Public Water System Forms and Applications

Boil Water Notice​

• Boil Water Notice Template 
• E. coli MCL template and Instructions
• Public Notice Certification
• Boil Water Procedure (Signed 10/8/2018)

It is the responsibility of the water system to make sure that all users are aware of what is going on with their water system and that their health is being protected in the response of actual or potential system contamination. Following an E. coli MCL violation, unconfirmed E. coli detection if repeat samples cannot be collected within 24 hours, emergencies, depressurization, certain repairs, unauthorized bulk water hauling, and other issues that may arise and adversely impact health of system users, a boil water notice will be required. In some instances, the Division will mandate a system distribute notice to users to boil water prior to any consumptive use; water systems must implement a boil water notice if there is a chance that the sanitary quality of the water in the water system has been compromised in any way. Not every repair completed at a water system requires a boil water notice or notifying the Division. Repairs that adhere to AWWA Standard C-651 or approved equally-protective approach minimizes the potential for contamination and does not require a boil water notice to be distributed.

Hand delivery of the notice to every user as soon as a situation arises is often the best method, but other options such as Front Porch Forum, Facebook, E-mail, website posting, press releases and enrollment of the water system and its users in the VT-Alert system may all be used in conjunction with direct delivery to ensure every user is informed in a timely manner. No matter what method or methods are used, the system needs to be confident that the notice has reach all users of the system.

The water system must coordinate with the Division in order to document that public health is being protected prior to lifting the boil water notice. Results of total coliform analysis, showing that the system is absent of bacteria are required to document that the system is free of contamination.  The number of samples and timing of samples must be worked out with the Division prior to sampling.

Operations Permit Applications

• Community and NTNC Operating Permit Application
• TNC Notice of Intent to Operate Subject to the General Permit
• TNC General Permit
• TNC Individual Permit to Operate Application

Operator Certification

• Certified Operator Application (Class 2, 3, 4 & D)
• Certified Operator Renewal Application (Class 2, 3, 4 & D)
• Application for Class 1A/1B Vermont Water System Operator
• Statement regarding Child Support and VT Taxes

Sampling-Based Forms and Applications

• Phase II/V Monitoring Waiver Application
  • Renewal Application
• Lead and Copper Rule
  • Corrosion Control Treatment (CCT) Recommendation Guidance including CCT Recommendation Form
  • Lead public education template (“Important Information About Lead in Your Drinking Water”)
  • Lead public education delivery certification form
  • Lead Participant Tap Notification
  • Lead and Copper Sampling Plan
  • Lead and Copper Sampling Plan Guidance
  • Alternate Lead and Copper Monitoring Schedule Application
• Revised Total Coliform Rule (RTCR)
  • RTCR Coliform Sampling Plan & Guidance 1,000 or Under Population
  • RCTR Coliform Sampling Plan & Guidance Greater than 1,000 Population
  • Groundwater Seasonal Start-Up Form 
  • Surface Water Seasonal Start-Up Form
  • RTCR Level 1 Assessment Form
• Disinfection By-products (DBPs)
  • DBP Sampling Form
  • Operational Evaluation Report
• LT2 Sampling Plan Form

Administrative Forms

• Water System Officials Contact Form
• Consecutive System Exemption Application
• Public Water Supply Survey Form
• Public Notice Certification Form
• Bulk Water Hauling as an Emergency Form and Guidance
• Extended Period- Bulk Water Hauling as an Emergency Source (to submit weekly)

Operating Reports

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

Construction Permits

• Construction Permit Application

Source Permit/Source Documents

• Source Water Permit Application Process Overview (Read first)
• Source Water Permit Applications
  • Public Water System source (PCWS, NTNC, TNC)
  • Domestic Bottled or Bulk Water System
• Source Testing Review Application
• Well ID Sheets
  • 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
  • GWUDI Exemption Application
  • Guidance
  • Laboratories performing Microscopic Particulate Analysis (MPA) Testing
• Source Water Protection "How To"
• Checklist for Completing a Source Water Protection Plan 

Operation and Maintenance Manuals

• O&M Manual Template
• Guidance for Template

Long Range Plan Templates

• Long Range Plan Template for Community Water Systems
• Long Range Plan Template for NTNC Water Systems

File Transfer Protocol (FTP) Instructions  and  Cover Sheet NEW