J.7_RedfeatherWork_2CenterWaterSystemSS_09-04-2018.pdf

Sanitary Survey – Redfeather Work Center #2 September 4, 2018

W- 1

Parts I, II, and III

OFFICE, FIELD AND REPORT DATA FOR

SANITARY/CONDITION SURVEY

of a

DRINKING WATER SYSTEM

Water System Name : Redfeather Work Center #2

System Classification (Public, Non-Public) : Transient, Non-Community (TNC)

Forest : Arapaho and Roosevelt National Forest and Pawnee National Grassland

District : Canyon Lakes Ranger District

Year of Survey (YYYY) 2018

Real Property Number 0300

Forest Service, or State or EPA I.D. Number: 335838

W- 2

PART I

OFFICE DATA FOR SANITARY/CONDITION SURVEY

(DRINKING WATER)

Forest : Arapaho and Roosevelt National Forest and Pawnee National Grassland

District : Canyon Lakes Ranger District

Forest Service, or State or EPA I.D. Number: 335838

Date Compiled (MM,DD,YY) : September 4, 2018

Data Compiled By : /s/ Chris Ida

INDEX

PART I

ITEM NO. PAGE

PART I - OFFICE DATA

Cover W-1 Index W-2 IA. Design and Construction Information W-3 IB. Water System Classification W-3 IC. Water Analysis Records W-4 ID. Baseline Testing W-5 IE. Potential Source of Contaminants W-7 IF. Certified Operator W-7 IG. Use Records

7. Water Meter Reading Worksheet

8. Electrical Meter Reading Worksheet

W-7 W-8 W-9

IH. Records

1. Operation and Maintenance

2. Sanitary/Condition Survey

3. Water Rights

4. Watershed

5. Record Retention

W-10 W-10 W-10 W-10 W-10 W-11

II. Annual Operation and Maintenance Worksheet - Drinking Water W-11

W- 3

PART I - OFFICE DATA

A. DESIGN AND CONSTRUCTION RECORDS

1. Engineering Report: YES (Y/N) When 2010

2. Design criteria: YES (Y/N)

3. Construction drawings and specifications: YES (Y/N)

4. "As-built" drawings: (If YES, provide copy) YES (Y/N)

5. Sketch: (If YES, provide copy) NO (Y/N)

6. Is there a site plan: (If YES, provide copy) YES (Y/N)

7. Final construction report: YES (Y/N)

8. Type of site served: ADMINISTRATIVE (Special Use, Admin, Recreation, Other)

9. When constructed: 2011

10. Modifications Since Construction: NO (Y/N) Describe:

a.

b.

Remarks:

B. WATER SYSTEM CLASSIFICATION

1.

2.

3.

Maximum number of persons using the system per day:

How many days per year?

Use Period Signature & Date of Whom made Determination: CHRIS N. IDA 03/04/2019 – ENG.

REPORT

153 DAYS

MAY 1 TO

SEPTEMBER 30

4. Drinking water is what classification TNC

5. Is the class in No. 4, the same as what the EPA or State have on file? YES (Y/N)

6. Class Definitions

a. Public: (At least 25 people, at least 60 days per year, or 15 service connections)

1. Community (C) serves a residential population on a year-round basis.

2. Transient Non-Community (TNC)-Does not serve a residential population (campgrounds)

3. Non-Transient, Non-Community (NTNC)-Does not serve a residential population but does serve at least 25 of the same people over 6 months per year on a regular basis. (School, Office)

b. Non-Public (NP) (serves less than 25 people, 60 days/per year or 15 service connections

1. Non-Public, Transient (NPT)- Does not serve more than 25 persons less than 180 days.

(small picnic and campgrounds).

2. Non-Public, Non-Transient (NPNT) - serves less than 25 year-round residents or serving less than 25 persons more than 180 days per year. (smaller workstations and work centers)

W- 4

7. Water meter readings available: NO (Y/N)

8. Electrical meter readings available: NO (Y/N) (If YES, provide copy)

9. Water meter reading worksheet (See Page WI-8) NO

10. Electrical meter reading worksheet (See Page WI-9) NO

C. WATER ANALYSIS RECORDS

1. Classification - Public, Non-Transient, Non-Community, Ground Water

Testing

1. Bacteriological:

A. Seasonal System-must monitor for total coliform 10 days prior to opening for season:

YES (Y/N)

B. Monthly routine sample: YES (Y/N) C. Comments: FOREST SERVICE PERFORMS BACTERLOGICAL

WATER TESTING

2. Turbidity: NOT REQUIRED

3. Baseline Testing: NOT REQUIRED

4. Inorganics (IOCs): Generally not required except for nitrates.

A. Nitrate: Required every year B. Nitrate: Required once (before chlorination):

NO (Y/N)

NO (Y/N)

5. Palatability and Esthetic Acceptability A. Alkalinity: YES (Y/N) B. Hardness: YES (Y/N) C. PH (on site)** YES (Y/N) D. Iron** YES (Y/N) E. Manganese** YES (Y/N) F. Sulfide: YES (Y/N) **Requred under baseline testing

6. Organics:

A. (Herbs and Pests) SOC's (Required for systems specified by Health

Department)

NO (Y/N)

B. THM's (Not Required) YES (Y/N) C. VOC's (Required) YES (Y/N)

7. Radioactivity: Not Required (Community Systems Only) NOT REQUIRED

8. Lead and Copper: YES (Y/N)

9. Disinfection: YES (Y/N)

10. Has a Microscopic Particulate Analysis (MPA) been completed on this source:

If yes, when:

NO (Y/N)

11. Remarks: NEED TO KEEP RECORDS OF BACTERIOLOGICAL AND

NITRATE TEST RESULTS

W- 5

2. Classification - Public, or Non-Public (Transient) Non-Community, Ground, or Surface Water

Testing

1. Bacteriological:

A. Seasonal System-must monitor for total coliform 10 days prior to opening for season:

YES (Y/N)

B. Monthly routine sample (USFS) YES (Y/N) C. Comments: NEED TO KEEP RECORDS OF BACTERIOLOGICAL

2. Turbidity: (Not Required for Ground Water, Required for Surface): NOT REQUIRED

3. Baseline Testing: (See page W-5) SEE BELOW

4. Inorganics (IOCs): (Generally not required except ) A. Nitrate: Required every year: NO (Y/N)

(EVERY 3

YEARS)

B. Nitrate: Required once (before chlorination): NO (Y/N)

(REQUIRED

ONCE BEFORE

CHLORINATION)

5. Palatability and Esthetic Acceptability (USFS) A. Alkalinity YES (Y/N) B. Hardness: YES (Y/N) C. PH (on site)** YES (Y/N) D. Iron** YES (Y/N) E. Manganese** YES (Y/N) F. Sulfide: YES (Y/N) **Required under baseline testing

6. Organics:

A. Herbs and Pests (Not Required) NOT REQUIRED B. THM's (Not Required) YES (Y/N) C. VOC's (Not Required) YES (Y/N) D. Unreq. VOC's (Not Required) YES (Y/N) E. SOC's (Not Required) NOT REQUIRED

7. Radioactivity (Not Required) NOT REQUIRED

8. Lead and Copper (Not Required) YES (Y/N)

9. Disinfection: YES (Y/N)

10. Has a Microscopic Particulate Analysis been completed on this source:

If yes, when

NO (Y/N)

11. Remarks: NEED TO KEEP RECORDS OF BACTERIOLOGICAL AND

NITRATE TEST RESULTS

D. BASELINE TESTING

FSM 7421.24a requires a baseline testing of all potable water systems (no class differentiation) to analyze for all primary and secondary inorganic and organic contaminants listed in the National Interim Primary Drinking Water Regulations, National Secondary Drinking Water Regulations

(NSDWR).

W- 6

1. Primary Drinking Regulations

A. Inorganic Contaminants – Date Tested:

1. Arsenic: YES (Y/N)

2. Barium: YES (Y/N)

3. Cadmium: YES (Y/N)

4. Chromium: YES (Y/N)

5. Lead: YES (Y/N)

6. Mercury: YES (Y/N)

7. Nitrate (as N): YES (Y/N)

8. Selenium: YES (Y/N)

9. Silver: YES (Y/N)

10. Fluoride: YES (Y/N) B. Organic Contaminants: - Date Tested:

1. Chlorinated Hydrocarbons A. Endrin: NO (Y/N) B. Lindane: NO (Y/N) C. Methoxychlor: NO (Y/N) D. Toxaphene: NO (Y/N)

2. National Secondary Drinking Water Regulations (NSDWR) A. Aluminum: YES (Y/N) B. Chloride: YES (Y/N) C. Color: YES (Y/N) D. Copper: YES (Y/N) E. Corrosivity: YES (Y/N) F. Foaming Agent: YES (Y/N) G. Iron: YES (Y/N) H. Manganese: YES (Y/N) I. Odor: YES (Y/N) J. PH (At Site): YES (Y/N) K. Sulfate: YES (Y/N) L. Silver: YES (Y/N) M. TDs YES (Y/N) N. Zinc: YES (Y/N)

W- 7

E. POTENTIAL SOURCE OF CONTAIMINANT WITHIN ONE HALF MILE OF A

WATER SOURCE

1. Agricultural Run-off: NO (Y/N)

2. Animal Feed Lots or Grazing: NO (Y/N)

3. Wastewater Treatment Plant Discharge NO (Y/N)

4. Hazardous Waste Site: NO (Y/N)

5. Solid Waste Disposal: NO (Y/N)

6. Pesticides, Rodenticides, Fungisides YES (Y/N)

7. Mining, Oil, or Gas Activities NO (Y/N)

8. Petroleum Products (eg., auto repair shop, gas station

(MTBE)):

NO (Y/N)

9. Septic System or other Wastewater System: YES (Y/N) 425 FEET

10. Is there a Source Water Protection Plan: NO (Y/N)

11. Logging in Last 10 Years: NO (Y/N)

12. Other (Please specify): NONE (Y/N)

13. Forest Fire in Last 10 Years: NO (Y/N)

14. Remarks: WATER QUALITY ISSUES WITH

PAST PESTIDCIDE USES FOR MOUNTAIN PINE

BEETLES. NEW MONITORING WELLS

CONSTRUCTED AND WATER QUALITY

MONITORED/TESTED.

Note: If any of 1-9 are yes, note size, distance, protection measures, sources, and system components.

F. CERTIFIED OPERATOR: YES (Y/N)

1. Name STEVEN J. WOOD

2. License No. 36397

3. Class S-WATER SYSTEMS

G USE RECORDS

1. Water Shortage experienced: (If YES, explain): NO (Y/N)

2. Water meter readings available (If YES, provide copy): NO (Y/N)

3. Electrical meter readings available (If YES, provide copy): NO (Y/N)

4. Water meter reading worksheet (See Page WI-8): NONE (Y/N)

5. Electrical meter reading worksheet (See Page WI-9): N/A (Y/N)

6. Remarks:

W- 8

7. Water Meter Readings Worksheet (Last 5 Years)

MONTH/YEAR READING

(GALLONS OR

CUBIC FEET

USED (GALLONS

OR CUBIC FEET)

COST ($)

1. NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

W- 9

8. Electrical Meter Readings Worksheet (Last 5 Years)

MONTH/YEAR

USE (KW)

COSTS ($)

1. NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

W- 10

H. RECORDS

1. Operation and Maintenance

a. Scheduled operation and maintenance adequate NO (Y/N)

b. Preventive maintenance: NO (Y/N)

c. O&M records adequate: NO (Y/N)

d. O&M manual available: NO (Y/N)

e. Is there a maintenance log book?: NO (Y/N)

f. Maintenance responsibilities clearly defined: NO (Y/N)

g. Is there a sampling site plan: NO (Y/N)

h. Is there a cross-connection control plan: NO (Y/N)

Improvements needed: NEED OPERATIONS AND MAINTENANCE PLAN AND

DOCUMENT PREVENTATIVE MAINTENANCE ACTIVITIES. SUBSEQUENT TO

MODIFING THE SYSTEM, AN O&M MANUAL SHOULD DESCRIBE THE

SYSTEM COMPONETS AND THEIR OPERATION. START-UP AND SHUT-DOWN

PROCEDURES FOR SPRING AND FALL SHOULD BE INCLUDED. A

PERMANENT LOG OF INSPECTIONS, MAINTENANCE OPERATIONS, AND

CHANGES.

Remarks: WATER SYSTEM RECORDS SHOULD BE KEPT, AN ALL WEATHER

BOUND NOTE BOOK, IS RECOMMENDED. A DETAILED SKETCH OF THE

SYSTEM IS ALSO REQUIRED.

2. Sanitary Surveys:

a. Reason for Sanitary/Condition Survey: ROUTINE (Initial, Routine, Compliance)

b. Previous Sanitary/Condition Surveys YES (Y/N)

(MM DD YY) 09/28/2012

3. Water Rights

a. Are there water rights: UNKNOWN (Y/N)

b. Water right name: UNKNOWN

c. State File No.: UNKNOWN

d. Reserved water rights claimed: YES (Y/N)

4. Watershed

a. Watershed name: NORTH FORK LONE PINE

CREEK

b. Watershed code: 101900070602

W- 11

4. Record Retention--Are the following records being retained:

Records

Time Period

a. Sanitary/Condition Surveys 10 Years YES (Y/N)

b. Bacteriological Analysis 5 Years NO (Y/N)

c. Chemical Analysis *10 Years YES (Y/N)

d. Physical Analysis *10 Years NO (Y/N)

d. Variances or Exemptions 5 Years NO (Y/N)

e. Turbidity Results 10 Years NO (Y/N)

f. Violations 37 Years NO (Y/N)

*Life of system, unless a flood, earthquake, etc.)

I. ANNUAL OPERATIONS & MAINTENANCE WORKSHEET – DRINKING WATER

Key to Deferred Maintenance Tasks

Task Description Dollars Needed

Unit Remarks

01 Start Up 01-002001 Start Up - Source - Chlorinate and Flush Well

$111.85 EACH 2 HOURS

01 Start Up 01-004001 Start Up - Treatment - Flush and Fill Chlorinator/Treatment Plant

$86.27 EACH 1-1/2 HOURS

01 Start Up 01-005001 Start Up - Storage - Flush and Fill Pressure Tanks

$51.15 HOUR 1 HOUR.

01 Start Up 01-005002 Start Up - Storage - Disinfect Storage Tank

$60.70 EACH 1 HOUR

01 Start Up 01-006001 Start Up - Disinfect Distribution Line - Disinfect and Drain all Distribution Lines

$519.14 EACH 10 HOURS

01 Start Up 01-006002 Start Up - Disinfect Distribution Line - Close Drains, Fill System, Operate all Valves

$204.60 EACH 4 HOURS

03 Operator Training & Certification

03-001001 Operator Training & Certification - Office - Seasonal Training

$409.20 EACH 8 HOURS

03 Operator Training & Certification

03-001002 Operator Training & Certification - Office - Confined Space Awareness Training

$102.30 EACH 2 HOURS

06 Condition Survey

06-001001 Condition Survey - Survey - Beginning of Season Inspection

$204.60 HOUR 4 HOURS

06 Condition Survey

06-001002 Condition Survey - Survey - End of Season Survey

$204.60 HOUR 4 HOURS

07 Sanitary Survey

07-001002 Sanitary Survey Survey - Surveys - Sanitary Survey/Condition Survey (FOREST

SERVICE)

$605.70 EACH 8 HOURS

08 System Operation

08-002001 System Operation - Pumps and Controls - Weekly Check

$818.40 HOUR 16 HOURS OVER

THE SEASON

08 System Operation

08-003001 System Operation - Treatment - Weekly Check

$818.40 HOUR 16 HOURS OVER

THE SEASON

08 System Operation

08-003002 System Operation - Treatment - Chlorine Solution, Refill Tank

$409.20 HOUR 8 HOURS OVER

THE SEASON

08 System Operation

08-004001 System Operation - Backflow Preventors - Hose Bibb:

Installation/Inspection/Replacement

$296.70 EACH 3 HOSE BIBBS IN

SHOP

10 Sampling 10-002001 Sampling - Source - Startup Bacteriological Test

$89.35 EACH 1 TEST

W- 12

10 Sampling 10-002002 Sampling - Source - Monthly Bacteriological Test

$536.10 EACH 6 SAMPLES

10 Sampling 10-002003 Sampling - Source - Nitrate/Nitrite Test

$453.13 EACH 1 TEST

10 Sampling 10-003001 Sampling - Treatment - Chlorine Residual Test

$818.40 HOUR 16 HOURS OVER

THE SEASON

11 Record Keeping

11-001001 Record Keeping - Office - INFRA Updates

$409.20 HOUR 8 HOURS

11 Record Keeping

11-001002 Record Keeping - Office - Water Quality Reports

$409.20 HOUR 8 HOURS

11 Record Keeping

11-001003 Record Keeping - Office - Well logs/As-Builts/O&M and Sampling Plans

$1,910.00 LS None

13 Consumables 13-001001 Consumables - Treatment - Chlorine Solution

$11.46 GAL. 6 GALLONS

13 Consumables 13-001003 Consumables - Treatment - Finishing Filters

$859.50 EACH 6 FILTERS

14 Shut Down 14-003001 Shut Down - Treatment - Drain Chlorinator/Plant/Tank

$51.15 HOUR 1 HOUR

14 Shut Down 14-004001 Shut Down - Storage - Drain Pressure Tank

$51.15 HOUR 1 HOUR

14 Shut Down 14-005001 Shut Down - Distribution - Drain Seasonal System, Open/Shut Valves

$204.60 EACH 4 HOURS

W- 13

PART II

FIELD DATA FOR SANITARY/CONDITION SURVEY

Pawnee National Grassland

District : Canyon Lakes Ranger District

Forest Service, or State or EPA I.D. Number: 335838

Date Surveyed : September 4, 2018

Surveyed By : /s/ Chris Ida

PART II

ITEM NO. PAGE

PART II - FIELD DATA

IIA. Source W-14

1. Well W-14

2. Spring W-15

3. Surface W-15

4. Municipal W-16

IIB. Pumps W-16

1. Well W-16

2. Supply W-17

3. Handpump W-18

IIC. Treatment System W-19 IID. Storage System W-20 IIE. Distribution System W-21 IIF. Point of Use W-22 IIG. Electrical System W-25

W- 14

PART II - FIELD DATA

A. SOURCE

1. Well

a. Well permit number: 9OVE353/239035

b. Well log: YES (Y/N)

c. Location: NW¼, NW ¼ OF

SECTION 34

Latitude: 40.793067° Longitude: -105.570278° Section: 34 Township: 10 NORTH Range: 73 WEST

d. Type: (Dug, Driven, Jetted, Bored, Drilled) DRILLED

e. Casing:

Diameter: (inches, I.D) 4-1/2” Material: (Plastic, Steel, Other) STEEL/PVC Wall thickness: (inches) 0.237/SCH. 40

f. Depth:

Ground surface to bottom of well: 191.6 (FEET) Ground surface to bottom of casing: 191.5 (FEET) Ground surface to first draw (top of screen/perforations or bottom of casings)

161.5 (FEET)

Static water level: 35 (FEET) Pump set at 166 (FEET)

g. Capacity (gpm at feet drawdown) 6.2 GPM

h. Type of sanitary seal: (Cement Grout, Bentonite, Well Cutting, Other)

CEMENT

i. Subject to flooding: NO (Y/N)

j. Has well been evaluated for 100 year flood: NO (Y/N)

k. Is casing 18 inches above natural grade:

YES (Y/N)

l. Concrete slab around casing: NO (Y/N)

m. Well screen Material: (Plastic, Steel, Other) PVC Type: (Slotted, Drilled, Torch Cut) SLOTTED Hole/Slot Size: 0.020

n. Sanitary well cover type: (Cap, Seal) CAP Vented: YES (Y/N)

o. Pitless Adapter: YES (Y/N)

p. Located how far from a possible source of contamination

(subsurface sewage disposal field, septic tank, vault toilet, stream, lake, marsh or ditch)

275 FEET TO LIFT

STATION

q. Has a microscope particulate analysis (MPA) been completed on this source:

If Yes, When: (mm/dd/yy)

NO (Y/N)

Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

W- 15

Possible sources of contamination: WATER QUALITY ISSUES DUE TO PAST PESTIDCIDE

USES FOR MOUNTAIN PINE BEETLES. NEW MONITORING WELLS CONSTRUCTED

AND WATER QUALITY MONITORED/TESTED.

Improvements needed:

2. Spring

a. Location:

Latitude:

Longitude:

Section:

Township:

Range:

b. Type: (Flowing, Non-flowing, Intermittent)

c. Estimated minimum capacity (GPM)

d. Surface drainage controlled: (Y/N)

e. Adequate fencing around spring: (Y/N)

f. Spring box watertight: (Y/N)

g. Spring box cover:

1. Lockable: (Y/N)

2. Watertight: (Y/N)

3. Overhanging (shoe box lid): (Y/N)

4. Material: (Concrete, Steel, Other) (Y/N)

5. Gasket adequate: (Y/N)

h. Spring box vent screened: (Y/N)

i. Spring box drain screened: (Y/N)

j. Spring box - has overflow and drain pipe: (Y/N)

k. Spring/well permit number:

l. Does spring box have laterals or open gravel bottom (Y/N)

m. Has a microscopic Particulate Analysis (MPA) been completed on this source? If Yes, When: (MM/DD/YY) (Y/N)

Condition: (Critical, Poor, Satisfactory, Good) Appraisal: (Maintain, Remove, Repair, Replace)

Possible sources of contamination in watershed: (pesticide usage, logging, spills, or grazing):

3. Surface (Stream, River, or Lake)

a. Name (s) :

Location:

Latitude:

Longitude:

Section:

Township:

W- 16

Range:

b. Flow: (Perennial or Intermittent)

c. Upstream human activity on watershed: (Y/N)

d. Intake structure or impoundment provided: (Y/N)

e. Intake structure overflow and drain provided: (Y/N)

f. Intake screened: (Y/N)

g. Intake inaccessible to public: (Y/N)

h. Impoundment easily cleaned of sedimentation and debris: (Y/N)

i. Collection Method: (Infiltration Gallery, Surface Intake) Condition: (Critical, Poor, Satisfactory, Good) Appraisal: (Maintain, Remove, Repair, Replace)

Possible sources of contamination in watershed: (pesticide usage, logging, spills, grazing or fires)

4. Municipal:

a. Name of Water System:

b. Water System I.D. Number:

c. Name of Owner:

d. Have there been any reports of waterborne disease: If

Yes, give details (Y/N)

e. Have there been any violations in the past 3 years:

If Yes, What:

(Y/N)

f. Water Source: (Ground, Spring, Surface)

B. PUMPS:

1. Well

a. Manufacturer: UNKNOWN

b. Model: UNKNOWN

c. Diameter: UNKNOWN

d. Horsepower: UNKNOWN

e. RPM: UNKNOWN

f. FLA: UNKNOWN

g. S.F. UNKNOWN

h. Voltage: UNKNOWN

i. Phase: UNKNOWN

j. Running Time Meter: (hrs) ## (HOURS)

k. Pump Operational Counter: (counts) ## (COUNTS)

l. Operating properly: YES (Y/N)

m. Pump properly sized: YES (Y/N)

n. Pump curve provided: NO (Y/N)

o. Pumping Rate Capacity: UNKNOWN (GPM)

p. Year of Installation: UNKNOWN

q. Pump protection:

1. Conductors to motor properly sized: YES (Y/N)

2. Motor running current below nameplate rating: YES (Y/N)

3. Circuit breaker or fuse properly sized: YES (Y/N)

W- 17

4. Motor starter overloads properly sized: YES (Y/N)

5. Motor starter properly sized: YES (Y/N)

6. Hand-off-Automatic switch: NO (Y/N)

7. Operation light: YES (Y/N)

8. Pump operation timer: NO (Y/N)

9. Start and stop pump controls adequate: YES (Y/N)

10. Low liquid level shutoff (Storage tank system) YES (Y/N)

11. Low water level shut off in well: NO (Y/N)

r. Pump discharge piping:

1. Pressure gauge with shutoff: YES (Y/N)

2. Check valve: YES (Y/N)

3. Control and shutoff valve: NO (Y/N)

4. Flow control valve: NO (Y/N)

## (GPM)

5. Pressure Relief Valve: NO (Y/N) Setting: ## (PSI)

6. Pressure Regulating Valve NO (Y/N) Setting: ## (PSI) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

2. Supply Pump (If there is a separate well and supply pump.)

a. Manufacturer: A.0.

SMITH/GOULDS

b. Model: C48A95A06/J068532

c. Horsepower: 1 HP

d. RPM: 3450

e. FLA: 13.0/6.5 AMPS

f. S.F.: 1.4

g. Voltage: 120/240

h. Phase: SINGLE

i. Running Time Meter: (hrs) ## (HOURS)

j. Pump Operation Counter: (counts) ## (COUNTS)

k. Operating properly: YES (Y/N)

l. Pump properly sized: YES (Y/N)

m. Pump curve provided: NO (Y/N)

n. Pumping Rate Capacity: 6 GPM

o. Year of Installation: 2001

p. Pump protection:

1. Conductors to motor properly sized: YES (Y/N)

2. Motor running current below nameplate rating: YES (Y/N)

3. Circuit breaker or fuse properly sized: YES (Y/N)

4. Motor starter overloads properly sized: YES (Y/N)

5. Motor starter properly sized: YES (Y/N)

6. Hand-off-Automatic switch: NO (Y/N)

W- 18

7. Operation light: YES (Y/N)

8. Pump operation counter: NO (Y/N)

9. Start and stop pump controls adequate: YES (Y/N)

10. Low liquid level shutoff (Storage tank system) YES (Y/N)

q. Pump discharge piping:

1. Pressure gauge with shutoff: YES (Y/N)

2. Check valve type: (Swing, Poppet, Disk) NONE

3. Control and shutoff valve: NO (Y/N)

4. Flow control valve: N/A (GPM) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

3. Handpump

a. Drainage

1. Drain pipe or trough clean: NONE (Y/N)

2. Excess water drains away from slab area: NONE (Y/N)

3. Surface water drains away from slab area: NONE (Y/N)

b. Slab

1. Open cracks in slab: NONE (Y/N)

2. Rodents burrowing under slab: NONE (Y/N)

3. Is there an open gap between the well casing and the slab: NONE (Y/N)

c. Pump Stand

1. Nuts and bolts on stand are tight: NONE (Y/N)

2. Pump secured to concrete slab or casing: NONE (Y/N)

d. Packing Nut and Packing (Stuffing Box)

1. Is there packing: NONE (Y/N)

2. Packing nut tight (tightened enough so there is no side movement):

NONE (Y/N)

3. Is packing in good condition: NONE (Y/N)

e. Upper Piston Guide

1. Is there more than 1/8 inch of play between guide and rod in the direction of the pump handle:

NONE (Y/N)

f. Pump Flanges

1. Check for presence of flange gasket. Can usually tell by gap between flanges and probing with a knife:

NONE (Y/N)

2. Is gasket in good condition? No cracks, etc: NONE (Y/N)

g. 1. Is pump located near a stream, lake, marsh, septic system, or toilet, etc:

NONE (Y/N)

2. How far from one of the above: NONE

h. Bubble reservoir clean: NONE (Y/N)

i. If pump outlet pipe is threaded, is there an anti-siphon device used:

NONE

j. Is a shroud installed on the pump: NONE (Y/N)

k. Year of installation: NONE Condition: (Critical, Poor, Satisfactory, Good) Appraisal: (Maintain, Remove, Repair, Replace)

W- 19

Possible sources of contamination:

C. TREATMENT SYSTEM

1. Type of disinfection: (Chlorine, Iodine, Ozone, Other) CHLORINE

2. Sedimentation: NO (Y/N)

3. Filtration: YES (Y/N)

4. Filter material: (Sand or Other medium) CARTRIDGE-

WOVEN

5. Equipment Flow Rate: NO (Y/N)

6. Treatment being provided in accordance with FSM 7420 and State

Drinking Water Design Criteria:

YES (Y/N)

7. Treatment equipment adequate: YES (Y/N)

8. Treatment equipment operating properly: YES (Y/N)

9. Test equipment adequate: NO (Y/N)

10. Disinfection contact time adequate: YES (Y/N)

11. Treatment building or enclosure:

a. Inaccessible to public: YES (Y/N)

b. Ventilation adequate: YES (Y/N)

c. Heating adequate: YES (Y/N)

d. Drainage adequate: YES (Y/N)

12. Disinfection Unit: YES (Y/N)

a. Manufacturer STENNER PUMP

CO.

Phone No. 800-683-2378

b. Model Number: 45MHP2

c. Discharge Flow: (gals./day) 3.0 (GALS/DAY)

d. Spare parts: NO (Y/N)

e. Records kept of disinfectant residual NO (Y/N)

f. Type (Pressure, Water, Electric, Tablet, Other) ELECTRIC

g. Protective equipment available:

1. Rubber gloves: NO (Y/N)

2. Face Shield: NO (Y/N)

3. Eye Bath: NO (Y/N)

h. Testing chlorine residual for total chlorine: NO (Y/N)

13. Disinfection monitor waiver: N/A (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY

Improvements:

W- 20

D. STORAGE SYSTEM

1. Tank Type: (Hydropneumatic, Elevated, Below Ground) ELEVATED /

HYDROPNEUMATIC

Manufacturer: ELEVATED-POLYETHYLENE CUSTOM Model No:

Manufacturer: HYDRO-PNUEMATIC Model No:

CUSTOM

WELLMATE

WM-60

2. Material of construction: (Steel, Concrete, Wood, Fiberglass, Polyethylene)

POLYETHYLENE /

STEEL

3. Capacity adequate for:

a. Domestic: YES (Y/N)

b. Fire: NO (Y/N)

c. Irrigation: NO (Y/N)

d. Capacity: 1500/187 (GALS)

e. Dimensions: (l x w x h) inches ELEVATED

Dimensions: (l x w x h) inches WELLMATE

6’x6’x6’ 30” DIA.x79” H

4. Vent with return bend and screened: NO (Y/N)

5. Is screen size 24 mesh or smaller: N/A (Y/N)

6. Outlet through tank bottom: YES (Y/N)

7. Outlet off the bottom: YES (Y/N)

8. Tank inlet and outlet separate: YES (Y/N)

9. Tank inlet and outlet insulated: NO (Y/N)

10. Overflow pipe provided: NO (Y/N)

11. Overflow properly daylighted and screened: N/A (Y/N)

12. Tank drain through bottom YES (Y/N)

13. Tank drain separate from inlet and outlet: YES (Y/N) 14 Drain properly daylighted and screened: NO (Y/N)

15. Access cover:

a. Lockable: NO (Y/N)

b. Watertight: YES (Y/N)

c. Overhanging (shoebox type): YES (Y/N)

d. If bolted, are all the bolts in place: N/A (Y/N)

e. Is gasket adequate: N/A (Y/N)

16. Exterior ladder serviceable:

a. Climb prevention device adequate: N/A (Y/N)

17. Interior ladder:

a. Provided: NO (Y/N)

b. Serviceable: N/A (Y/N)

18. Roof watertight: YES (Y/N)

19. Steel tanks:

a. Interior paint adequate: YES (Y/N)

b. Exterior paint adequate: YES (Y/N)

20. Concrete tanks:

a. Protective coating adequate: N/A (Y/N)

b. Concrete watertight: N/A (Y/N)

c. Tank interior painting system NSF of ANSI approved: N/A (Y/N)

21. Liquid level controls adequate: YES (Y/N)

W- 21

22. Level control type: (Probes, Floats) FLOATS

23. Level control manufacturer: UNKNOWN

24. Level control model number: UNKNOWN

25. Low level alarm provided: NO (Y/N)

26. Volume gauge provided: NO (Y/N)

27. Pressure relief valve on hydropneumatic tank: YES (Y/N)

a. Is the valve sized properly: YES (Y/N)

28. Confined space plan in place for this tank: NO (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY

E. DISTRIBUTION SYSTEM

1. Pipe material: (PVC, Polyethylene, Ductive Iron, Copper) PVC, COPPER

2. Approximate length of piping system UNKNOWN (FEET)

3. Pressure at all fixtures adequate: YES (Y/N) If no, explain:

4. Pressure rating/other: (PSI Pressure Rating, SDR, Class, or

Schedule)

UNKNOWN

5. Pressure regulator provided: NO (Y/N)

6. Air relief valve (s) provided: NO (Y/N)

7. Vacuum relief valve (s) provided: NO (Y/N)

8. Drains to daylight: YES (Y/N)

9. Pumped Drain: NO (Y/N)

10. Drains screened: NO (Y/N)

11. Lines adequately buried: YES (Y/N)

12. Water pipe NSF approved: YES (Y/N)

13. Adequate coverage with fire hydrants: N/A (Y/N)

14. Water hammer arrestors provided: NO (Y/N)

15. Water meter provided: YES (Y/N)

16. Tap for obtaining sample of raw water provided: YES (Y/N)

17. Access point for adding disinfectant provided: YES (Y/N)

18. Valve pits - free of water: N/A (Y/N)

19. Is there an interconnection with any other system: NO (Y/N) If yes, explain: (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY

Possible sources of contamination:

W- 22

F. POINT OF USE

1. Type: (Hydrant, Fountain, Hydrant & Fountain) HYDRANT P1 TO P3 IN SHOP AREA OF

BLDG. #309

a. Manufacturer: UNKNOWN Phone: UNKNOWN

b. Model No: UNKNOWN c.. Accessibility Status: (Not-Accessible, Usable, Accessible) NOT-ACCESSIBLE

d. Drainage:

1. Drain pipe or trough clean: N/A (Y/N)

2. Excess water drains away from slab area: N/A (Y/N)

3. Surface water drains away from slab area: N/A (Y/N)

e. Slab:

1. Open cracks in slab: N/A (Y/N)

2. Rodents burrowing under slab: N/A (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

Improvements: NEW BACKFLOW PREVENTORS ON THREE FAUCETS

Type: (Hydrant, Fountain, Hydrant & Fountain) BLDG. #309. BATHROOM (1 TOILET, 1

SHOP BUILDING #309 LAVATORY, 1 SHOWER), SHOP

(UTILITY SINK)

a. Manufacturer: UNKNOWN Phone: UNKNOWN

b. Model No: UNKNOWN c.. Accessibility Status: (Not-Accessible, Usable, Accessible) NOT-ACCESSIBLE

d. Drainage:

1. Drain pipe or trough clean: N/A (Y/N)

2. Excess water drains away from slab area: N/A (Y/N)

3. Surface water drains away from slab area: N/A (Y/N)

e. Slab:

1. Open cracks in slab: N/A (Y/N)

2. Rodents burrowing under slab: N/A (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

Type: (Hydrant, Fountain, Hydrant & Fountain) BLDG. #308. FIVE BATHROOMS (5

NFP LARGE BUNKHOUSE #308 TOILETS, 5 LAVATORYS, 5 SHOWERS),

KITCHEN (2 SINKS AND 2 DISH

WASHERS), LAUNDRY ROOM

(2 WASHER HOOKUPS)

W- 23

a. Manufacturer: UNKNOWN Phone: UNKNOWN

b. Model No: UNKNOWN c.. Accessibility Status: (Not-Accessible, Usable, Accessible) NOT-ACCESSIBLE

d. Drainage:

1. Drain pipe or trough clean: N/A (Y/N)

2. Excess water drains away from slab area: N/A (Y/N)

3. Surface water drains away from slab area: N/A (Y/N)

e. Slab:

1. Open cracks in slab: N/A (Y/N)

2. Rodents burrowing under slab: N/A (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

Type: (Hydrant, Fountain, Hydrant & Fountain) BLDG. #312. BATHROOM (1 TOILET, 1

PILOT READY ROOM BLDG. #312 LAVATORY)

a. Manufacturer: UNKNOWN Phone: UNKNOWN

b. Model No: UNKNOWN c.. Accessibility Status: (Not-Accessible, Usable, Accessible) NOT-ACCESSIBLE

d. Drainage:

1. Drain pipe or trough clean: N/A (Y/N)

2. Excess water drains away from slab area: N/A (Y/N)

3. Surface water drains away from slab area: N/A (Y/N)

e. Slab:

1. Open cracks in slab: N/A (Y/N)

2. Rodents burrowing under slab: N/A (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

2. Host Site Hydrant

a. Manufacturer: NONE Phone: NONE

b. Model No: NONE

c. Accessibility Status:(Not-Accessible, Usable, Accessible) NONE

d. Number of Host Sites: NONE

e. How Many have water: NONE

f. Drainage:

1.Drain pipe or trough clean: N/A (Y/N)

W- 24

2.Excess water drains away from slab area: N/A (Y/N) 3.Surface water drains away from slab area: N/A (Y/N)

g. Slab:

1.Open cracks in slab: N/A (Y/N) 2.Rodents burrowing under slab: N/A (Y/N) Condition: (Critical, Poor, Satisfactory, Good) Appraisal: (Maintain, Remove, Repair, Replace)

3. RV Site Hydrant

a. Manufacturer:

Phone:

b. Model No:

c. Accessible Status: (Not-Accessible, Usable, Accessible)

d. Number of RV sites:

e. How many have water:

Condition: (Critical, Poor, Satisfactory, Good)

4. Trailer Dump Station Tower (Drinking Water)

a. Manufacturer:

Phone no:

b. Model No:

c. Does the drinking water tower have a backflow device: (Y/N) Condition: (Critical, Poor, Satisfactory, Good)

5. If the outlets are threaded, are there any backflow prevention devices used: NO (Y/N)

a. If Yes, manufacturer: N/A (Y/N) Phone: N/A (Y/N)

b. Model No: N/A (Y/N) Condition: (Critical, Poor, Satisfactory, Good) POOR Appraisal: (Maintain, Remove, Repair, Replace) REPLACE

Remarks: INSTALL BACKFLOW PREVENTORS ON FAUCETS P1, P2, P3 IN SHOP AREA

OF BUILDING #309

6. Are frost proof Hydrants NSF approved: NO (Y/N)

a. Manufacturer: N/A Phone: N/A

b. Model No: N/A Condition: (Critical, Poor, Satisfactory, Good) N/A Appraisal: (Maintain, Remove, Repair, Replace) N/A

W- 25

Remarks:

7. If this system serves any stock watering tanks, is there backflow prevention:)

Note: (Air gaps are not approved Backflow Prevention) Possible Sources of Contamination:

Improvements Needed:

G. ELECTRICAL SYSTEM

1. Power Source:

a. Utility Name: POUDRE VALLEY

REA

Phone No.: 800-432-1012

1. Characteristics:

Voltage: UNKNOWN Overhead: YES (Y/N) Underground: NO (Y/N)

2. Transformer:

Ownership POUDRE VALLEY

REA

Voltage: UNKNOWN Phase: UNKNOWN Capacity: UNKNOWN Impedance: UNKNOWN

b. Generator Manufacturer: N/A Phone No: N/A Model: N/A Rating: (KW 120/240, phases) N/A

c. Photovoltaic:

Panel Manufacturer Phone No:

Number of Panels:

Watts (ea):

Size:

2. Distribution: (From Meter) (Overhead/Underground): OVERHEAD

3. Host Site Power

a. Power Pedestal or box:

1. Manufacturer:

Phone:

2. Model No.:

3. How many host sites:

4. How many have power:

5. Main receptacle amperage:

6. Receptacle amperage:

Condition: (Critical, Poor, Satisfactory, Good)

W- 26

Appraisal: (Maintain, Remove, Repair, Replace)

4. RV Site Power

a. Power pedestal or box:

1. Manufacturer:

Phone:

2. Model No.:

3. How many host sites:

4. How many have power:

5. Main receptacle amperage:

6. Receptacle amperage:

Condition: (Critical, Poor, Satisfactory, Good) Appraisal: (Maintain, Remove, Repair, Replace)

W- 27

PART III

REPORT ON SANITARY/CONDITION SURVEY

(A copy of the Sanitary/Condition Survey, Parts I, II, and III, should be attached to this report.)

Pawnee National Grassland

District : Canyon Lakes Ranger District

Forest Service, or State or EPA I.D. Number: 335838

Date of Survey : September 4, 2018

Survey Made By : /s/ Chris Ida

Date of this Report : March 4, 2019

Report Made By : /s/ Chris Ida

Reviewed By: Date:

District Ranger

Recreation Staff

Forest Engineer

PART III

ITEM NO. PAGE

PART III - FIELD DATA

IIIA. Site Identification W-28 IIIB. System Description W-28 IIIC. Attachments W-30

W- 28

REPORT OUTLINE

PART III – FIELD DATA

A. Site Identification

1. Forest: Arapaho and Roosevelt National Forest and

Pawnee National Grassland

2. Ranger District: Canyon Lakes Ranger District

3. Water System Identification Number: 335838

4. Type of Sites Served:

(Special Use, Admin., Recreation, Other) Administrative

5. Maximum Number of Persons using System per Day: (Persons/Day) 23 Persons at One Time

6. How many days are the persons in number 5 actually using the system: 153 Days

7. Use Period: May 1 to September 30 (mm/dd)

B. System Description

The Redfeather Work Center #2 water system is a seasonal administrative site typically open from May to September that is a non-public, transient water system. The system consists of a 191 feet well, submersible pump and controls, above ground polyethylene storage tank with water level probes, booster supply pump, one woven cartridge filter unis, chlorine pump and tank, hydropneumatic storage tank, and a distribution system that serves 3 buildings. The existing well was drilled in 2001 by the Bureau of Reclamation claiming reserved water rights on reserved federal lands. A well permit application and drillier log was submitted to the State Division of Water Resources as a follow-up under well permit 239035.

The existing 191-feet deep, 4-1/2-inch diameter well is located east of the old large bunkhouse #301

Water from the well is pumped via a submersible pump to the above ground polyethylene storage tank located in the Engine Cashe Storage Building #309. Water is controled by loats in the above ground tank. A booster/supply pump water to the distribution system and has associated pressure tanks/filtration/chlorination/valve components prior to entering the distibution system. No submersible pump information was available at the time of this sampling event; however, the pump appears to be sized and operating correctly and there is adequate pump protection. Water flow from the above ground storage tank is controlled by a pressure switch. There are no supply pump controls other then the pressure switch.

There is a chlorinator/chlorine solution tank on site for the water system and a fitting in the suply line to

W- 29 accommodate chlorine injection.

The water then flows from the Engine Cashe Storage Building #309 to the distribution system and to the remaining 2 building facilities (with varied points of use)..

W- 30

Redfeather Work Center #2 Water System – Wellhead

Redfeather Work Center #2 Water System – Building #309 (Engine Cashe)

W- 31

Redfeather Work Center #2 Water System – Building #309. Elevated Storage Tank, Submersible Pump Controls, Supply Pump, and Pressure Tank

Redfeather Work Center #2 Water System – Building #309. Supply Pump

W- 32

Redfeather Work Center #2 Water System – Building #309. Pressure Tank and Chlorination System

Redfeather Work Center #2 Water System – Building #309. Woven Cartridge Filter

W- 33

Redfeather Work Center #2 Water System – Building #309. Valves P1

Redfeather Work Center #2 Water System – Building #309. Valves P2

W- 34

Redfeather Work Center #2 Water System – Building #309. Valves P3

Redfeather Work Center #2 Water System – Building #309. UtIlity Sink

W- 35

Redfeather Work Center #2 Water System – Building #309. Bathroom

Redfeather Work Center #2 Water System – Building #309. Bathroom Shower

W- 36

Redfeather Work Center #2 Water System – Building #308 (NFP Large Bunkhouse)

Redfeather Work Center #2 Water System – Building #308. Bathroom (Typical)

W- 37

Redfeather Work Center #2 Water System – Building #308. Bathroom Shower (Typical)

Redfeather Work Center #2 Water System – Building #308. Washer/Dryer Hookups

W- 38

Redfeather Work Center #2 Water System – Building #308. Kitchen Sink and Dishwasher

Redfeather Work Center #2 Water System – Building #308. Kitchen Sink and Dishwasher

W- 39

Redfeather Work Center #2 Water System – Building #312. (Pilot Ready Room)

Redfeather Work Center #2 Water System – Building #312. Bathroom

W- 40

Redfeather Work Center #2 Water System – Daylight Drain Valve Box Northeast of Engine Cashe Storage Bldg.

Redfeather Work Center #2 Water System – Daylight Drain Northeast of Engine Cashe Storage Bldg.

W- 41

Redfeather Work Center #2 Water System – Daylight Drain Valve Box Northeast of NFP Large Bunkhouse.

Redfeather Work Center #2 Water System – Daylight Drain Northeast of NFP Large Bunkhouse.

W- 42

Redfeather Work Center #2 Water System – Site Plan

W- 43

Redfeather Work Center #2 Water System – Well Log (Bureau of Redclamation)

W- 44

Redfeather Work Center #2 Water System – Chemical Analysis. Page One

W- 45

Redfeather Work Center #2 Water System – Chemical Analysis. Page Two

WATER SYSTEM

Annual / Deferred Maintenance Cost Summary Form

Forest: Arapaho and Roosevelt NF and Pawnee NG Water System Name: RedFeather WC #2 Water System District: Canyon Lakes RD Site Id: 300 Admin. Org 21005 Date: 9/4/2018 By: C.Ida

ANNUAL MAINTENANCE TASKS

Key to Deferred Maintenance Tasks

Task Description Dollars Needed

Unit Task Type Reason Priority Remarks

01 Start Up 01-002001 Start Up - Source - Chlorinate and Flush Well $111.85 EACH Annual Health and Safety Critical 2 HOURS 01 Start Up 01-004001 Start Up - Treatment - Flush and Fill

Chlorinator/Treatment Plant $86.27 EACH Annual Health and Safety Critical 1-1/2 HOURS

01 Start Up 01-005001 Start Up - Storage - Flush and Fill Pressure Tanks

$51.15 HOUR Annual Health and Safety Critical 1 HOUR.

01 Start Up 01-005002 Start Up - Storage - Disinfect Storage Tank $60.70 EACH Annual Health and Safety Critical 1 HOUR 01 Start Up 01-006001 Start Up - Disinfect Distribution Line - Disinfect and Drain all Distribution Lines $519.14 EACH Annual Health and Safety Critical 10 HOURS

01 Start Up 01-006002 Start Up - Disinfect Distribution Line - Close Drains, Fill System, Operate all Valves

$204.60 EACH Annual Health and Safety Critical 4 HOURS

03 Operator Training & Certification

03-001001 Operator Training & Certification - Office - Seasonal Training

$409.20 EACH Annual Health and Safety Critical 8 HOURS

03 Operator Training & Certification

03-001002 Operator Training & Certification - Office - Confined Space Awareness Training

$102.30 EACH Annual Health and Safety Critical 2 HOURS

06 Condition Survey 06-001001 Condition Survey - Survey - Beginning of Season Inspection

$204.60 HOUR Annual Health and Safety Critical 4 HOURS

06 Condition Survey 06-001002 Condition Survey - Survey - End of Season Survey

$204.60 HOUR Annual Health and Safety Critical 4 HOURS

07 Sanitary Survey 07-001002 Sanitary Survey Survey - Surveys - Sanitary Survey/Condition Survey (FOREST SERVICE)

$605.70 EACH Annual Health and Safety Critical 8 HOURS

08 System Operation 08-002001 System Operation - Pumps and Controls - Weekly Check

$818.40 HOUR Annual Health and Safety Critical 16 HOURS OVER

THE SEASON

08 System Operation 08-003001 System Operation - Treatment - Weekly Check

$818.40 HOUR Annual Health and Safety Critical 16 HOURS OVER

THE SEASON

08 System Operation 08-003002 System Operation - Treatment - Chlorine Solution, Refill Tank

$409.20 HOUR Annual Health and Safety Critical 8 HOURS OVER

THE SEASON

08 System Operation 08-004001 System Operation - Backflow Preventors - Hose Bibb: Installation/Inspection/Replacement

$296.70 EACH Annual Health and Safety Critical 3 HOSE BIBBS IN

SHOP

10 Sampling 10-002001 Sampling - Source - Startup Bacteriological Test

$89.35 EACH Annual Health and Safety Critical 1 TEST

10 Sampling 10-002002 Sampling - Source - Monthly Bacteriological Test

$536.10 EACH Annual Health and Safety Critical 6 SAMPLES

10 Sampling 10-002003 Sampling - Source - Nitrate/Nitrite Test $453.13 EACH Annual Health and Safety Critical 1 TEST 10 Sampling 10-003001 Sampling - Treatment - Chlorine Residual

Test $818.40 HOUR Annual Health and Safety Critical 16 HOURS OVER

THE SEASON

11 Record Keeping 11-001001 Record Keeping - Office - INFRA Updates $409.20 HOUR Annual Forest Mission Critical 8 HOURS 11 Record Keeping 11-001002 Record Keeping - Office - Water Quality

Reports $409.20 HOUR Annual Forest Mission Critical 8 HOURS

11 Record Keeping 11-001003 Record Keeping - Office - Well logs/As- Builts/O&M and Sampling Plans

$1,910.00 LS Annual Forest Mission Critical None

13 Consumables 13-001001 Consumables - Treatment - Chlorine Solution $11.46 GAL. Annual Health and Safety Critical 6 GALLONS 13 Consumables 13-001003 Consumables - Treatment - Finishing Filters $859.50 EACH Annual Health and Safety Critical 6 FILTERS 14 Shut Down 14-003001 Shut Down - Treatment - Drain

Chlorinator/Plant/Tank $51.15 HOUR Annual Health and Safety Critical 1 HOUR

14 Shut Down 14-004001 Shut Down - Storage - Drain Pressure Tank $51.15 HOUR Annual Health and Safety Critical 1 HOUR 14 Shut Down 14-005001 Shut Down - Distribution - Drain Seasonal

System, Open/Shut Valves $204.60 EACH Annual Health and Safety Critical 4 HOURS

00 Blank ****** $0.00 ***** ***** ***** ***** None 00 Blank ****** $0.00 ***** ***** ***** ***** None 00 Blank ****** $0.00 ***** ***** ***** ***** None 00 Blank ****** $0.00 ***** ***** ***** ***** None

TOTAL ANNUAL OPERATION AND MAINTENANCE

COSTS $10,706.03

Water System Name: RedFeather WC #2 Water System

DEFERRED MAINTENANCE TASKS / CAPITAL IMPROVEMENTS (CONTINUED)

Key to Deferred Maintenance Tasks

Task Description Dollars Needed

Unit Task Type Reason Priority Remarks

04 Repair 04-005001 Repair - Storage - Reservoir Cleaning, Professional

$9,652.30 EACH Deferred Maintenance Forest Mission Non-Critical CLEAN STORAGE

TANK

04 Repair 04-006004 Repair - Distribution - Annual Backflow Preventor Inspection

$879.90 EACH Deferred Maintenance Forest Mission Non-Critical BACKFLOW

PREVENTOR ON

HOSE BIBBS IN

ENGINE SHOP

05 Replacement 05-003004 Replacement - Pumps and Controls - Replace Submersible Pump

$1,910.00 EACH Deferred Maintenance Forest Mission Non-Critical NEW PUMP

05 Replacement 05-003005 Replacement - Pumps and Controls - Drop Pipe Replacement

$2,701.20 EACH Deferred Maintenance Forest Mission Non-Critical NEW DROP PIPE

05 Replacement 05-004006 Replacement - Treatment - Water Conditioning

$19,100.00 EACH Deferred Maintenance Forest Mission Non-Critical NEW WATER

CONDITIONER

FOR IRON &

MANGANESE

00 Blank ***** $0.00 ***** ***** ***** ***** None 00 Blank ***** $0.00 ***** ***** ***** ***** None 00 Blank ***** $0.00 ***** ***** ***** ***** None 00 Blank ***** $0.00 ***** ***** ***** ***** None 00 Blank ***** $0.00 ***** ***** ***** ***** None 00 Blank ****** $0.00 ***** ***** ***** ***** None 00 Blank ****** $0.00 ***** ***** ***** ***** None 00 Blank ****** $0.00 ***** ***** ***** ***** None 00 Blank ****** $0.00 ***** ***** ***** ***** None

TOTAL DEFERRED MAINTENANCE COSTS $34,243.40