J.8_ArrowheadLodgeWaterSystemSS_08-27-2018.pdf

Sanitary Survey – Arrowhead Lodge August 27, 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 : Arrowhead Lodge Vistor Center

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

(TNPNT)

Forest : Arapaho and Roosevelt National Forest and Pawnee National Grassland

District : Canyon Lakes Ranger District

Year of Survey (YYYY) 2018

Real Property Number 03920

Forest Service, or State or EPA I.D. Number: 335132

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: 335132

Date Compiled (MM,DD,YY) : August 27, 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: NO (Y/N) When

2. Design criteria: NO (Y/N)

3. Construction drawings and specifications: NO (Y/N)

4. "As-built" drawings: (If YES, provide copy) NO (Y/N)

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

6. Is there a site plan: (If YES, provide copy) NO (Y/N)

7. Final construction report: NO (Y/N)

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

9. When constructed: 1995

10. Modifications Since Construction: UNKNOWN Describe:

a.

b.

Remarks: NEED TO OBTAIN AN ENGINEERING REPORT, DESIGN AND

CONSTRUCTION CRITERIA, AS-BUILTS, SITE PLAN, AND FINAL

CONSTRUCTION REPORT. THE LOCATION OF ARROWHEAD LODGE IS

SHOWN ON A PORTION OF THE KINIKINIK 7 ½ MINUTE QUADRANGLE MAP

ATTACHED. THE PROPERTY WAS ACQUIRED BY THE USFS IN 1989 IN A

LAND EXCHANGE SO LITTLE PREVIOUS RECORDS EXIST.

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 02/13/2019 - INFRA

53 ( ESTIMATED )

131 DAYS

MAY 22 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

Remarks:

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:

(Y/N)

B. Monthly routine sample: (Y/N) C. Comments:

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):

(Y/N)

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

6. Organics:

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

Department) (Y/N)

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

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

8. Lead and Copper: (Y/N)

9. Disinfection: (Y/N)

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

If yes, when:

11. Remarks:

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: CONCESSIONAIRE DOES BACTERIOLOGICAL

TESTING AND SENDS TO THE STATE HEALTH DEPARTMENT.

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: NONE (Y/N)

(EVERY 3

YEARS)

B. Nitrate: Required once (before chlorination): NONE (Y/N)

(REQUIRED

ONCE BEFORE

CHLORINATION)

5. Palatability and Esthetic Acceptability (USFS) A. Alkalinity YES (Y/N) B. Hardness: NO (Y/N) C. PH (on site)** YES (Y/N) D. Iron** YES (Y/N) E. Manganese** YES (Y/N) F. Sulfide: NO (Y/N) **Required under baseline testing

6. Organics:

A. Herbs and Pests (Not Required) NOT REQUIRED B. THM's (Not Required) NOT REQUIRED C. VOC's (Not Required) NOT REQUIRED D. Unreq. VOC's (Not Required) NOT REQUIRED 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 JULY 7, 2003

YES (Y/N)

11. Remarks:

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: NO (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: NO (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: NO (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: NO (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 NO (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)

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:

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.

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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.

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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: TO THE SYSTEM 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) 09/01/2013

Remarks: THE PROPERTY WAS ACQUIRED BY THE USFS IN 1989.

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: UNKNOWN (Y/N)

4. Watershed

a. Watershed name: BLACK HOLLOW-CASHE LA

POUDRE RIVER

b. Watershed code: 101900070208

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

$102.30 HOUR 1 HOUR PER

TANK. TWO

TANKS

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

06 Condition Survey

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

$102.30 HOUR 2 HOURS

06 Condition Survey

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

$102.30 HOUR 2 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

08 System Operation

08-003001 System Operation - Treatment - Weekly Check

$818.40 HOUR 16 HOURS

08 System Operation

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

$409.20 HOUR 8 HOURS

08 System Operation

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

Installation/Inspection/Replacement

$395.60 EACH 4 OUTSIDE

HYDRANTS/BIBBS

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

$89.35 EACH 1 TEST

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

$536.10 EACH 6 MONTHLY

TESTS OVER THE

SEASON

10 Sampling 10-002003 Sampling - Source - Nitrate/Nitrite Test $453.13 EACH 1 TEST

W- 12

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

$818.40 HOUR 16 HOURS

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

Consumables

13-001001 Consumables - Treatment - Chlorine Solution

$11.46 GAL. 6 GALLONS

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

$102.30 HOUR 2 HOURS

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

$51.15 HOUR 2 HOURS

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: 335132

Date Surveyed : August 27, 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-19 IIE. Distribution System W-21 IIF. Point of Use W-21 IIG. Electrical System W-25

W- 14

PART II - FIELD DATA

A. SOURCE

1. Well

a. Well permit number: 184693

b. Well log: YES (Y/N)

c. Location: SW ¼, NE ¼ OF

SECTION 36

Latitude: 40.703697° Longitude: -105.636267° Section: 36 Township: 9 NORTH Range: 74 WEST

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

e. Casing:

Diameter: (inches, I.D) 6 5/8”, 4” Material: (Plastic, Steel, Other) STEEL, PVC Wall thickness: (inches) 0.250”, 0.237”

f. Depth:

Ground surface to bottom of well: 140 (FEET) Ground surface to bottom of casing: 140 (FEET) Ground surface to first draw (top of screen/perforations or bottom of casings)

90 (FEET)

Static water level: 62 (FEET) Pump set at 140 (FEET)

g. Capacity (gpm at feet drawdown) 3 GMP AT 140 FEET

DRAWDOWN

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

CEMENT GROUT

i. Subject to flooding: YES (Y/N)

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

k. Is casing 18 inches above natural grade:

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

m. Well screen Material: (Plastic, Steel, Other) PLASTIC Type: (Slotted, Drilled, Torch Cut) SLOTTED Hole/Slot Size: 0.028

n. Sanitary well cover type: (Cap, Seal) N/A Vented: N/A

o. Pitless Adapter: NO

p. Located how far from a possible source of contamination

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

10 FEET

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

If Yes, When: (mm/dd/yy) 07/07/2003

Condition: (Critical, Poor, Satisfactory, Good) GOOD

W- 15

Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

Possible sources of contamination:

Improvements needed: CONCRETE PAD AROUND WELLHEAD.

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):

Improvements needed:

3. Surface (Stream, River, or Lake)

a. Name (s) :

Location:

Latitude:

Longitude:

Section:

Township:

Range:

W- 16

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 (Y/N)

p. Year of Installation: UNKNOWN (Y/N)

q. Pump protection:

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

2. Motor running current below nameplate rating: UNKNOWN

3. Circuit breaker or fuse properly sized: UNKNOWN

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

W- 17

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

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

7. Operation light: NO (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) N/A (Y/N)

11. Low water level shut off in well: UNKNOWN (Y/N)

r. Pump discharge piping:

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

2. Check valve: NO (Y/N)

3. Control and shutoff valve: YES (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:

b. Model:

c. Horsepower:

d. RPM:

e. FLA:

f. S.F.:

g. Voltage:

h. Phase:

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

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

k. Operating properly: (Y/N)

l. Pump properly sized: (Y/N)

m. Pump curve provided: (Y/N)

n. Pumping Rate Capacity: (Y/N)

o. Year of Installation: (Y/N)

p. Pump protection:

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

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

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

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

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

6. Hand-off-Automatic switch: (Y/N)

7. Operation light: (Y/N)

8. Pump operation counter: (Y/N)

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

W- 18

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

q. Pump discharge piping:

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

2. Check valve type: (Swing, Poppet, Disk)

3. Control and shutoff valve: (Y/N)

4. Flow control valve: ## (GPM) Condition: (Critical, Poor, Satisfactory, Good) Appraisal: (Maintain, Remove, Repair, Replace)

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) Possible sources of contamination:

W- 19

C. TREATMENT SYSTEM

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

2. Sedimentation: NO (Y/N)

3. Filtration: NO (Y/N)

4. Filter material: (Sand or Other medium) N/A

5. Equipment Flow Rate: YES (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: NO (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 PULSATRON Phone No. UNKNOWN

b. Model Number: LC54SA-VHC1

c. Discharge Flow: (gals./day) 30 (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: YES (Y/N)

13. Disinfection monitor waiver: N/A (Y/N) Condition: (Critical, Poor, Satisfactory, Good) GOOD Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN Improvements:

Remarks:

D. STORAGE SYSTEM

1. Tank Type: (Hydropneumatic, Elevated, Below Ground) HYDROPNEUMATIC Manufacturer: WELLMATE Model No: WM-35WB, WT-120

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

STEEL

3. Capacity adequate for:

a. Domestic: YES (Y/N)

b. Fire: NO (Y/N)

c. Irrigation: NO (Y/N)

d. Capacity: 120 (GALS)

W- 20

e. Dimensions: (l x w x h) inches 24” DIA.x74.25” H

4. Vent with return bend and screened: N/A (Y/N)

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

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

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

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

9. Tank inlet and outlet insulated: N/A (Y/N)

10. Overflow pipe provided: N/A (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: NO (Y/N) 14 Drain properly daylighted and screened: NO (Y/N)

15. Access cover:

a. Lockable: N/A (Y/N)

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

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

22. Level control type: (Probes, Floats) PRESSURE SWITCH

23. Level control manufacturer: SQUARE D

24. Level control model number:

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

Improvements:

W- 21

E. DISTRIBUTION SYSTEM

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

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: YES (Y/N)

10. Drains screened: UNKNOWN (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: NO (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 Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

Possible sources of contamination: BACKFLOW FROM DAYLIGHT DRAIN SUMP Improvements:

Remarks: PUMP DAYLIGHT DRAIN AT END OF SEASON

F. POINT OF USE

1. Type: (Hydrant, Fountain, Hydrant & Fountain) HYDRANT #1 (ADA DRINKING IN

FRONT OF BUILDING-INACTIVE)

a. Manufacturer: UNKNOWN Phone: UNKNOWN

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

d. 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)

e. Slab:

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

2. Rodents burrowing under slab: NONE (Y/N) Condition: (Critical, Poor, Satisfactory, Good) POOR Appraisal: (Maintain, Remove, Repair, Replace) REMOVE

W- 22

Improvements: REMOVE HYDRANT Remarks: REMOVE HYDRANT

Type: (Hydrant, Fountain, Hydrant & Fountain) HYDRANT #2 (ADA DRINKING IN

BACK OF BUILDING-INACTIVE)

a. Manufacturer: UNKNOWN Phone: UNKNOWN

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

d. 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)

e. Slab:

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

2. Rodents burrowing under slab: NONE (Y/N) Condition: (Critical, Poor, Satisfactory, Good) POOR Appraisal: (Maintain, Remove, Repair, Replace) REMOVE

Host Site Hydrant HYDRANT #3 AND #4 (HOST HYDRANTS)

a. Manufacturer: UNKNOWN Phone: UNKNOWN

b. Model No: UNKNOWN

c. Accessibility Status:(Not-Accessible, Usable, Accessible) NOT-ACCESSIBLE

d. Number of Host Sites: TWO

e. How Many have water: TWO

f. Drainage: NO CONCRETE

SLAB

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)

g. Slab:

1.Open cracks in slab: NONE (Y/N) 2.Rodents burrowing under slab: NONE (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

Improvements: NEED BACKFLOW PREVENTORS Remarks: NEED BACKFLOW PREVENTORS

Type: (Hydrant, Fountain, Hydrant & Fountain) HYDRANT #5 (EAST SIDE OF

BUILDING-INACTIVE)

a. Manufacturer: UNKNOWN Phone: UNKNOWN

b. Model No: UNKNOWN

W- 23 c.. Accessibility Status: (Not-Accessible, Usable, Accessible) NOT-ACCESSIBLE

d. 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)

e. Slab:

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

2. Rodents burrowing under slab: NONE (Y/N) Condition: (Critical, Poor, Satisfactory, Good) POOR Appraisal: (Maintain, Remove, Repair, Replace) REMOVE

Type: (Hydrant, Fountain, Hydrant & Fountain) HYDRANT #A (IN PUMP ROOM)

Phone: UNKNOWN

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

d. 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)

e. Slab:

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

2. Rodents burrowing under slab: NONE (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

Improvements: NEED BACKFLOW PREVENTOR Remarks: NEED BACKFLOW PREVENTOR

Type: (Hydrant, Fountain, Hydrant & Fountain) HYDRANT #B (IN PUMP ROOM)

Phone: UNKNOWN

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

d. 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)

e. Slab:

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

2. Rodents burrowing under slab: NONE (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

W- 24

Type: (Hydrant, Fountain, Hydrant & Fountain) HYDRANT #C (IN PUMP ROOM)

Phone: UNKNOWN

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

d. 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)

e. Slab:

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

2. Rodents burrowing under slab: NONE (Y/N) Condition: (Critical, Poor, Satisfactory, Good) SATISFACTORY Appraisal: (Maintain, Remove, Repair, Replace) MAINTAIN

3. RV Site Hydrant

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) Appraisal: (Maintain, Remove, Repair, Replace)

4. Trailer Dump Station Tower (Drinking Water)

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) MAINTAIN

Remarks: INSTALL BACKFLOW PREVENTORS ON HYDRANTS 3,4,A,B,C

W- 25

6. Are frost proof Hydrants NSF approved: (Y/N)

a. Manufacturer:

Phone:

b. Model No:

Condition: (Critical, Poor, Satisfactory, Good)

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.:

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:

Phone No:

Model:

Rating: (KW 120/240, phases)

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:

W- 26

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)

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.)

Water System Name : Arrowhead Lodge Visitor Center

Pawnee National Grassland

District : Canyon Lakes Ranger District

Forest Service, or State or EPA I.D. Number: 335132

Date of Survey : August 27, 2018

Survey Made By : /s/ Chris Ida

Date of this Report : February 13, 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: 335132

4. Type of Sites Served:

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

5. Maximum Number of Persons using System per Day: (Persons/Day) 53 Persons at One Time

6. How many days are the persons in number 5 actually using the system: 131 Days

7. Use Period: May 22 to September 30 (mm/dd)

B. System Description

Arrowhead Lodge Visitor Center is a seasonal administrative and recreation site open from May to September that is supplied by a transient, non-community (TNC) water system. The system consists of one well, one submersible pump, two 350-gallon hydropneumatic storage tanks, one chlorination system, approximately 1000 feet of polyvinyl chloride (PVC) piping, 15 points of use, and one identified drain·. The Visitor Center is located in the Poudre Canyon, approximately 50 miles west-northwest of Fort Collins, Colorado along Colorado State Highway 14.

Arrowhead Lodge was transferred to the USFS for administrative use in 1984 after serving as a private family lodging business for over 50 years. There are approximately 15 vacant cabins on the north side of the Visitor Center, unused since 1984. A sizable kitchen within the Visitor Center is used only by USFS employees and volunteers. There are day use picnic tables on the Visitor Center grounds;

however, no overnight camping is allowed.

The 140-feet deep, 6-5/8-inch diameter well is located approximately 30 feet southwest and up gradient of the Visitor Center building. The depth of the well intake interval is from 70 feet to 140 feet below ground surface. The well casing extends approximately 15 inches above the natural grade and is not surrounded by a concrete slab. The well cap seal has a rubber gasket and is secured with a padlock.

The well location is open to public access, as it is secured in any building or fenced area. The well location is not subject to flooding. The well was installed in 1995 and appears to be in excellent condition.

W- 29

The submersible pump is installed in the well and is operated through a pitless adapter. No 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.

The storage system consists of two 350-gallon hydropneumatic storage tanks located in back of the Visitor Center. From the well, water flows through a flow meter and pressure gage into one 350-gallon hydropneumatic storage tank from the bottom. The second 350-gallon hydropneumatic storage tank acts as a reservoir and stores water for excess use, starting automatically when the pressure of the first tank experiences inadequate pressure to supply the points of use. There is a pipe exiting the top of storage tank #1, re-joining the distribution system at the flow meter, and this return pipe is presumably used for flushing the tank with water for periodic cleanings. The hydropneumatic storage tanks, manufactured by Well Mate, are model WM-35WB, are in good condition. The water then flows towards either a hot water heater for Visitor Center use, or towards a chlorination system for external use. Water flows to the 15 points of use on demand by the pressurized storage tanks. The treatment system consists of one 35-gallon chlorination tank and one Pulsatronic Electronic Metering pump. Chlorine is added to the water upon exiting the storage tank . It is unknown if the water is tested for free and total chlorine residual.

W- 30

Arrowhead Lodge VIS – Front View

Arrowhead Lodge VIS Water System – Wellhead

W- 31

Arrowhead Lodge VIS Water System – ADA Hydrant #1 in Front of Lodge (INACTIVE)

Arrowhead Lodge VIS Water System – ADA Hydrant #2 in Back of Lodge (INACTIVE)

W- 32

Arrowhead Lodge VIS Water System – Hosts Hydrant #3 and #4 in Back of Lodge

Arrowhead Lodge VIS Water System –Hydrant #5 east of Lodge (INACTIVE)

W- 33

Arrowhead Lodge VIS Water System – Lodge Pump Room Hydrant #A

Arrowhead Lodge VIS Water System – Lodge Pump Room Hydrant #B

W- 34

Arrowhead Lodge VIS Water System – Lodge Pump Room Hydrant #C

Arrowhead Lodge VIS Water System – Lodge Bathroom Points of Use (Shower and Toilet)

W- 35

Arrowhead Lodge VIS Water System – Lodge Bathroom Point of Use (Bathroom Sink)

Arrowhead Lodge VIS Water System – Lodge Kitchen Point of Use (Sink #1)

W- 36

Arrowhead Lodge VIS Water System – Lodge Kitchen Point of Use (Sink #2)

Arrowhead Lodge VIS Water System – Toilet Building Point of Use (Mens Sink #3)

W- 37

Arrowhead Lodge VIS Water System – Toilet Building Point of Use (Womens Sink #4)

Arrowhead Lodge VIS Water System – Lodge Pump Room

W- 38

Arrowhead Lodge VIS Water System – Lodge Pump Room Storage Tanks

Arrowhead Lodge VIS Water System – Lodge Pump Room Control Panel

W- 39

Arrowhead Lodge VIS Water System – Lodge Pump Room Chlorination Unit

Arrowhead Lodge VIS Water System – Lodge Pump Room Chlorination Tank

W- 40

Arrowhead Lodge VIS Water System – Site Plan

W- 41

Arrowhead Lodge VIS Water System – Well Permit

W- 42

Arrowhead Lodge VIS Water System – Well Log

W- 43

Arrowhead Lodge VIS Water System – Chemical Test (Page One)

W- 44

Arrowhead Lodge VIS Water System – Chemical Test (Page Two)

WATER SYSTEM

Annual / Deferred Maintenance Cost Summary Form

Forest: Arapaho and Roosevelt NF and Pawnee NG Water System Name: Arrowhead Lodge Water System District: Canyon Lakes RD Site Id: 3500 Admin. Org 21005 Date: 8/27/2018 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

$102.30 HOUR Annual Health and Safety Critical 1 HOUR PER

TANK. TWO TANKS

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

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

$102.30 HOUR Annual Health and Safety Critical 2 HOURS

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

$102.30 HOUR Annual Health and Safety Critical 2 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

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

$818.40 HOUR Annual Health and Safety Critical 16 HOURS

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

$409.20 HOUR Annual Health and Safety Critical 8 HOURS

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

$395.60 EACH Annual Health and Safety Critical 4 OUTSIDE

HYDRANTS/BIBBS

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 MONTHLY TESTS

OVER THE

SEASON

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

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 14 Shut Down 14-003001 Shut Down - Treatment - Drain

Chlorinator/Plant/Tank $102.30 HOUR Annual Health and Safety Critical 2 HOURS

14 Shut Down 14-004001 Shut Down - Storage - Drain Pressure Tank $51.15 HOUR Annual Health and Safety Critical 2 HOURS 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 $9,680.13

Water System Name: Arrowhead Lodge 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 04-006002 Repair - Distribution - Clean/Repair Drains $242.80 EACH Deferred Maintenance Forest Mission Non-Critical PUMP WATER

SYSTEM DRAIN

SUMP. 4 HOURS

04 Repair 04-002003 Repair - Source - Raise Wellhead $1,910.00 EACH Deferred Maintenance Forest Mission Non-Critical CONCRETE PAD

AROUND

WELLHEAD

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

$586.60 EACH Deferred Maintenance Forest Mission Non-Critical INSTALL

BACKFLOW

PREVENTORS ON

TWO HOST

HYDRANTS

05 Replacement 05-006002 Replacement - Distribution - ADA Faucet Replacement

$866.30 EACH Deferred Maintenance Forest Mission Non-Critical REMOVE TWO

ADA OUTSIDE

HYDRANTS (NOT

WORKING)

00 Blank ***** $0.00 ***** ***** ***** ***** 00 Blank ***** $0.00 ***** ***** ***** ***** 00 Blank ***** $0.00 ***** ***** ***** ***** 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 $3,605.70