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Public Water Systems - Applications & Forms

Applications

Consecutive System Exemption Application
Operating Permit Application

Source Water Permit Applications

PCWS
NTNC
TNC

Domestic Bottled and Bulk

Source Testing Review

Well ID Sheet-Production Well

Well ID Sheet-Observation Well

Certified Operator Application (Class 2, 3, 4 & D)
Statement regarding Child Support and VT Taxes
Certified Operator Renewal application (Class 2, 3, 4 & D)
Avoidance of Filtration for Surface Water and GWUDI of Surface Water

Certification of Water Source Likely Affected by Agricultural Lands

GWUDI Exemption Application & Guidance ; Laboratories performing Microscopic Particulate Analysis (MPA) Testing
Phase II/V Monitoring Waiver Application
        Renewal Application
Construction Permit Application

Forms

Water System Officials Contact Form
Public Water Supply Survey Form
Public Notice Certification Form
Lead and Copper Sampling Plan
Lead and Copper Sampling Plan Guidance
Bacteriological Sampling Plan & Guidance Less than 1000 Population
Bacteriological Sampling Plan & Guidance Greater than 1000 Population
Bulk Water Hauling as an Emergency Form and Guidance

Extended Period- Bulk Water Hauling as an Emergency Source (to submit weekly)

Monthly Operations Report for Filtered Surface Water Systems

Letter and Instructions for Filtered Surface Water Reporting
Monthly Operations Report for Groundwater and Systems Purchasing Groundwater

Boil Water Notice Forms

Issuing and Rescinding a Boil Water Notice
Boil Water Notice Template for general use
Boil Water Notice Acute (E. coli) MCL template and Instructions
Boil Water Notice Non- Acute MCL Template and Instructions

Non-Boil Water Notice Forms

MCL Violation Non-Boil Template and Instructions
Corrective Action Guidance
Tier 3 Public Notice Form & Guidance

Tools

Ultraviolet Disinfection Guidelines  (For NTNC & TNC systems)

O&M Manual

Template

Guidance for Template

 

 

 

 

drinkingwater.vermont.gov   groundwater.vermont.gov   septic.vermont.gov wastewater.vermont.gov
VT DEC Drinking Water and Groundwater Protection Division 1 National Life Drive, Main Building, 2nd Floor  Montpelier, VT  05620-3521
Telephone toll-free in VT: 800-823-6500 or call 802-241-3400    Fax: 802-828-1541

 

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