Public Drinking Water Program Forms

Public Drinking Water Program
Public Water Supply Operation
Anne Lynam, Environmental Specialist Senior
Telephone: 515-725-0280, anne.lynam@dnr.iowa.gov

 

IDNR Public Water Supply Report forms:
Listed below are the monthly operation report templates, sampling plan templates, and other forms and guidance documents used by public water supplies to report information to IDNR's Water Supply Operation Section and Environmental Field Offices.  Several of the forms and templates are based upon the population served in the system and the source water type: groundwater (GW), surface water (SW), or groundwater under the direct influence of surface water (also called influenced groundwater, or IGW). 

Monthly Operation Reports (MORs):	Form #	*.xls	*.pdf
Large (>10,000 people served) surface water or influenced groundwater system monthly operation report form	542-8030 thru 34
Small (<10,000 people served) surface water or influenced groundwater system monthly operation report form	542-8100 thru 07
Consecutive surface water or influenced groundwater system monthly operation report form	542-8110
Membrane filtration monthly operation report form for SW/IGW systems	542-8109
Groundwater system monthly operation report form	542-3104
Groundwater system monthly operation report form where system has been approved for 4-log virus inactivation under the Groundwater Rule	542-0038
Consecutive groundwater system monthly operation report form	542-8099

Sampling Plans:
Stage 2 DBPR groundwater system serving 25-9,999 people monitoring plan (542-0458)
Stage 2 DBPR groundwater system serving 25-9,999 people monitoring plan (542-0458)

Stage 2 DBPR groundwater system serving 10,000-99,999 people monitoring plan (542-0459)
Stage 2 DBPR groundwater system serving 10,000-99,999 people monitoring plan (542-0459)

Stage 2 DBPR surface water or IGW system serving 25-499 people monitoring plan (542-0460)
Stage 2 DBPR surface water or IGW system serving 25-499 people monitoring plan (542-0460)

Stage 2 DBPR surface water or IGW system serving 500-3,300 people monitoring plan (542-0461)
Stage 2 DBPR surface water or IGW system serving 500-3,300 people monitoring plan (542-0461)

Stage 2 DBPR surface water or IGW system serving 3,301-9,999 people monitoring plan (542-0462)
Stage 2 DBPR surface water or IGW system serving 3,301-9,999 people monitoring plan (542-0462)

Stage 2 DBPR surface water or IGW system serving 10,000-49,999 people monitoring plan (542-0463)
Stage 2 DBPR surface water or IGW system serving 10,000-49,999 people monitoring plan (542-0463)

Stage 2 DBPR surface water or IGW system serving 50,000-249,999 people monitoring plan (542-0464)
Stage 2 DBPR surface water or IGW system serving 50,000-249,999 people monitoring plan (542-0464)

Stage 2 DBPR - Change of Sampling Site form (542-0465)
Stage 2 DBPR - Change of Sampling Site form (542-0465)

Stage 2 DBPR - Operational Evaluation Level Report Form (542-0554)
Stage 2 DBPR - Operational Evaluation Level Report Form (542-0554)

TCR Bacteria Sampling Plan Template for system collecting one bacteria sample per month
TCR Sampling Plan - Groundwater Rule Supplement
TCR Sampling Plan - Groundwater Rule Supplement for Consecutive Systems

Other Forms and Guidance:	*.doc	*.pdf
Groundwater Rule 4-Log Virus Inactivation Application
IDNR Groundwater Rule Quick Reference Guide
Lead Consumer Notice for Community Systems
Lead Consumer Notice for Nontransient Noncommunity Systems
Lead and Copper Consumer Notice for Community Systems
Lead and Copper Consumer Notice for Nontransient Noncommunity Systems
Lead and Copper 90th Percentile Calculation Form
Water well abandonment reporting form: Abandoned Water Well Plugging Record, Form# 542-1226
Operator Certification Compliance Plan, form 542-3120 Operator Certification Compliance Plan, form 542-3120