Revised 7/30/2021

Utah Division of Drinking Water

Stage 2 Disinfectant Byproduct (DBP) Sampling Plan

In accordance with State of Utah Rule R309-210-10(3): Any Community (COM) or Non-Transient Non-Community (NTNC) drinking water system that regularly applies a chemical disinfectant must develop and implement a DBP monitoring plan. The system must maintain current version of the plan on file and submit a copy of 1) the monitoring plan, 2) a schematic of the distribution system, and 3) the justification for site selection (IDSE water, modeling analysis, etc.) to the Division of Drinking Water.

BASIC WATER SYSTEM INFO

Water System Name: Water System #:

Residual Disinfectant Type: ☐ Chlorine ☐ Chlorine Dioxide ☐ Ozone

# of Service Connections:

Population (# of customers):

Sampling Schedule ( # of sampling locations):

Per Quarter Per Year

SITE SELECTION INFO

Associated Rules:

R309-210-9(2)(b)(i)(Q): A dual sample set (i.e., a TTHM and an HAA5 sample) must be taken at each monitoring location during each monitoring period.

Associated Info:

Disinfection By Product Sampling schedules are based on population and source water type. DBPs may be required quarterly, annually, or every three years. For a complete list of possible schedules please see associated DBP handout.

• One dual sample set must be taken at the highest TTHM (trihalomethanes) sampling site, at a location that represents maximum residence time; typically in the furthest reaches of your distribution system, or where water is oldest.

This location is denoted as MR001.

• One dual sample set must be taken at the highest HAA5 (haloacetic acids) sampling site, at a location that represents the average residence time; typically located mid distribution system This location is denoted as MD001.

R309-210-10(3)(ii):

• Water system must identify which locations will be used for compliance monitoring by alternating selection of locations representing high TTHM and high HAA5 levels until the required number of compliance monitoring locations have been identified.

Water system sampling schedules with sampling locations and details are available at any time at WaterLink.utah.gov

SAMPLES

Sample Code

Specific sampling location

ADDRESS

Site Characteristics / Site Selection Justification (check those that apply)

MR001

MR002

MR003

MR004

☐Highest TTHM/HAA5 in prior data ☐ Endpoint of distribution system and/or maximum water age ☐Other:

MD001

MD002

MD003

MD004

☐Highest TTHM/HAA5 in prior data ☐Midpoint of a large distribution system ☐ Endpoint of distribution system and/or maximum water age ☐Other:

Annual samples must be collected within a specific time frame in accordance with State of Utah Rules R309-210-10(2)(a)(ii)(N): All systems must monitor during months of highest DBP concentrations.

R309-210-9(2)(b)(i)(R): The peak historical month is the month with the highest TTHM or HAA5 levels or the warmest water temperature.

Source Water Types:

☐Ground water

☐Ground water purchasing from wholesale Water System #: UTAH

☐Ground water Under Direct Influence of surface water

☐Surface water

☐Surface water purchasing from wholesale Water System #: UTAH

CERTIFICATION

I certify that I am the person authorized to fill out this application and the information I have provided is accurate and complete to the best of my knowledge at the time it was completed.

X X Printed Name Signature

Date: Title: ☐ Administrative Contact ☐ Operator

SUBMITTAL

Mail the completed form to:

Or Email:

Division of Drinking Water Attn: DBP Rule Manager 195 N 1950 W

PO BOX 144830

Salt lake City, UT 84114

DDWREPORTS@UTAH.GOV

This application and related environmental information are available online at DrinkingWater.utah.gov

For more information, or to answer questions, please contact the DBP Rule Manager, Luke Treutel at (385) 258-6084 ltreutel@utah.gov

Revised 7/30/2021 file:///C:/Users/dyaniwood/Documents/Temp/drinkingwater.utah.gov ltreutel@utah.gov