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Public Water Systems - Applications & Forms


Operations Permit Applications:

Consecutive System Exemption Application
Operating Permit Application

Certified Operator Application (Class 2, 3, 4 & D)
Statement regarding Child Support and VT Taxes
Certified Operator Renewal Application (Class 2, 3, 4 & D)

Phase II/V Monitoring Waiver Application
        Renewal Application

Construction Permit Application:
Construction Permit Application

NEW- Source Water Permit Application Process- Effective Immediately

Source Water Permit Applications:

Public Community Water System
Non-Transient Non-Community Water System
Transient Non-Community Water System

Domestic Bottled or Bulk Water System

Source Testing Review Application

Well ID Sheet-Production Well

Well ID Sheet-Observation Well

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

File Transfer Protocol (FTP) Instructions  NEW


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

Monthly Operations Report Instructions for Filtered Surface Water Reporting

Monthly Operations Report for Groundwater and Systems Purchasing Groundwater

Voluntary Coliform Response Assessment Form  NEW

Completed Examples:

Class 1A

Class 2

Class 3

Boil Water Public 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 Public Notice Forms

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


Ultraviolet Disinfection Guidelines  (For NTNC & TNC systems)

O&M Manual


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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