Step 1 Step 2 Step 3 Step 4 Chemical Chemical Chemical Chemical Type: Type: Type: Type: NSF 60 Certified? NSF 60 Certified? NSF 60 Certified? NSF 60 Certified? UV UV UV UV Filtration Filtration Filtration Filtration Process Ion exchange Ion exchange Ion exchange Ion exchange Softener Softener Softener Softener Other: Other: Other: Other: Dosage: Dosage: Dosage: Dosage: Treatment of bacteria, Treatment of bacteria, Treatment of bacteria, Treatment of bacteria, viruses viruses viruses viruses Turbidity removal Turbidity removal Turbidity removal Turbidity removal Objective: Hardness removal Hardness removal Hardness removal Hardness removal Taste & odor removal Taste & odor removal Taste & odor removal Taste & odor removal Metals removal Metals removal Metals removal Metals removal Other: Other: Other: Other: Is this process Yes No Yes No Yes No Yes No required by EPA? At Well At Well At Well At Well Location of At Treatment Plant At Treatment Plant At Treatment Plant At Treatment Plant process? Other: Other: Other: Is this process Yes No Yes No Yes No Yes No adequate to meet the objective? Explain: Explain: Explain: Explain: Permanent Permanent Permanent Permanent Seasonal Seasonal Seasonal Seasonal Frequency of use: Emergency Emergency Emergency Emergency Other: Other: Redundant Yes No Yes No Yes No Yes No Equipment? Explain: Explain: Explain: Explain: Yes No Yes No Yes No Yes No Backup power? Explain: Explain: Explain: Explain: Groundwater and Consecutive Systems UV Disinfection Yes No Is a flow meter to monitor/alarm or a flow restrictor valve so the max flow rate is not exceeded? Describe how the system ensures the flow does not exceed max flow rate: Is an intensity sensor and alarm (visible/audible) to indicate low intensity? Is there a UV lamp status alarm (visible/audible) to indicate lamps off? Is there a UV lamp age counter/alarm? Is there an automatic shut-off fail-safe solenoid valve so that water does not flow through the unit without adequate treatment? Are there spare bulbs on hand? How often are the unit cleaned and the bulbs changed? of use Treatment For PWSs with required Point of Use (POU) treatment, ask the operator – Yes No NA
Step 1 Step 2 Step 3 Step 4 Process Chemical Type: NSF 60 Certified? UV Filtration Ion exchange Softener Other: Dosage: Chemical Type: NSF 60 Certified? UV Filtration Ion exchange Softener Other: Dosage: Chemical Type: NSF 60 Certified? UV Filtration Ion exchange Softener Other: Dosage: Chemical Type: NSF 60 Certified? UV Filtration Ion exchange Softener Other: Dosage: Objective: Treatment of bacteria, viruses Turbidity removal Hardness removal Taste & odor removal Metals removal Other: Treatment of bacteria, viruses Turbidity removal Hardness removal Taste & odor removal Metals removal Other: Treatment of bacteria, viruses Turbidity removal Hardness removal Taste & odor removal Metals removal Other: Treatment of bacteria, viruses Turbidity removal Hardness removal Taste & odor removal Metals removal Other: Is this process required by EPA? Yes No Yes No Yes No Yes No Location of process? At Well At Treatment Plant At Well At Treatment Plant Other: At Well At Treatment Plant Other: At Well At Treatment Plant Other: Is this process adequate to meet the objective? Yes No Explain: Yes No Explain: Yes No Explain: Yes No Explain: Frequency of use: Permanent Seasonal Emergency Permanent Seasonal Emergency Permanent Seasonal Emergency Other: Permanent Seasonal Emergency Other: Redundant Equipment? Yes No Explain: Yes No Explain: Yes No Explain: Yes No Explain: Backup power? Yes No Explain: Yes No Explain: Yes No Explain: Yes No Explain: Groundwater and Consecutive Systems UV Disinfection Yes No Is a flow meter to monitor/alarm or a flow restrictor valve so the max flow rate is not exceeded? Describe how the system ensures the flow does not exceed max flow rate: Is an intensity sensor and alarm (visible/audible) to indicate low intensity? Is there a UV lamp status alarm (visible/audible) to indicate lamps off? Is there a UV lamp age counter/alarm? Is there an automatic shut-off fail-safe solenoid valve so that water does not flow through the unit without adequate treatment? Are there spare bulbs on hand? How often are the unit cleaned and the bulbs changed? of use Treatment For PWSs with required Point of Use (POU) treatment, ask the operator – Yes No NA
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