Oklahoma Department of Environmental Quality Water Quality Division, Public Water Supply Group Revised Total Coliform Rule Level 1 Assessment Form

Transcription

1 Oklahoma Department of Environmental Quality Water Quality Division, Public Water Supply Group Revised Total Coliform Rule Level 1 Assessment Form PWS Name: PWS ID #: City/Town: County: Section A Review Elements of the PWS Date of Level 1 Assessment: RTCR-1 The RTCR Level 1 Assessment shall be completed by the water system and returned to DEQ within 30 days of: a) a failure to take all three repeat samples after a total coliform positive routine sample, b) two total coliform positive samples in the same month (population less than 41,000), and/or c) at least 5% of bacteriological samples are total coliform positive (population larger than 41,000). Instructions: a) Review and evaluate each of the listed elements typically found in a PWS. Mark (χ) for each element that was reviewed. b) Mark (χ) if any potential causes of contamination were identified with that element. c) Mark (χ) No issues, identified, or N/A for each section, as appropriate. d) In the Notes box, explain why any elements were not reviewed and describe any issues that were identified. e) For help filling out this form, contact DEQ s PWS district engineer for your county at GENERAL Fire-fighting event Recent heavy precipitation (heavy snow, rainfall, flooding, ice storm, etc.) Recent extreme heat or cold Interruptions to the electrical power Drought conditions Signs of vandalism or forced entry at water system assets Water system has been dormant (has not served water for more than 60 days) Any historical issues from previous inspections that have not been corrected Did you identify any General issues with the water system? No issues identified N/A 2. WATER SOURCES Well(s) Defective/damaged well cap/well seal Missing/damaged grout seal Unprotected opening in pump/pump assembly Pitless adapter Damaged or inadequate well casing Damaged/unscreened vent feet of the well

2 Damaged or inadequate well pad Changes in static/pumping levels Spring(s) feet of the spring Changes in water table/spring production Poorly maintained spring box Surface Water Source(s) feet of the water body Changes in water table/reservoir capacity High turbidity measurements in raw water Recently switched to a different source/intake Cross connection Improper development Changes in water source (lake turnover, algal blooms, etc.) Did you identify any issues with the Water Sources? No issues identified N/A 3. TREATMENT PROCESS Exceeded design flow rate Inadequate point of entry disinfection (less than 1.0 ppm free chlorine residual or less than 2.0 ppm total chlorine residual) Treatment changed Interruption in treatment Finished turbidity measurements above 0.3 NTU (rapid sand surface water treatment) or 1.0 NTU (slow sand surface water treatment) Power loss Did you identify any issues with the Treatment Process? No issues identified N/A 4. WATER STORAGE Improper operation of level control valves, altitude valves, and related appurtenances Pressure tank improperly installed or used Potential source of contamination Tank needs cleaning Hatch not sealed Observed leaks

3 Deterioration, rust, holes, or other breaches in vent, overflow pipe, access hatch, screens, ladders, foundation, roof, walls, etc. Did you identify any issues with the Water Storage? No issues identified N/A 5. DISTRIBUTION SYSTEM Power loss Standing water in valve vault Operation of isolation valves resulting in breakage Pump or valve failure Pressure loss/inadequate pressure (less than 25 psi) Improper surge control Main breaks Improper operation of pumps/valves Flushing activity Improper operation of air-relief/air-vacuum valves in buildings (valve vaults, pumping facilities, etc.) Installation of new mains or other recent construction/maintenance activity Sheared or improperly used hydrant Cross connection Water leaks Did you identify any issues with the Distribution System? No issues identified N/A 6. SAMPLING Infrequently used sample tap Hot water intrusion Change in conditions at sample site Unsuitable sample tap (e.g. frost-free hydrant, below ground level, tap points upward, etc.) Cross connection after service connection Threads on inside of tap Inadequate tap flushing Sample tap not disinfected Aerator was not removed Auto-sensing faucet / ball joint faucet / swivel-type faucet / etc. Leaky packing material around the stem Visibly unsanitary sampling site/tap Inadequate pressure (less than 25 psi) Treatment device in use (e.g. a softener) Did you identify any issues with the Sampling? No issues identified N/A

4 Section B Additional Information Instructions: Use this space to provide additional information that supports your findings (e.g. water quality and pressure monitoring data). Include corresponding dates with your findings. Section C Required Corrective Actions Instructions: Use this space to describe any required corrective actions that have been taken or are required to be taken to fix the issues found. Include a schedule for completion of required corrective actions. For help determining corrective actions, contact DEQ s PWS district engineer for your county at Section D Recommended Corrective Actions Instructions: Use this space to describe any recommended corrective actions that have been taken or are recommended to be taken. Include a schedule for completion of recommended corrective actions. Section E Certification of Revised Total Coliform Rule Level 1 Assessment Form I certify that the information contained herein is true, accurate, and complete to the best of my knowledge and belief. Signature: Print Name: Phone Number: Date: Title: Sample Collector(s) ( same as person completing form):

5 Section F Submit Completed Form to DEQ Water system must retain a copy of this form on file. Return the original form to the DEQ Public Water Supply Group within 30 days after the violation(s). Attn: Total Coliform Rule Coordinator Oklahoma Department of Environmental Quality Water Quality Division P.O. Box 1677 Oklahoma City, OK DEQ USE ONLY Date received: DEQ Reviewer: Violations addressed by RTCR Level 1 Assessment: