB			agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
control number in any correspondence. Do not send the completed survey to this address.			number. The OMB control numbers for EPA's regulations are listed in 40 CFR Part 9 and 48 CFR Chapter 15.
			If you wish, you may send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods
			for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S.
			Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460; and to the Office of Information and Regulatory Affairs,
			Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk Officer for EPA. Include the EPA ICR number and OMB
			control number in any correspondence. Do not send the completed survey to this address.

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Sheet 3: II

Dear Owners and Operators of Community Water Systems:

The United States Environmental Protection Agency (EPA) is conducting a national survey of drinking water systems using the attached questionnaire.

About 1,700 water systems have been randomly selected to participate in this survey, and yours was one such system. This survey is conducted

approximately every five years, the last one being in 2000. We are sending you this questionnaire because you were identified in your state's database (State

Drinking Water Information System) as the most appropriate person to provide information about your water system. Participation in the survey is voluntary.

This survey attempts to identify key characteristics of many aspects of a water system to determine a national picture of operations, treatment schemes,

and finances. The questions asked in the questionnaire reflect myriad issues and topics including: current technology at the water system, sources of

drinking water, treatment techniques and objectives, storage, the distribution system, security questions, and system finance.

Once the questionnaires have been returned, the information collected will be reviewed and statistical inferences about water systems country will be made.

With this information, EPA will then determine the best policies and procedures for production of safe drinking water throughout the country.

This will accomplish a number of important objectives. First, it will give us current data that will allow us to better consider the costs and benefits to

water systems when we develop new national drinking water regulations. It will also allow us to measure the impact of drinking water regulations that have

been put in place since the last survey. This, in turn, will help us determine more affordable approaches to drinking water treatment. Furthermore, the answers

you provide in this questionnaire will help us in developing more effective programs to safeguard our nation's drinking water, provide guidance to the states

and measure the effectiveness of federal programs already in existence, such as the Drinking Water State Revolving Fund.

As we have done in the past, EPA will only make use of the information you provide when it has been aggregated with the responses of many other water

systems in the same size category as yours. We will never disclose your name or the name of your water system in any public documents. Please see the

inside cover of the questionnaire if you'd like more details on how your privacy will be protected.

Answers to this questionnaire will help EPA to understand your circumstances better than any other single tool we have. If you have ever wanted to have a

larger say in the development of national rules that could directly effect you and your water system, providing answers to this questionnaire is an important

contribution. Because only 1,700 of you are being asked to speak for over 50,000 other systems, your voice is that much more important and will carry that

much more weight. If you have ever felt that Federal regulators don't understand your situation, then please take this opportunity to tell us, in detail, just

what your situation is. It will make a difference.

Sincerely,

Brian C. Rourke

Program Analyst

Standards and Risk Management Division

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Sheet 4: III

GENERAL INSTRUCTIONS

This questionnaire asks about your system's operational and financial characteristics.

Questions 1-4 ask for general information about your system.

Questions 5 through 20 ask about your systems operational characteristics, including its water sources, treatment practices, storage and distribution system.

Question 20 through 28 ask about your systems financial characteristics, including number of connections, revenue, expenses, and capital investment.

Please complete the questionnaire.

Paper version

Please make a copy of your completed questionnaire. Return the completed questionnaire, along with any supporting documentation, in the pre-paid FedEx

envelop provided.

Your are encouraged to enclose schematics, diagrams, financial reports, or other information that will help provide a complete picture of your water system. If

you have a map of your service area, please send it with your questionnaire. If schematics, diagrams, financial or other reports contain the information

requested by a question, you may enclose and refer to the documentation rather than fill out the question. If you are responding electronically, you may

upload any of these files at www.CWSSQuestionnaire.com.

Spreadsheet version:

You may send the completed questionnaire to us electronically via e-mail, or you may upload it to our website. You also may print a copy and send it to us by

FedEx or US mail.

Your are encouraged to enclose schematics, diagrams, financial reports, or other information that will help provide a complete picture of your water system. If

you have a map of your service area, please send it with your questionnaire. If schematics, diagrams, financial or other reports contain the information

requested by a question, you may enclose and refer to the documentation rather than fill out the question. If have electronic copies of the documents, you

may upload any of these files at www.CWSSQuestionnaire.com. Please have your Responder ID available to upload files. You also may request a pre-paid

FedEx envelope at our web site, by e-mailing us at CWSSurvey@cadmusgroup.com, or by calling toll-free XXX-XXX-XXXX

Web-version

As with the paper and spreadsheet version of the questionnaire, you do not need to complete the questionnaire in one session. Your data will be saved as

you enter it. When you are finished, click on the "Done" button. Follow the instructions to save a copy of the completed questionnaire on your computer.

Your are encouraged to enclose schematics, diagrams, financial reports, or other information that will help provide a complete picture of your water system. If

you have a map of your service area, please send it with your questionnaire. If schematics, diagrams, financial or other reports contain the information

requested by a question, you may enclose and refer to the documentation rather than fill out the question. If have electronic copies of the documents, you

may upload any of these files at www.CWSSQuestionnaire.com. Please have your Responder ID available to upload files. You also may request a pre-paid

FedEx envelope at our web site, by e-mailing us at CWSSurvey@cadmusgroup.com, or by calling toll-free XX

If you require more space to answer an question than is provided, please record the information on a copy of the question or use a blank

sheet of your own.

If you have any questions, please call us toll-free at XXX-XXX-XXXX

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Sheet 5: 1-2

1	Please provide the name, title, and telephone number of the most knowledgeable person to contact for
	information. Also, please provide the name of the responder if it does not match the label:
			A. Part I – Operating Characteristics			B. Part II – Financial Characteristics
						(Write “SAME” if same as A)
	Name:
	Title:
	Tel. No.
	Fax No.
	E-mail:
2	This survey will ask you to provide operating and financial information for your public water system for
	the most recent 12-month period for which data are available. Please specify below the end dates for which
	data are provided.
	A	Operating information (end date):
				mm		dd		yy
	B	Financial information (end date):
				mm		dd		yy

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Sheet 6: 3-4

3	Please classify your water system using the following criteria. (Please check one only)
		Owned and operated by a government or public agency (not including government-owned systems that hire a private company to operate the system)
		Owned by a government or public agency and operated by a private contractor
		Owned privately and operated for profit primarily as a water business (e.g., American Water Company)
		Owned privately and not operated for profit (e.g., a homeowners association or a non-profit cooperative)
		Owned privately and operated as a necessary part of another business (e.g., a mobile home park)
4	A	Do you have regular access to a computer for sending and receiving information?
				(Skip to question 5)
	B	Do any of your computers have the following features? (Please check all that apply)
			Microsoft Excel
			Microsoft Access
			CD drive
			DVD player
	C	What access do you have to the internet? (Please check one only)
			High speed internet access (e.g., cable, DSL, wireless, or T1)
			Dial-up modem access
			No access

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Sheet 7: Fig 1

The following definitions of the components of a water system are used in this survey. Figure 1 is an example of a schematic of a water system showing water sources, treatment plants, transmission lines, and the distribution system.
Please refer to these definitions and the schematic for an explanation of the terms used in questions 6 through 11. Please submit diagrams or schematics, using figure 1 as a guide.
Please note that the identifier numbers used in the questions do not refer to specific items in figure 1. For example, use ‘S1' to refer to your first surface water source, regardless of whether it is a flowing stream, as depicted in the schematic, or another surface water source.
Term	Example Code	Definition	Figure 1: Sample diagram of intakes, treatment plants, and entry points
Surface water intake	S1, S2	A surface water intake refers to the structure at the surface water source (flowing stream, lake, reservoir, or ground water under the direct influence of surface water) that permits the withdrawal of the water from that source.
Ground water source	G1, G2, G3	A ground water source refers to the connection of untreated water from one or more wells to a water treatment plant or directly into the distribution system. Where the water from multiple wells flows through a common pipe prior to entry into the treatment plant or distribution system, the combined flow is considered one ground water source.
Purchased water connection	P1, P2	A purchased water connection refers to the transmission of water from the seller's water system to a water treatment plant or directly into the distribution system of the purchaser's water system.
Water treatment plant	WTP 1, WTP 2	A water treatment plant is any facility where water is filtered, disinfected, and/or otherwise treated prior to its transmission into the distribution system (or its conveyance to another purchasing water system). For the purposes of this survey, simple disinfection only or pH adjustment prior to entry into the distribution system are considered to be a water treatment plant. Other examples include large scale filtration plants and chemical feed on wells for disinfection. It does not include facilities within the distribution system that boost disinfection.
Buyer	B1, B2, B3	A buyer refers to any system to whom water is sold.
Entry point	E1, E2, E3	An entry point is where treated or untreated potable water enters into the water system's distribution system.

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Sheet 8: 5

5	Please draw your schematic here or submit a schematic on a separate sheet of paper. Figure 1 is an example of the type
	of schematic requested.
r

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Sheet 9: 6A

6	Provide the following information for the ground water sources, surface water intakes, or purchased water connections for this water system.
	MG is millions of gallons of water.
	MGD is millions of gallons per day.
	If the source is used on a seasonal or emergency basis, the average daily amount is for the days the source is used.
A	Ground water sources grouped by entry point to the distribution system.
	Please list each well or group of wells feeding into a single ground water entry point separately by line.
	Ground water sources grouped by entry point to the distribution system	How many individual wells supply this ground water entry point?	Is this a seasonal source? (Yes or No)	Is this an emergency source? (Yes or No)	If this is a seasonal or emergency source, how many months was it used in the 12-month period reported in question 2A?	Is the water from this source treated by your system?1 (Yes or No)	What is the total amount of water drawn from this source in the 12-month period reported in question 2A? (MG)	On average, how much water is drawn from this source on a typical day that they were used during the reporting period in question 2A? (MGD)	Estimate the maximum daily amount of water that can be drawn from this source that supplies each ground water entry point.2 (MGD)
	G1
	G2
	G3
	G4
	G5
	G6
	G7
	G8
	G9
	G10
	1. Treatment includes any process that alone or in combination with other processes has an objective of producing or maintaining potable water.
	2. If there is no limit on the amount of water that can be withdrawn, enter "no limit" here.
	Limits on the availability of water include source capacity, water quality requirements, state and local water resource plans, local economic development and growth
	projections, contractual obligations, permits, water rights, and legal constraints. Limits also include current equipment constraints imposed by system components,
	pumps, and water treatment plant capacity.

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Sheet 10: 6B

B	Surface water intake identifiers.
	Please list each surface water intake separately by line.
	Surface water intake identifiers	What is the source for this surface water intake? (Please select one)	Is this a seasonal source? (Yes or No)	Is this an emergency source? (Yes or No)	If this is a seasonal or emergency source, how many months was it used in the 12-month period reported in question 2A?	Is the water from this intake treated by your system?2 (Yes or No)	What is the total amount of water drawn from this source in the 12-month period reported in question 2A? (MG)	On average, how much water is drawn from this source on a typical day that it was used during the reporting period in question 2A? (MGD)	Estimate the maximum daily amount of water that can be drawn from each surface water intake.3
		1) Flowing stream, 2) Reservoir or lake, 3) GWUDI1
	S1
	S2
	S3
	S4
	S5
	S6
	S7
	S8
	S9
	S10
	1. GWUDI is ground water under the direct influence of surface water.
	2. Treatment includes any process that alone or in combination with other processes has an objective of producing or maintaining potable water.
	3. If there is no limit on the amount of water that can be withdrawn, enter "no limit" here.
	Limits on the availability of water include source capacity, water quality requirements, state and local water resource plans, local economic development
	and growth projections, contractual obligations, permits, water rights, and legal constraints. Limits also include current equipment constraints imposed by
	system components, pumps, and water treatment plant capacity.

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Sheet 11: 6C

C

Purchased water connections.

If your system purchases water from one source but has multiple connections or turnouts, please list each connection or turnout separately by line.

Purchased water con-nections

Provide the PWSIDs or name of the sellers for each connection. A seller can appear more than once.

Is this a seasonal source? (Yes or No)

Is this an emergency source? (Yes or No)

If this is a seasonal or emergency source, how many months was it used in the 12-month period reported in question 2A?

When you purchase this water, is it one of the following? (Please select one)

What is the source of the purchased water? (Please select one)

Do you boost disinfection of water from this source after it enters the distribution system? (Yes or No)

Do you provide any other treatment1 to this water? (Yes or No)

What is the total amount of water drawn from this source in the 12-month period reported in question 2A? (MG)

On average, how much water is drawn from this connection on a typical day that it was used during the reporting period in question 2A? (MGD)

Estimate the maximum daily amount of water that can be drawn from each purchased water connection.3

1) Finished, 2) Partially treated1, 3) Untreated, 4) Unknown

1) Ground, 2) Surface, 3) GWUDI,2 4) Unknown

P1

P2

P3

P4

P5

P6

P7

P8

P9

P10

1. Treatment includes any process that alone or in combination with other processes has an objective of producing or maintaining potable water.

2. GWUDI is ground water under the direct influence of surface water.

3. If there is no limit on the amount of water that can be withdrawn, enter "no limit" here.

Limits on the availability of water include source capacity, water quality issues, state and local water resource plans, local economic development and growth

projections, contractual obligations, permits, water rights, and legal constraints. Limits also include constraints imposed by system components, pipeline carrying

capacity, and water treatment plant capacity.

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Sheet 12: 7

7	Provide the following information for each water treatment plant in this water system. A water treatment plant is any facility that treats or otherwise improves
	the quality of the water. It includes large scale filtration plants, chemical feeds on wells for disinfection, and facilities that adjust pH prior to entry to the
	distribution system. It does not include facilities within the distribution system that boost disinfection.
	Average daily production is the total amount of water produced by the plant divided by the number of days the plant was in use in the 12-month reporting
	period in question 2A. Mathematically, it is the sum of all the daily flows divided by the number of daily flows. Design capacity refers to the maximum
	amount of water the plant can produce in a single 24-hour period with all treatment trains operating at capacity. Peak daily production refers to the maximum
	amount produced in a single day over the 12-month reporting period in question 2A.
	Water treatment plant identifier	List all of the surface, ground, and purchased water sources from question 6 that feed into each water treatment plant.	What was the average daily production of each water treatment plant for the 12-month period reported in question 2A?	What was the design capacity for each water treatment plant?	What was the peak daily production for each water treatment plant for the 12-month period reported in question 2A?
	WTP1
	WTP2
	WTP3
	WTP4
	WTP5
	WTP6
	WTP7
	WTP8
	WTP9
	WTP10

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Sheet 13: T1 & T2

Use the treatment processes in table 1 and the objectives in table 2 to describe the treatment processes used by each plant in question 8.
Table 1: Treatment Processes Codes					Table 2: Treatment Objectives Codes
Treatment	Code	Treatment	Code		Treatment	Code
Disinfection		Filtration (continued)			Algae control	O1
Chlorine	T1	Rapid sand filter	T21		Corrosion control	O2
Chlorine dioxide	T2	Deep bed mono-media	T22		Primary disinfection	O3
Chloramines only	T3	Dual/multi media	T23		Secondary disinfection	O4
Chloramine with a free chlorine	T4				Disinfectant byproduct control	O5
period (based on need in the		Membranes			Dechlorination	O6
distribution system and not		Reverse osmosis	T24		Oxidation	O7
routinely done)		Microfiltration	T25		Iron removal	O8
Chloramine with seasonal	T5	Ultrafiltration	T26		Manganese removal	O9
(routine) free chlorine use		Nanofiltration	T27		Taste/odor control	O10
Ozone	T6				TOC removal	O11
Ultraviolet light	T7	Other			Particulate/turbidity removal	O12
Mixed oxidant	T8	Aeration	T28		Softening (hardness removal)	O13
		Potassium permanganate	T29		Recarbonation	O14
Filtration Processes		Corrosion control	T30		Organic chemical contaminant removal (e.g., VOCs, pesticides)	O15
Coagulant addition/rapid mix	T9	Ion exchange	T31		Inorganic chemical contaminant removal (e.g., arsenic)	O16
Polymer addition	T10	Activated alumina	T32		Radionuclides contaminant removal	O17
Flocculation	T11	Iron-based adsorptive media	T33		Security	O18
Settling/sedimentation	T12	Sequestration	T34		Mussel control	O19
Lime/soda ash softening	T13	Fluoride addition	T35		Disinfection byproduct control	O20
Recarbonation	T14	Dissolved air flotation	T36		Fluoridation	O21
		Granular activated carbon	T37		Other (1) see question 8	O22
Filtration		Centrally managed POU/POE	T38		Other (2) see question 8	O23
Micro strainer	T15	Clearwell and/or contact vessel	T39		Other (3) see question 8	O24
Slow sand filter	T16	(e.g., basin, pipeline)
Bag or cartridge	T17	Other (1) see question 8	T40
Diatomaceous earth	T18	Other (2) see question 8	T41
Pressure filtration	T19	Other (3) see question 8	T42
Green sand	T20

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Sheet 14: 8

8 Using the water treatment plant identifiers from question 7, characterize the treatment practices used in each of your system's treatment plants.

-

Please enter the treatment process and objective for each step of the treatment practice. Use the codes from tables 1 and 2 above.

-

There are a total of 15 steps available to select these processes and objectives. Each step may have up to three processes and six objectives. Copy this page if you

have more than 10 plants or use more than 15 steps in a single plant. If you have more than six objectives for a treatment step, please provide the six most important objectives.

-

Do not include disinfection booster stations that are within the distribution system.

Two examples are provided. The first is example is conventional filtration. The second is iron/manganese removal.

WTP

Step 1

Step 2

Step 3

Step 4

Step 5

Step 6

Step 7

Step 8

Step 9

Step 10

Step 11

Step 12

Step 13

Step 14

Step 15

Ex. 1

Process

T10

T11

T12

T24

T1

T40

Objective

O12

O12

O12

O12

O3

O3

Ex. 2

Process

T8

T22

T1

Objective

O6

O8

O7

O8

O3

O7

WTP 1

Process

Objective

WTP 2

Process

Objective

WTP 3

Process

Objective

WTP 4

Process

Objective

WTP 5

Process

Objective

WTP 6

Process

Objective

WTP 7

Process

Objective

WTP 8

Process

Objective

WTP 9

Process

Objective

WTP 10

Process

Objective

Use treatment codes T40, T41, and T42 for any treatment process you use that is not listed in Table 1 on page 9.

Use treatment codes O21, O22, and O23 for any objective that is not listed in Table 2 on page 9.

Please specify what each process is:

Please specify what each objective is:

T40: Other (1)

O21: Other (1)

T41: Other (2)

O22: Other (2)

T42: Other (3)

O23: Other (3)

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Sheet 15: 9

9

Using the water treatment plant identifiers from question 7, indicate if the specified residuals management practices are used and provide the

requested information regarding potential discharge. (Yes or No for each category)

Do you use the following residual management process in the following water treatment plants? (Use the water treatment plant numbers from Question 8)

Dewatering

Disposal

Mechanical dewatering (e.g., belt presses, centrifuges, pressure filters, and vacuum filters)

Non-mechanical dewatering (e.g., lagoons, drying beds, and freeze assisted drying beds)

Land ap-plication (e.g., bene- ficial use)

Deep well injection

Waste landfill

Waterway

Septic system

Sanitary sewer

Water treatment plant identifier

On-Site Storage

Hazar- dous waste landfill

Non-hazard-ous waste landfill

Can you discharge to a water- way (surface water)?

If yes, do you discharge to a water- way?

Can you discharge to a septic system?

If yes, do you discharge to a septic system?

Can you discharge to a sanitary sewer?

If yes, do you discharge to a sanitary sewer?

Recycle filter back- wash

Other (specify)

WTP 1

WTP 2

WTP 3

WTP 4

WTP 5

WTP 6

WTP 7

WTP 8

WTP 9

WTP 10

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Sheet 16: 10

[QUESTION 10 ASKED OF VERY LARGE SYSTEMS ONLY]
10	A	Is your system currently treating (directly or indirectly) for any contaminants not regulated by the federal government? (Directly means that the treatment
		in place is due to the presence of the unregulated contaminant. Indirectly means that the unregulated contaminant is being addressed because of current
		treatment practices for a regulated contaminant.)
		Yes
		No (Skip to question 11)
	B	Please provide the following information about unregulated contaminants addressed by your treatment plants.
		(If you have more than 10 unregulated contaminants, please make a copy of this table.)
		What are the unregulated contaminants that are being addressed by your treatment plants?	If known, please provide the concentration of the unregulated contaminant in the raw and finished water as it leaves the plant. Enter N/A if unknown. Enter ND if the contaminant was not detected. Please provide the units as well (e.g., mg/L).				What water treatment plant treats for the unregulated contaminant (use plant identifiers from questions 8)?	Is the plant treating directly for this contaminant, i.e., is it in place to treat specifically for this contaminant?
			Raw water		Finished Water
			Concentration	Units	Concentration	Units

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Sheet 17: 11

11

A

What is the total capacity of storage located past

D

Please provide the following information about the practices you use to maintain water

the first residential customer?

quality in storage vessels.

(in millions of gallons)

1

2

B

Please indicate the number of each type of storage facility that you

Check below if

have in your utility that are located past the first residential

you believe you

customer.

Do you use any

have adequate

of the following

information on

1

Fully or partially buried

practices to

how to use each

maintain water

strategy to

2

Ground level

quality in

address water

storage vessels

quality

3

Elevated

in your system?

degradation in

(Please check all

your storage

4

Hydropneumatic

that apply)

facilities

5

a. Standpipes

a

Modeling or other detention time evaluations

b. How many standpipes are operated

b

Longer fill/draw cycles to increase mixing

as surge tanks?

c

Inlet/outlet modifications

6

Other

d

Mechanical mixing

C

Indicate the typical number of years between

cleaning an individual storage vessel:

e

Increase or switch disinfectant residual

f

Operational modifications to maintain

disinfectant residual

g

Other (please specify)

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Sheet 18: 12

12

Estimate the length of the transmission lines and distribution mains in your system, and length of pipe replaced in the last five years.

A transmission line is defined as a pipeline that transports raw or partially treated water to a water treatment plant or finished water to a

distribution grid.

A distribution main is defined as part of the pipeline network that distributes water to the consumers.

Replaced pipe is pipe that has either been physically removed from the ground or has been subject to major rehabilitation efforts.

New pipe installed is new transmission lines or distribution mains that do not replace existing pipe.

Distribution Mains

Water Treatment Plant

Source

Transmission Line

Transmission Line

Pipe Type and Diameter

Existing (or Current) Length of Pipe (In Miles)

Length of Pipe Replaced in the Last 5 Years1 (In Miles)

Length of New Pipe Installed in the Last 5 Years1 (In Miles)

Transmission lines

Mains

Less than 6"

6-10"

Greater than 10" and Less than 24"

24" or greater

1. Ending on the date shown in your answer to question 2A.

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Sheet 19: 13-17

13	A	Please provide the following information about each pressure zone in your distribution system.
		1	How many pressure zones do you have in your distribution system?
		2	How many pressure zones have booster disinfection stations?
		3	How many booster disinfection stations do you have throughout your distribution system?
	B	If your system has experienced a loss of pressure during the past operating year below 20 psi,
		please tell us the number of pressure losses that occurred for each of the following reasons:
		1	Power outage
		2	Fire
		3	Main pipeline burst
		4	Other (such as maintenance, flushing; please specify)
14	Do you flush your distribution system on a regular basis?
		Yes		No	(If No, skip to question 17)
15	What percentage of the distribution system is flushed each year on a regular basis?							%
16	What approach is used when you flush your system on a regular basis?
	A	(Uni-) Directional (Restricting water flow to one direction using closed valves to maximize velocity,
		generally from source/plant to the lowest elevation in the system)
	B	Random or non-directional (Opening hydrants on lines without closing valves or restricting the direction of water flow)
	C	Dead end (opening a hydrant or flush valve on the dead-end line)
	D	Other (Please specify)
17	A	If you do not flush your system on a regular basis, have you ever flushed your system?
			Yes		No	(If No, skip to question 18)
	B	1	What was the last year you flushed your system?
		2	What year did you flush the system before that?
			(Enter "NA" if you only flushed the system once.)

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Sheet 20: 18-19

18

Please provide the following data on disinfection residuals for one summer month (June, July, August, September) and one winter month

(December, January, February).

Average Entry Point Disinfectant Residual for the Treatment Plant with the Highest Average Daily Flow (mg/L)

Distribution system

Surface water entry point1

Ground water entry point

Average distribution disinfectant residual

Percentage of Distribution System Samples <0.2 mg/L, including non-detects

(mg/L as Cl2)

(mg/L as Cl2)

(mg/L as Cl2)

Season

Month

Total Cl2

Free Cl2

Total Cl2

Free Cl2

Total Cl2

Free Cl2

Total Cl2

Summer

%

Winter

%

1. Surface water entry points includes ground water under the direct influence of surface water. If the plant treats both surface and ground water,

report the results in the surface water entry points columns.

[QUESTIONS 19 ASKED OF SMALL AND MEDIUM SYSTEMS ONLY]

19

Please list the 5-digit ZIP codes included in your service area. This information will be used to identify the unique demographic characteristics

of your service area so that EPA can better assess the financial and operating characteristics of the system

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Sheet 21: 20

20	Please answer the following questions about water security.				Enter Yes or No
	A	1		Has your water system attended any EPA-sponsored water security training?
		2		Have you used EPA's web-based water security technology product guides?
		3		Have you heard of EPA's Response Protocol Toolbox?
		4		Have you heard of the 14 features of an “active and effective” water security program?
		5		What, if any, information do you need that would help you protect your system against security threats? (Please write a brief answer below)
	B	1		Have you heard of mutual aid and assistance agreements and/or compacts? (If No, skip to section C)
		2		Would you be interested in joining such an agreement and/or contract?
		3		If not, please explain why not ______________________________________________________________________________________
	C	What are the two largest barriers to enhancing security at your system? (Please select only 2)
		1		Lack of interest at the system, public, or rate board level
		2		Competing priorities (regulatory compliance, aging infrastructure, etc.)
		3		Lack of funding
		4		Lack of knowledge / guidance / training materials
		5		Other (Please specify)
	D	Who do you prefer to get Water Security Information / Products from? (Please select only one)
		1		Department of Homeland Security
		2		EPA
		3		Water Associations
		4		No preference
		5		Other (Please specify)

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Sheet 22: 21

21

A

Please complete the table below for the most recently completed fiscal year (the

B

Please indicate your water system's revenue during the last

12-month period indicated in question 2B). Financial information is needed to assess

year from other water-related revenue sources.

the financial condition of the water system, to assess possible future expenditures, and

to see how costs are distributed among customers. No financial information provided

1

Connection and development fees

$

will affect any EPA or other Federal financial assistance program.

2

Revenue from the Government (e.g. General

fund of Municipal Government, public

Column A: What was the amount of water produced and delivered to each of the following

systems only)

$

customer categories? Report the amount in millions of gallons per year (MGY).

3

Other water-related revenue not reported

Unaccounted for water includes system losses and uncompensated uses (e.g., fire flow).

above (e.g., fines, penalties, other fees;

$

please specify)

Columns B and C: How many connections and people did your drinking water

system serve year-round? Please indicate the number of connections and number of

people served by your water system for all customer types that apply. If you do not

know the connections or people served, please provide your best estimate.

C

Provide the PWSID or name of each public water supplier

included in the response to part A1 above.

Column D: What were your drinking water system's revenues from water sales for

each of the following customer categories? (Enter “0” if you do not have revenue

1

Finished water

from a source.)

Column A

Column B

Column C

Column D

Water

Number of

Number of

Water

Quantity

Connections

People

Sales

2

Partially treated or untreated water

Delivered

Served

Served

Revenue

1

Sold to other water suppliers

a Finished water

MGY

$

b Partially-treated

D

Please indicate the revenue you receive from

or untreated water

MGY

$

non-drinking water related business, not

included above, including rental income and the

2

Residential

MGY

$

sale of other goods and services:

$

3

Non-residential (Commercial, Industrial, Agricultural)

E

If you did not report any revenue under parts A, B, and D,

a Finished water

MGY

$

how did you pay for your system's operations?

b Partially-treated or

untreated water

MGY

$

4

Unaccounted for water and

uncompensated usage

MGY

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Sheet 23: 22-25

22

Please identify your drinking water system's billing structure.

[QUESTIONS 24 ASKED OF SMALL, MEDIUM, SYSTEMS ONLY]

(Please check all that apply)

Non-

24

A

Does your system serve a residential population that changes on a

Does your system serve a residential population that changes on a seasonal basis? The seasonal population is considered the population that fluctuates within a system based on the seasons. For example, the population of a water system serving a winter or summer resort area has an influx during certain periods of the year. (Please check Yes or No)

Residential

residential

seasonal basis? The seasonal population is considered the population

A

Metered charges

Customers

Customers

that fluctuates within a system based on the seasons. For example, the

1

Uniform rate

population of a water system serving a winter or summer resort area has

2

Declining block rate

an influx during certain periods of the year. (Please check Yes or No)

3

Increasing block rate

4

Peak period rate (e.g., seasonal)

B

Unmetered charges

B

Please indicate the average daily flow during peak season:

5

Separate flat fee for water

C

Please indicate the approximate length in days

6

Annual connection fee

of the peak season (e.g. 30, 60, or 90 days):

7

Combined flat fee for water

25

Please enter the average cumulative number of hours operators, mangers, and

and other services (e.g., rental fees,

administrative staff work in the water system each week. Please include part-

association fees, pad fees):

time and contract employees that operate the system. For staff employed

C

Other billing methods (please specify):

directly by the system, enter the average hourly wage or salary of each. Enter

directly by the system, enter the average hourly wage or salary of each. Enter the cost of

the cost of fringe benefits provided as a percentage of wages or salaries.

fringe benefits provided as a percentage of wages or salaries. (Fringe

(Fringe benefits include pension and other retirement contributions, health

benefits include pension and other retirement contributions, health insurance

23

A

Does your system have a program that lowers the cost of drinking water

insurance contributions, vacation, and sick leave.) For contract employees

contributions, vacation, and sick leave.) For contract employees that operate

for low- or fixed-income households? (Please check only one)

that operate the system, provide the average hourly cost to the system of the

the system, provide the average hourly cost to the system of the contract

contract employees (including wages, salaries, benefits, and fees).

employees (including wages, salaries, benefits, and fees).

Yes

No (Skip to question 24)

Contract

employees

B

What are the eligibility requirements for this program?

Hours per

that operate

week

Employees of the system:

the system

employees

Benefits as a

work in the

Average

percentage

Average

water

hourly

of salary or

hourly labor

Staff

system

wage/salary

wages

cost

A

Operators

C

How many households qualify

1

Treatment Plant

$

%

$

for the program?

2

Distribution System

$

%

$

B

Managers

$

%

$

C

Administrative staff

$

%

$

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Sheet 24: 26-27b

26	This question is intended to account for all of your drinking water expenses						27	A	If you have paid for major capital improvements, repairs, or
	related to the revenues referred to in question 21 A and B. Please provide								expansions in the last five years ending on the date reported in
	finanical data for the latest 12 month period for which they are available. Please								question 2B, please indicate the total amount spent on these capital
	do not compile new data specifically for the survey if data already exists. The								expenditures.
	categories below are intended to be mutually exclusive. For example, expenses
	for purchased water in part B should include the cost of the water only (an								1	a Land:	$
	operating expense), not the capital required to bring it to the system.
										b How much land was purchased (acres):
	A	Please attach available summaries of financial statements, including a
		balance sheet, income statement, and statement of cash flows. Please							2	Water source:	$
		attach a depreciation schedule, if one is available (i.e., a program defining
		your process for depreciating the value of capital improvements).							3	Transmission and distribution system:	$
	B	Please enter the following routine operating expenses in the last year:							4	Treatment:	$
		1	Expenses for purchased water:	$					5	Storage:	$
		2	Security related expenses (spending for						6	Security (include security-related
			security only, e.g., gates, locks, or guards):	$						spending not included in other capital
										expenditures):	$
		3	Other routine operating expenses (including
			expenses for labor, chemicals, power, materials						7	All other not included above:	$
			and supplies, and contractor services):	$
		4	Depreciation expenses:	$					What percentage of the total capital expenditures identified in part A were
									used for the following (must sum to 100 percent)?
		5	Income taxes (privately owned systems):	$
									1	System expansion, regardless of whether
		6	Other payments to the general fund, e.g.,							expenditure includes replacement and repair
			payment in lieu of taxes (publicly owned					B		of equipment or compliance with regulations	%
			systems):	$
									2	Replacement and repair of equipment, regardless
	C	Please enter the amount of debt service expenditures in the last year:								of whether it includes compliance with regulations
										but excluding spending for system expansion	%
		7	Interest payments:	$
									3	Compliance with regulations, excluding expendi-
		8	Principal payments:	$						tures for system expansion and replacement
										and repair of equipment	%
	D	Other Expenses
		9	Capital improvements:	$
		10	Payments to reserve funds:	$

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Sheet 25: 27c-28

	C	How were the major capital improvements, repairs, and expansions of the past five years from question 27A funded?
					Percentage of capital expenses		For borrowed funds, please provide the:
					funded from each source (should sum to 100 percent)		Average Interest Rate		Average Length of Loan Period (Years)
		1	Current revenue (including payments
			from reserve funds):		%
		2	Equity or other funds from private investors:		%
		3	Department of Homeland Security Grant:		%
		4	Other government grants:		%
		5	Drinking Water State Revolving Fund
			a Principal Repayment Forgiveness:		%
			b Loans:		%		%
		6	Other borrowing from public sector
			sources (e.g., state or regional authorities):		%		%
		7	Borrowing from private sector sources
			(e.g., banks or the bond market):		%		%
		8	Other (please specify):
					%		%
28	A	Do you have an asset management plan or other formal written strategy addressing
		your long-term (e.g., 20 years or more) needs for infrastructure rehabilitation and replacement?
		Yes
		No