20250714Ex G 2022_01_06 DEQ Sanitary Survey.pdf

STATE OF IDAHO
DEPARTMENT OF
ENVIRONMENTAL QUALITY
2110 Ironwood Parkway,Coeur d'Alene, ID 83814(208)769-1422 Brad Little,Governor
John H.Tippets,Director
January 06, 2022
Bear Claw Subdivision
Jennifer Schmidt, Administrative Contact
Marty Lowell, Designated Operator
1603 N Fourth St.
Coeur d'Alene, ID 83814
j enn i fer.sciiin i [e-mail]
hopeboat(a,hotmail.com
Subject: Sanitary Survey for Bear Claw Subdivision, ID1090231
Survey Date: December 09,2021
Last Survey Date: June 02, 2015
Dear Jennifer and Marty:
Marty Lowell and Andy Olson assisted in the field inspection for the Sanitary Survey that is normally
required every five years for this public water supply system.
The purpose of the Sanitary Survey is to document a detailed record of the water system configuration,
evaluate current operating procedures, provide recommendations, and identify deficiencies that require
correction. The Sanitary Survey Report, enclosed for your files, consists of 7 pages of narrative description
including this cover letter and 13 pages of photographic documentation.
Requirements and recommendations to protect public health, prevent future problems, minimize
contamination potential, maximize safety, and promote effective system operation are listed on pages 6-7.
The water system is advised to implement solutions to these issues as soon as practical.
The water system appears to be substantially in compliance with Idaho Department of Environmental Quality
(DEQ) requirements and Idaho Rules for Public Drinking Water Systems (Rules).
I would be glad to assist you with any questions or concerns regarding this report.
Sincerely,
Andy Olson
Drinking Water Compliance Officer Andy.Olson@d_eq.idaho.gov
Enclosures
Ec: Anna Moody, Drinking Water Compliance Supervispr, Anna.Moody.a deq.idaho.gov
EDMS: ID 1090231-2022ACA94

IDAHO DEPARTMENT OF ENVIRONMENTALQUALITY
ReportDrinking Water Sanitary Survey
NUMBER: YEAR: 2021
PWS 1'1
Bear Claw Subdivision • Kootenai
LowellOPERATOR PRESENT: Marty
• • Bear Claw ' • Clark Fork,
INSPECTOR: Andy Olson DATE OF SURVEY: Dec 9, 2021
POPULATION SERVED: 1
NUMBER OF • • residential
AERIAL VICINITY MAP
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SUMMARY
Bear Claw Subdivision is a small community water system that serves a residential population of 70
with 28 total connections. The system is under the direct oversight of licensed operator Marty
Lowell. Bear Claw Subdivision is located just east of Clark Fork, Idaho off Highway 200 on Bear
Claw Road.
SOURCE
Well#1 (E0009230)
Original Construction Date: March 14, 1995 Well Log: Yes
Total Depth: 141 ft Casing: 8in 5/8 Intake: N/A
Static Level: 137 ft Pump: 7.5 hp Gould Max. Tested Yield: 43 gpm
Lat/Long: 48.097601 /-116.113106 TRS: T55N R3E S20
Surface Seal: Bentonite 40ft Confining Layers: No
There is one well that Bear Claw Subdivision uses to supply water to the water system. A GWUDI
analysis was done on Well #1 on June 14, 2009. A Source Water Assessment was completed on the
well in 2013. No existing ground water problems were identified in the Source Water Assessment
report or the Ground Water Under Direct Influence of Surface Water(GWUDI) report. The well is
located on the southeast corner of lot number 16 in the Bear Claw Subdivision.
Source water assessments are available at: littps://www2.dcq,idalio.gov/water/swaOnlinc/Scarch
The drinking water for Bear Claw Subdivision is provided by well 1. It is drilled to a depth of
139.5 ft and produces 43 gpm. The well was drilled in March 1995 by Ruen Drilling in Clark
Fork, ID. The well casing is an 8-inch steel casing that extends to a depth of 141 feet below
ground surface (bgs). The bentonite surface seal extends to a depth of 40 feet bgs.
The sanitary cap for the well is vented with intact electrical conduit and appears to be in good
condition. A 7.5 horsepower Gould submersible pump model number 70LG7532 is in use. The well
has flow to waste capability from inside the well house and prior to pumping to the reservoir.
According to the historical information in the Bear Claw Subdivision file it was the Idaho
Department of Environmental Quality's(DEQ)understanding that the developer would be
responsible for drilling a second well. The second well was supposed to be online before the 25tn
connection was made to the water system. As it stands the system has 28 connections. No
additional connections can be made without approval from the Coeur D'Alene DEQ.
Dan Larson with 7b Engineering (Sandpoint, ID) is currently developing a facility plan for this
system. This plan is the first step in assessing the drinking water redundancy needs for the Bear
Claw subdivision. There is a need for a second source of drinking water now that the system has
exceeded the allowable connections for one source per the Idaho Rules for Public Drinking Water
Systems (IDAPA 58.01,11.501.17).
Well #1 has a flow meter and pressure gage inside the well house. The raw water sample tap is a
threaded faucet located inside the well house. This was discussed with the operator of the water
system. The threaded sample tap represents a cross contamination concern and will have to be
fitted with an Atmospheric Vacuum Breaker(AVB).
3

STORAGE
From the well, water is pumped to a partially buried 50,000-gallon concrete reservoir built in 1996
via a 6-inch line that rides on the system as well as pumped to distribution. This 6-inch line is used
for both the water traveling to and from the reservoir. The water enters and exits the reservoir at the
same point in the reservoir.
The water level in the reservoir is controlled by a float switch that signals the well pump to turn on
and off via underground lines from the reservoir to the pump house. The reservoir is vented and
fitted with overflow pipe, both of which are properly screened. The reservoir hatch has adequate
gaskets in place at the time of the survey. DEQ recommends the storage tank be inspected and
cleaned every 5 years.
The cover of the reservoir consists of concrete precast panels covered by plastic and organic
matter. During the last sanitary survey performed by DEQ in 2015 it was recommended that the
storage tank be cleaned and inspected for structural issues. This has not been done over the past 5
years. It is important to inspect the surface of the structure for cracks or entry points for surface
contamination or animals.
DISTRIBUTION
Bear Claw Subdivision has 28 connections and 3 fire hydrants. Distribution mains consist of 2-, 4-,
and 6-inch PVC pipe. The routine coliform sampling plan was discussed during the survey. The
operator takes total coliform bacteria samples from a representative number of sites throughout the
system. A 2009 sanitary survey references a copy of the total coliform sample site plan submitted to
DEQ. No known plan was found in DEQ records. We recommend that plan gets updated and
resubmitted.
If any known leaks are discovered, it may be helpful to inform homeowners that leaks cost all
homeowners in the form of increased costs due to excessive pump and power usage and wear and
tear on equipment. If a leak should cause an unexpected loss of pressure, a contamination event
could occur. When water pressure within the system is known to have fallen below twenty (20)psi,
the water supplier must notify DEQ, provide public notice to the affected customers within twenty-
four (24) hours, and disinfect or flush the system as appropriate. When sampling and corrective
procedures have been conducted and after determination by DEQ that the water is safe, the water
supplier may re-notify the affected customers that the water is safe for consumption. The water
supplier shall notify the affected customers if the water is not safe for consumption. Please consider
the repair of all leaks in your water system as soon as possible.
The Bear Claw Water system has established a formal cross connection control program,but DEQ
does not have a copy of this program for our file. Please provide a copy of your cross-connection
control program. A cross connection control program and by laws related to its enforcement are
required by IDAPA 58.01.08.552.06. The water system must ensure that cross connections do not
exist or are isolated from the potable water system by an approved backflow prevention assembly.
Backflow prevention assemblies shall be inspected and tested annually for functionality by an Idaho
licensed tester, as specified in Subsection 552.06.c.
Annual backflow testing of all backflow assemblies installed on underground sprinkler systems
within distribution is required.
4

MONITORING,REPORTING,AND DATA VERIFICATION
This water system is classified as a community water system serving greater than 15 service
connections used by year-round residents.
Online tools for reviewing currently updated monitoring schedules are available for viewing
on the web: https://www.deg.idaho. ov/water-quality/drinking-water/public-water-system-
switchboard/
Monitoring schedules may be changed or modified by DEQ as required. Before sampling,
water system operators are advised to review the monitoring schedule for the most current
requirements to ensure compliance. There are no monitoring violations on record in the past
decade.
The water system is reminded to maintain accurate and complete testing records, and to make
these available to DEQ upon request. Per DEQ Rules and Federal CFR 141.33, records of
bacteriological analyses are to be kept for not less than five years, and records of chemical
analyses are to be kept for not less than ten years. The water system is advised to review all
applicable statutes for additional requirements.
FINANCIAL AND MANAGMENT
Bear Claw Subdivision is privately owned by the James E. White Trust; the administrative contact
is Jennifer Schmidt(US Bank). The designated operator in charge of the water system is Martin
Lowell who holds DWD1 and DWT1 licensures with Idaho Bureau of Licensures. This meets
operator requirements for this water system, as it is classified as a Very Small Water System.
SMART Financial planning tools are available on the Idaho DEQ public water system switchboard
at: https://www.deq.idaho.jzov/water-quality/drinking-water/public-water-system-switchboard/
DRINKING WATER PROTECTION PLAN
The water system does not appear to have a Drinking Water Protection Plan prepared by DEQ or
Idaho Rural Water Association. Source water protection (synonymous with the term drinking water
protection) is a voluntary effort a community can implement to help prevent contamination of the
source water that supplies its public water system. The drinking water protection plan outlines the
management tools local committees can use to protect drinking water sources and describes the
implementation of regulatory and/or non-regulatory management practices. The Drinking Water
Protection Plan builds upon the work completed in the Source Water Assessment.
1) Regulatory tools include items such as zoning ordinances, overlay districts, or site plan
review requirements.
2) Non-regulatory tools include items such as pollution prevention activities and
implementation of Best Management Practices.
3) Every plan should also include a public education and information component.
DEQ recommends that the water system pursue a Drinking Water Protection Plan to establish
further protective measures against contamination in the watershed. Andy Olson, DEQ Drinking
Water Compliance officer may be contacted at 208-666-4630 for further information regarding the
plan.
5

Part of a Drinking Water Protection Plan can include an emergency response plan. Knowing what
to do, who to call and what resources are available and where can make a difference in emergency
situations. For more information on how to create a FREE source water protection plan or
emergency response plan contact your regional DEQ office.
CONCLUSION
At the time of the survey, it was evident that Martin Lowell takes the responsibility of providing
safe drinking water to the users seriously; and his efforts are appreciated by DEQ. The water
system was found to be operating in compliance with the Idaho Rules for Public Drinking Water
Systems.
The deficiencies and additional requirements listed below need to be addressed in a written Plan of
Correction(POC), submitted to DEQ within 30 days of the receipt of this letter. The POC is a simple
narrative document that lists the deficiencies and additional requirements, how they will be corrected,
and the date by which correction will be completed.
DEFICIENCIES
1. The sample tap and hose must have an AVB (atmospheric vacuum breaker) installed to
protect against cross contamination.
2. DEQ Staff was unable to assess the structural integrity of the reservoir due to organic
debris buildup on the top of the reservoir. When reservoir roof becomes accessible in
spring, please assess for cracks and conduct repairs as necessary to prevent intrusion of
surface water and animals.
ADDITIONAL REQUIREMENTS
1. In 2015 the sanitary survey writer provided this system with a well tag and the request
was made for the tag to be attached to the well. The well tag was not observed during the
2022 inspection. Please provide an update on tag location.
2. The Bear Claw Water system has established a formal cross connection control program, but
DEQ does not have a copy of this for our file. Please provide a copy of your cross-
connection control program. Please contact the Homeowners Association to provide this
document. If document cannot be produced a new plan will need to be created.
3. Past records indicate a Coliform sample siting plan was created for this system. DEQ does
not have a copy. Please provide copy of plan or update and submit a new Coliform sample
siting plan. Andy with the Coeur d' Alene regional office can assist with plan updates.
RECCOMENDATIONS
1. DEQ recommends all valves are exercised on an annual basis.
2. DEQ recommends the storage tank be inspected and cleaned every 5 years.
6

3. DEQ recommends that the water system pursue a Drinking Water Protection Plan to
establish further protective measures against contamination in the watershed. Andy Olson,
DEQ Drinking Water Compliance Officer may be contacted at 208-666-4630 for further
information regarding the implementation of the plan.
4. DEQ recommends an operation and maintenance manual be provided for the PWS.
5. DEQ recommends every system develop a water loss/efficiency control program. Contact
Andy Olson at Coeur d'Alene regional DEQ for further details.
6. It is recommended every community water system have a back up operator. Consider
training another person incase Marty does not operate this system forever.
7. Develop an asset management plan to assist with future planning and financial
management.
7

January 1, 2022
Andy Olson, Drinking Water Compliance Officer
2110 Ironwood Parkway
Coeur d'Alene Idaho 83814
RE: Sanitary Survey of PWS#1090231, Bear Claw Subdivision Water System
Dear Andy Olson,
I appreciate your time in coming out to inspect the Bear Claw Subdivision Water System. In regards to
The sanitary survey conducted December 9th and the items listed as Deficiencies and Additional
Requirements, they will be addressed as outlined below.
Deficiencies
1. The sample tap (atmospheric vacuum breaker) has been purchased and will be installed by
February 28, 2022.
2. Cleaning off the top surface of the reservoir is scheduled for spring and will be completed by
June 30, 2022. This will be done in order to assess the structural integrity and organic intrusion
to the reservoir.
Additional Requirements
1. The new (replaced)well tag was received Saturday January 29th and will be installed at well head
Monday January 31, 2022
2. 1 will meet with HOA and come up with the Cross connection control plan and forward to you
(DEQ) by August 31, 2022
3. Coliform sampling plan. I will communicate with Andy Olson (DEQ) concerning this.
Recommendations
1. Hydrants and valves are currently exercised on an annual basis.
2. Will work with (IRWA) on a (DWPP).
3. Will work with Andy Olson (DEQ) on all further recommendations.
Again,Thank You for your time and I look forward to working with You in the future.
Sincerely,
Marty Lowell, Water Operator, Bear Claw Subdivision Water System

Photographic Documentation
Inspection Date(s): Thursday, December 09, 2021
Facility ID: 1090231
Name of Facility: Bear Claw Subdivision
Inspector(s): Andy Olson
Purpose of Inspection: 2021 ESS
State of Idaho
Department of Environmental Quality

Idaho Department of Environmental Quality
Photographic Documentation For: Bear Claw Subdivision - 1090231
Table of Photographs:
Photograph 1: Well house, well 1, protective rock barricade. ......................................................3
Photograph 2: Utility Panel Shed. .................................................................................................3
Photograph 3: Well 1 wellhead and protective barrier.................................................................4
Photograph 4: Intact electrical conduit to well.............................................................................4
Photograph 5: Screened Well Vent...............................................................................................5
Photograph 6: Pressure switch, flow meter, Cl2 injection site, associated appurtenances,
chlorine flow sensing switch, Chlorine tank, metering pump, and multi-chlor.............................5
Photograph 7: C12 metering pump................................................................................................6
Photograph 8: C12 metering pump specs. .....................................................................................6
Photograph 9: Isolation Valve for distribution in wellhouse. ........................................................7
Photograph 10: Pressure Gauge....................................................................................................7
Photograph 11: Flow meter for well. ............................................................................................8
Photograph 12: Screened pump to waste.....................................................................................8
Photograph 13: Sample tap needs ABV (atmospheric breaker valve), floor drain. .......................9
Photograph 14: Floor drain daylight outlet...................................................................................9
Photograph 15: Screened overflow piping and isolation valve from distribution for cleaning.
Reservoir is covered with plastic and built up organics. Cannot determine integrity. ................10
Photograph 16: Reservoir hatch is gasketed and lockable..........................................................10
Photograph 17: Float in reservoir controls call for water............................................................11
Photograph 18: Screened reservoir vent.....................................................................................11
Photograph 19: Blow-off hydrant 1 of 3......................................................................................12
Photograph 20: Blow-off hydrant 2 of 3......................................................................................12
Photograph 21: Blow-off hydrant 3 of 3......................................................................................13
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Photograph 1: Well house,well 1, protective rock barricade.
12/09/2021
Photograph 2: Utility Panel Shed.

Idaho Department of Environmental Quality
Photographic Documentation For: Bear Claw Subdivision -1090231
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Photograph 3: Well 1 wellhead and protective barrier.
Photograph 4: Intact electrical conduit to well.
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Idaho Department of Environmental Quality
Photographic Documentation For: Bear Claw Subdivision - 1090231
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Photograph 5: Screened Well Vent.
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Photograph 6: Pressure switch, flow meter, C12 injection site, associated appurtenances, chlorine flow
sensing switch, Chlorine tank, metering pump, and multi-chlor.
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Idaho Department of Environmental Quality
Photographic Documentation For: Bear Claw Subdivision - 1090231
Photograph 7: C12 metering pump.
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Idaho Department of Environmental Quality
Photographic Documentation For: Bear Claw Subdivision - 1090231
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Photograph 9: Isolation Valve for distribution in wellhouse.
Photograph 10: Pressure Gauge.
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Idaho Department of Environmental Quality
Photographic Documentation For: Bear Claw Subdivision - 1090231
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Photograph 11: Flow meter for well.
Photograph 12: Screened pump to waste.
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•, • Department of • Quality
Photographic Documentation For: •• • 1090231
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Photograph 13: Sample tap needs ABV (atmospheric breaker valve),floor drain.
Photograph 14: Floor drain daylight outlet.
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Photographic Documentation For: Bear Claw Subdivision-1090231
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Photograph 15: Screened overflow piping and isolation valve from distribution for cleaning. Reservoir is
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Photograph 16: Reservoir hatch is gasketed and lockable.
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Idaho Department of Environmental Quality
Photographic Documentation For: Bear Claw Subdivision - 1090231
Photograph 17: Float in reservoir controls call for water.
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Photograph 18: Screened reservoir vent.
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Idaho Department of Environmental Quality
Photographic Documentation For: Bear Claw Subdivision -1090231
12/09/2021
Photograph 19: Hydrant 3 of 3.
12109/2021
Photograph 20: Hydrant 2 of 3.
12

Idaho Department of Environmental Quality
Photographic Documentation For: Bear Claw Subdivision-1090231
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Photograph 21: Hydrant 3 of 3.
13

AORIL
AAL STATE OF IDAHO
DEPARTMENT OF
t�o ENVIRONMENTAL QUALITY
2110 Ironwood Parkway•Coeur d'Alene.Idaho 83814•[phone] C.L."Butch"Otter,Governor
Toni Hardesty,Director
August 3, 2009
U.S, Bank Trustee
James E. White Trust
PO Box 5099
Coeur d'Alene, ID 83814-1951
RE: Sanitary Survey of PWS#ID1090231, Bear Claw Subdivision
James E.White Trust:
This letter was revised after the site visit on July 14, 2009. The Department conducted this site visit to inspect parts of
the system that were inaccessible at the time of the original survey. Bear Claw Subdivision is a community water
system that serves a residential population of 37 with 15 connections.
I would like to thank Jay White and Chad "Mike" Vandyken for taking the time to assist with the sanitary survey that
DEQ performed on the Bear Claw Subdivision on March 18, 2009 and July 14, 2009. They were both very helpful
during the survey.
During the inspection we found that the water system is operating in compliance with the Idaho Rules for Public
Drinking Water Systems.
The deficiencies and additional requirements listed below need to be addressed in a written Plan of Correction (POC),
submitted to DEQ within 45 days of the receipt of this letter. The POC is a simple narrative document that lists the
deficiencies and additional requirements, how they will be corrected, and the date by which correction will be
completed. Please afford yourself adequate time to address the problems so that time extensions will not be
necessary.
Deficiencies
1. Well#1 does not have a flow meter. Bear Claw Subdivision must install a flow meter on Well#1 and provide
the Department with construction plans and specifications for modifications stamped by a licensed engineer in
the state of Idaho prior to construction. New deficiency since revision on July 29, 2009,
2. Well#1 does not have a pressure gage. Bear Claw Subdivision must install a pressure gage on Well#1 and
provide the Department with construction plans and specifications for modifications stamped by a licensed
engineer in the state of Idaho prior to construction. New deficiency since revision on July 29, 2009.
3. Well #1 does not have a raw water sample tap. Bear Claw Subdivision must install a sample tap on Well#1
next to the well and provide the Department with construction plans and specifications for modifications
stamped by a licensed engineer in the state of Idaho prior to construction. New deficiency since revision on
July 29, 2009,
4. Bear Claw Subdivision must install a line to allow the well to flow to waste on well #1 prior to the reservoir.
New deficiency since revision on July 29, 2009.
Additional Requirements
1. DEQ requires that all dead end mains are flushed at a velocity of 2.5 fttsec every 6 months.
2. Within 60 days Bear Claw Subdivision must submit a Total Coliform Sample Plan to the Department.

3. The sanitary cap for the well does not provide a vent for the well. Within 60 days Bear Claw Subdivision must
install a sanitary cap that vents the well.
4. Provide the Department within 60 days information on the number of metered connections, size of piping on
the fire hydrants and the rates that water users are charged.
5. Within 60 days the Department requires that Bear Claw Subdivision develop and actively enforce a cross
connection ordinance by implementing a cross connection control program. Also provide an approved copy of
a cross connection control ordinance within 60 days. Bear Claw Subdivision must have all backflow
assemblies inspected on an annual basis by a certified backflow tester
6, Provide the Department within 60 days verification that the three hydrants on the system are installed on a 6-
inch main.
7. At the time of the survey the Department observed a hole near the hatch of the reservoir where some wiring
enters the reservoir. Within 60 days this hole needs to be filled in with silicone to prevent contaminants and
insects from contaminating the reservoir.
Follow up Items
1. Within 60 days Bear Claw Subdivision must provide the Department with verification of how the reservoir is
connected to the water system.
Recommendations
1, The Department recommends all valves are exercised on an annual basis.
2. The Department recommends that Bear Claw Subdivision mechanically clear our all of the large vegetation
without the use of herbicides around the reservoir to ensure the reservoir is not damaged. New
recommendation since revision on July 29, 2009.
3. The Department recommends the storage tank be inspected and cleaned every 5 years.
4. DEQ recommends that the water system pursue a Drinking Water Protection Plan to establish further
protective measures against contamination in the watershed. Yvonne Pettit, DEQ Drinking Water Protection
Coordinator may be contacted at 208-769-1422 for further information regarding the implementation of the
plan.
5. The Department recommends an operation and maintenance manual be provided for the PWS.
If you have any questions or comments regarding the survey, please do not hesitate to contact me at 769-1422.
Regards,
r�-C;;
Troy Wassink
Drinking Water Analyst
Enc: Narrative
c: Suzanne Scheidt, DEQ
Jay White
Chad"Mike"Vandyken

• STATE OF IDAHO
DEPARTMENT OF
ENVIRONMENTAL QUALITY
2110 Ironwood Parkway•Coeur d'Alene,Idaho 83814-[phone] C L "Butch"Otter.Governor
Toni Hardesty,Director
August 3, 2009 `'� t
U.S. Bank Trustee
James E. White Trust
PO Box 5099 U TR L
Coeur d'Alene, ID 83814-1951 Cccor &Alane, Idas
RE: Groundwater Under Surface Water Influence - Determination for Bear Claw
Subdivision, PWS# ID1090231
James E. White Trust:
Idaho is required by state drinking water regulations (IDAPA §58.01.08.300) to
determine whether groundwater sources serving public drinking water systems are
directly influenced by surface water. Groundwater that is directly influenced by surface
water (GWUDI) may contain disease causing organisms which are normally only found
in surface water, and may require additional treatment including filtration and/or
disinfection and contact time. Under current state rules, filtration treatment is not
required if sources are truly groundwater.
We have inspected the groundwater source serving your system and based on our
review, your well has been found to be groundwater.
Since your water source is groundwater, no additional treatment is currently required.
This notification is for your records and should be kept on file for future reference. If you
have questions or comments on this matter, please contact the Department of
Environmental Quality (DEQ) at [phone].
Sincerely,
Troy Wassink
Drinking Water Analyst
TLo,wassirik_ de ,id ha.goy
c: Suzanne Scheidt, DEQ-CDA suzanne.scheidt de .daho Qov
Jay White, PO Box 528, Clark Fork, ID 83811
Chad "Mike" Vandyken rhadvan(a-).firehouse com

Drinking Water Supply Report
Idaho Department of Environmental Quality
Revised July 29, 2009
System: Bear Claw Subdivision County: Bonner PWS #: ID1090231
Date of Survey: March 18,2009
System Representatives Present at Survey: Chad "Mike"Vandyken &Jay White
Surveyed by: Troy Wassink& Suzanne Scheidt
Available Sources:Well
Primary Source: Ground Water Water System Type: Community
Population: 37 Service Connections: 15
Bear Claw Subdivision
This survey was revised after the site visit on July 14, 2009, The Department conducted this
site visit to inspect parts of the system that were inaccessible at the time of the original survey.
Bear Claw Subdivision is a community water system that serves a residential population of 37
with. 15 connections. The system is under the direct oversight of licensed operator'Chad"Mike"
Vandyken:
Source
There is one well that Bear Claw Subdivision uses to supply water to the water system. A
GWUDI analysis was done on Well#1 on June 14, 2009 and it'was determined that the well is
not under the direct influence of surface water. A Source Water Assessment has not been
completed on the well.
s
Well#1
The supply of water for Bear Claw Subdivision well is provided by a well drilled to a depth of
139.5 ft and produces 30 gpm. The well is located on the southeast corner of lot number 16 in
the Bear Claw Subdivision. The sanitary cap for the well does not provide a vent for the well.
Bear Claw Subdivision must install a sanitary cap that vents the well. A 7.5 horsepower Gould
submersible pump model number 70LG7532 Is provided. In order for Bear Claw Subdivision to
pump to waste,they have to pump water from the well to the reservoir and then drain the
reservoir prior to distribution. The Department strongly recommends that on Well#1 Bear Claw
Subdivision install a line to allow the well to flow to waste before the reservoir. Flow to waste
capability at the well will be required at the time of next material modification.

According to the historical file in the Bear Claw Subdivision file it was the Department's
understanding that the developer would be responsible for drilling a second well. The second
well must be online before the 251" connection is made to the water system.
Weil#1 does not have a flow meter or pressure gage. Bear Claw Subdivision must install a flow
meter and pressure gage on Well#1 and must provide the Department with construction plans
and specifications for modifications stamped by a licensed engineer in the state of Idaho prior to
construction. Well 41 does not have a raw water sample tap. Bear Claw Subdivision must
install a sample tap on Well#1 next to the well and must provide the Department with
construction plans and specifications for modifications stamped by a licensed engineer in the
state of Idaho prior to construction.
Storage
From the well, water is pumped to a partially buried 50,000 gallon concrete reservoir built in
1996 via a 6-inch line that rides on the system as well as pumped to distribution. This 6-inch
line is used for both the water traveling to and from the reservoir. The water enters and exits
the reservoir at the same point in the reservoir. The water system must install a rubber gasket
seal on the hatch of the reservoir to prevent insects from getting into the reservoir. After talking
to Jay White at the time of the survey the Department had the understanding that a 2-inch line
went directly from the well to the reservoir and a 6-inch line going to distribution but the records
that the Department has shows a single 6-inch line traveling to and from the reservoir. Bear
Claw Subdivision must provide the Department with verification of how the reservoir is
connected to the water system.
T M
!Ir;
�n 4
C
Reservoir Reservoir
The water level in the reservoir is controlled by a float switch that signals the well pump to turn
on and off via underground lines from the reservoir to the pump house. The reservoir has both
a vent and overflow, both of which are properly screened. The reservoir has a drain. The cover
of the reservoir consists of concrete precast panels covered by visqueen, wood chips and a final
layer of soil. Over time the joints may degrade and allow bacteria to contaminate the water.
The Department recommends that Bear Claw Subdivision clear out all of the large vegetation
around the reservoir to ensure the reservoir is not damaged. Vegetation must be cleared
mechanically; the use of herbicides are not approved in proximity to the reservoir. At the time
of the survey the Department observed a hole near the hatch of the reservoir where some wiring
enters the reservoir. This hole needs to be filled in with silicone to prevent contaminants and
insects from contaminating the reservoir. The Department recommends the storage tank be
inspected and cleaned every 5 years.

Monitoring
Bear Claw Subdivision is required to collect total coliform samples monthly and has not had any
positive sample for total coliform since July 2005. DEQ tested for pH and turbidity using the
Department's Hach pH colorimeter II and bench top turbidimeter(Hach 2100P); the pH was 7.9
and turbidity was measured at.20 NTU. The table below shows all of the sampling
requirements for Bear Claw Subdivision.
Sample Type Frequency Sample Location
Total coliform 1 every month Distribution
VOCs 1 every quarter Well
Lead and Copper 5 every 6 months Distribution
Nitrate 1 eve ear Well
Arsenic 1 every 3 years Well
Sodium 1 every 3 years Well
IOCs 1 every 3 years Well
Radium 226 1 every 9�rears Well
Radium 228 1 every 9 years Well
Gross Alpha 1 every 9 ears Well
Nitrite 1 every 9 years Well
Uranium 1 every 9 years Well
Application to waive monitoring for the following chemical contaminants: inorganic chemicals
(IOCs), asbestos, cyanide, volatile organics (VOCs), synthetic organics (SOCs), and dioxin was
received on March 3, 2009. The following waivers have been granted for Well#1:
Contaminant Next monitoring due Waiver renewal Duration
Asbestos none this period 1/1/2011 9 yr
Cyanide none this period 1/1/2011 9 yr
SOCs none this period 1/1/2011 3 yr
Dioxin none this period 1/1/2011 3 yr
Financial & Management Capacity
Bear Claw Subdivision is privately owned by the James E. White Trust; the administrative
contact is Jay White. The designated operator in charge of the water system is Chad "Mike"
Vandyken who holds VSWS and Drinking Water Treatment Level 1 licensures with Idaho
Bureau of Licensures. This meets operator requirements for this water system. The
Department recommends an operation and maintenance manual be provided for the drinking
water system. Operation and maintenance manuals should include daily operating instructions,
trouble shooting, operator safety procedures, location of valves and other key system features,
parts list and parts order forms and information for contacting the water system operator.
Source Water Assessment and Drinking Water Protection Plan
A Source Water Assessment report for the Bear Claw Subdivision has not been completed.
The Department will compile the Source Water Assessment and provide a copy to Bear Claw
Subdivision in the future. DEQ recommends that the water system pursue a Drinking Water
Protection Plan to establish further protective measures against contamination in the watershed.

Yvonne Pettit, DEQ Drinking Water Protection Coordinator may be contacted at 208-769-1422
for further information regarding the plan.
Conclusion
At the time of the survey it was evident that Jay White and Chad "Mike" Vandyken take the
responsibility of providing safe drinking water to the users seriously; their efforts are appreciated
by DEQ. The water system was found to be operating in compliance with the Idaho Rules for
Public Drinking Water Systems.
The deficiencies and additional requirements listed below need to be addressed in a written
Plan of Correction (POC), submitted to DEQ within 45 days of the receipt of this letter. The
POC is a simple narrative document that lists the deficiencies and additional requirements, how
they will be corrected, and the date by which correction will be completed. Please afford
yourself adequate time to address the problems so that time extensions will not be necessary.
Deficiencies
1. Well#1 does not have a flow meter. Bear Claw Subdivision must install a flow meter on
Well#1 and provide the Department with construction plans and specifications for
modifications stamped by a licensed engineer in the state of Idaho prior to construction.
New deficiency since revision on July 29, 2009.
2. Well #1 does not have a pressure gage. Bear Claw Subdivision must install a pressure
gage on Well #1 and provide the Department with construction plans and specifications
for modifications stamped by a licensed engineer in the state of Idaho prior to
construction. New deficiency since revision on July 29, 2009.
3. Well#1 does not have a raw water sample tap. Bear Claw Subdivision must install a
sample tap on Well#1 next to the well and provide the Department with construction
plans and specifications for modifications stamped by a licensed engineer in the state of
Idaho prior to construction. New deficiency since revision on July 29, 2009.
4. Bear Claw Subdivision must install aline to allow the well to flow to waste on well#1
prior to the reservoir. New deficiency since revision on July 29, 2009.
Additional Requirements
1. DEQ requires that all dead end mains are flushed at a velocity of 2.5 ftlsec every 6
months.
2. Within 60 days Bear Claw Subdivision must submit a Total Coliform Sample Plan to the
Department.
3. The sanitary cap for the well does not provide a vent for the well. Within 60 days Bear
Claw Subdivision must install a sanitary cap that vents the well.
4. Provide the Department within 60 days information on the number of metered
connections, size of piping on the fire hydrants and the rates that water users are
charged.

5. Within 60 days the Department requires that Bear Claw Subdivision develop and actively
enforce a cross connection ordinance by implementing a cross connection control
program. Also provide an approved copy of a cross connection control ordinance within
60 days. Bear Claw Subdivision must have all backflow assemblies inspected on an
annual basis by a certified backflow tester
6. Provide the Department within 60 days verification that the three hydrants on the system
are installed on a 6-inch main.
7. At the time of the survey the Department observed a hole near the hatch of the reservoir
where some wiring enters the reservoir. Within 60 days this hole needs to be filled in
with silicone to prevent contaminants and insects from contaminating the reservoir.
Follow up Items
1. Within 60 days Bear Claw Subdivision must provide the Department with verification of
how the reservoir is connected to the water system.
Recommendations
1. The Department recommends all valves are exercised on an annual basis.
2. The Department recommends that Bear Claw Subdivision mechanically clear our all of
the large vegetation without the use of herbicides around the reservoir to ensure the
reservoir is not damaged. New recommendation since revision on July 29, 2009.
3. The Department recommends the storage tank be inspected and cleaned every 5 years.
4. DEQ recommends that the water system pursue a Drinking Water Protection Plan to
establish further protective measures against contamination in the watershed. Yvonne
Pettit, DEQ Drinking Water Protection Coordinator may be contacted at 206-769-1422
for further information regarding the implementation of the plan.
5. The Department recommends an operation and maintenance manual be provided for the
PWS.
Troy Wassink, Drinking Water Analyst Date

.a Hole near hatch of
reservoir.
Reservoir
The Department has a concern on the size of the reservoir compared to the number of users
possibly causing stagnant water. The Department strongly recommends Bear Claw Subdivision
monitor the flow meter throughout the year to ensure the reservoir is getting adequate turnover.
Distribution
Bear Claw Subdivision has 15 connections. The water system has three fire hydrants. The
Department was unable to determine the size of pipe the fire hydrants are connected to due to
discrepancies between engineering plans. Please verify to the Department that the three
hydrants are installed on a 6-inch main,
The Department requires that Bear Claw Subdivision develop and actively enforce a cross
connection ordinance by implementing a cross connection control program. A cross connection
is any actual or potential connection between the public water supply and a source of
contamination or pollution, A cross connection may result indirectly when the pressure in a
water user's plumbing system is greater than the pressure in the public water supply (back
pressure) or connections to the potable water supply. In such cases, the water user's water
supply may be directed back into the distribution system, and contamination of the entire water
supply may occur. When draining and flushing the system, care should be taken by the
operator to eliminate the potential for cross contamination and/or depressurization of the
distribution system.
Implementing the program involves writing a cross connection ordinance and the passing of the
ordinance by the Bear Claw Subdivision. An ordinance will provide authority for the operator of
the system to inspect for potential cross connections as necessary. The ordinance must also
require that back flow assemblies are tested on an annual basis; an inventory of assembly
testing must be kept by the system. Please contact the Department for assistance in
developing a cross connection control ordinances.
It does not appear that the Department has a copy of Bear Claw Subdivision's total coliform
sample plan; Bear Claw Subdivision must submit a copy to our office. A total coliform sampling
plan lists five sampling locations throughout the distribution system. According to coliform
sampling requirements, the total coliform sampling plan must represent the entire distribution
system. This is completed by alternating sampling locations throughout the distribution system.
Once written, the sampling plan must be followed to the best of the operator's abilities; each
alternating location must be written on the coliform sample submittal form.
Bear Claw Subdivision must have all backflow assemblies inspected on an annual basis by a
certified backflow tester. The Department recommends that all valves are exercised on an
annual basis. DEQ requires that all dead end mains are flushed at a velocity of 2.5 ft/sec every
6 months.

STATE OF IDAHO
r
DEPARTMENT OF
ENVIRONMENTAL QUALITY
2110 Ironwood Parkway•Coeur d'Alene,Idaho 83814•[phone] C.L."Butch"Otter,Governor
Toni Hardesty,Director
April 15, 2009
U.S. Bank Trustee
James E. White Trust
PO Box 5099
Coeur d'Alene, ID 83814-1951
RE. Sanitary Survey of PWS#ID1090231, Bear Claw Subdivision
James E. White Trust;
I would like to thank Jay White and Chad "Mike" Vandyken for taking the time to assist with the sanitary
survey that DEQ performed on the Bear Claw Subdivision on March 18, 2009. They were both very helpful
during the survey.
During the inspection we found that the water system is operating in compliance with the Idaho Rules for
Public Drinking Water Systems.
Deficiencies
No significant deficiencies were found at the time of the survey.
Additional Requirements
The requirements listed below, while not considered significant deficiencies, must be completed by the
system.
1, DEQ requires that all dead end mains are flushed at a velocity of 2.5 ft/sec every 6 months.
2. Within 60 days Bear Claw Subdivision must submit a Total Coliform Sample Plan to the Department.
3. The sanitary cap for the well does not provide a vent for the well. Within 60 days Bear Claw
Subdivision must install a sanitary cap that vents the well.
4. Provide the Department within 60 days information on the number of metered connections, size of
piping on the fire hydrants and the rates that water users are charged.
5. Within 60 days the Department requires that Bear Claw Subdivision develop and actively enforce a
cross connection ordinance by implementing a cross connection control program. Also provide an
approved copy of a cross connection control ordinance within 60 days. Bear Claw Subdivision must
have all backflow assemblies inspected on an annual basis by a certified backflow tester.
6. Provide the Department within 60 days verification that the three hydrants on the system are
installed on a 6-inch main,

7. At the time of the survey the Department observed a hole near the hatch of the reservoir where.
some wiring enters the reservoir. Within 60 days this hole needs to be filled in with silicone to
prevent contaminants and insects from contaminating1he reservoir.
Follow up items
1. Within .60 days Bear Claw Subdivision must provide the Department with verification of how the
reservoir,is connected to the water system.
Recommendations
1. The Department recommends all valves are exercised on an annual basis.
2. The Department recommends the storage tank be inspected and cleaned every 5.years.
3. DEQ recommends that the water system pursue a Drinking Water Protection Plan to establish
further protective measures against contamination in the watershed. Yvonne Pettit, DEQ Drinking
Water Protection Coordinator may be contacted at 208-769-1422 for further information regarding
the implementation of the plan.
4. The Department recommends an operation and maintenance manual be provided for the PWS.
If you have any questions or comments regarding the survey, please do not hesitate to contact me at 769-
1422.
Regards,
;-17
Troy Wassink
Drinking Water Analyst
Eric: Narrative, example of Public Notification, Form.for chlorine residuals and Idaho Statues.
c: Suzanne Scheidt, DEQ
Jay White
Chad "Mike"Vandyken

Drinking Water Supply Report
Idaho Department of Environmental Quality
System: Bear Claw Subdivision County:Bonnier PWS M ID1090231
Date of Survey: March 18, 2009
System Representatives Present at Survey: Chad "Mike"Vandyken &Jay White
Surveyed by: Troy Wassink& Suzanne Scheidt
Available Sources: Well
Primary Source: Ground Water Water System Type: Community
Population: 37 Service Connections: 15
Bear Claw Subdivision
Bear Claw Subdivision is a community water system that serves a residential population of 37
with 15 connections. The system is under the direct oversight of licensed operator Chad "Mike"
Vandyken.
Source
There is one well that Bear Claw Subdivision uses to supply water to the water system. A
GWUDI analysis has not been done on Well#1. The Department plans to complete a GWUDI
analysis in the spring of this year after the snow is gone. A Source Water Assessment.has not
been completed on the well.
Well#1
The supply of water for Bear Claw Subdivision well is provided by a well drilled to a depth of
139.5 ft and produces 30 gpm. The well is located on the southeast corner of lot number 16 in
the Bear Claw Subdivision. The sanitary cap for the well does not provide a vent for the well.
Bear Claw Subdivision must install a sanitary cap that vents the well. A 7.5 horsepower Gould
submersible pump model number 70LG7532 is provided.
According to the historical file in the Bear Claw Subdivision file it was the Departments
understanding that the developer would be responsible for drilling a second well, The second
well most be online before the 25u'connection is made to the water system.
Due to snow at the time of the survey the Department.was not able to inspect all of the facilities,
The Department plans to revisit Bear Claw Subdivision late spring to inspect the entire system.

Storage
From the well, water is pumped to a partially buried 50,000 gallon concrete reservoir built in
1996 via a 6-inch line that rides on the system as well as pumped to distribution. This 6-inch
line is used for both the water traveling to and from the reservoir. The water enters and exits
the reservoir at the same point in the reservoir. The water system must install a rubber gasket
seal on the hatch of the reservoir to prevent insects from getting into the reservoir. After talking
to Jay White at the time of the survey the Department had the understanding that a 2-inch line
went directly from the well to the reservoir and a 6-inch line going to distribution but the records
that the Department has shows a single 6-inch line traveling to and from the reservoir. Bear
Claw Subdivision must provide the Department with verification of how the reservoir is
connected to the water system.
I , r
Reservoir Reservoir
The water level in the reservoir is controlled by a float switch that signals the well pump to turn
on and off via underground lines from the reservoir to the pump house. The reservoir has both
a vent and overflow both of which are properly screened. The reservoir has a drain. The cover
of the reservoir consists of concrete precast panels covered by visqueen, wood chips and a final
layer of soil. Over time the joints may degrade and allow bacteria to contaminate the water. At
the time of the survey the Department observed a hole near the hatch of the reservoir where
some wiring enters the reservoir. This hole needs to be filled in with silicone to prevent
contaminants and insects from contaminating the reservoir. The Department recommends the
storage tank be inspected and cleaned every 5 years.
l •�
Hole near hatch of
y reservoir.
Reservoir
The Department has a concern on the size of the reservoir compared to the number of users
possibly causing stagnant water. The Department strongly recommends Bear Claw Subdivision
monitor the flow meter throughout the year to ensure the reservoir is getting adequate turnover.

Distribution
Bear Claw Subdivision has 15 connections. The water system has three.fire hydrants. The
Department was unable to determine the size of pipe the fire hydrants are.connected to due to
discrepancies between engineering plans. Please verify to the Department that the three
hydrants are installed on a 6-inch main.
The Department requires that Bear Claw Subdivision develop and actively enforce a cross
connection ordinance by implementing a cross connection control program. A cross connection
is any actual or potential connection between the public water supply and a source of
contamination or pollution. A cross connection may result indirectly when the pressure in a
water user's plumbing system is greater than the pressure in the public water supply (back
pressure) or connections to the potable water supply. In such cases, the water user's water
supply may be directed back into the distribution system, and contamination of the entire water
supply may occur. When draining and flushing the system, care should be taken by the
operator to eliminate the potential for cross contamination and/or depressurization of.the
distribution system.
Implementing the.program involves writing a cross connection ordinance and the passing of the
ordinance by the Bear Claw Subdivision. An ordinance will provide authority for the operator of
the system to inspect for potential cross connections as necessary. The ordinance must also
require that back flow assemblies are tested on an annual basis; an inventory of assembly
testing must be kept by the system. Please contact the:Department for assistance.in
developing a cross. connection control ordinances.
It does not appear that the.Department has a copy of.Bear Claw Subdivision's total coliform
sample plan; Bear Claw Subdivision must submit a copy to our office. A total coliform sampling
plan lists five sampling locations throughout the distribution system. According to coliform
sampling requirements, the total coliform sampling plan must represent the entire distribution
system. This is completed by alternating sampling locations throughout the distribution system.
Once written, the sampling plan must be followed to the best of the operator's abilities; each
alternating location must be written on the coliform sample submittal form.
Bear Claw Subdivision must have all backflow assemblies inspected on an annual basis by:a
certified backflow tester. The Department recommends that all valves are exercised on an
annual basis. DEQ requires that all dead end mains are flushed at a velocity of 2.5 ft/sec every
6 months.
Monitoring
Bear Claw'Subdivision is required to collect total coliform samples monthly and has not had any
positive sample for total coliform since July 2005. DEQ tested for pH and turbidity using the
Department's Hach pH colorimeter II and bench top turbidimeter(Hach 2100P); the pH was 7.9
and turbidity was measured at.20 NTU. The table below shows all of the sampling
requirements for Bear Claw Subdivision,
Sample:Type Frequency Sample Location
Total coliform 1 every month Distribution
VOCs 1 every quarter Well
Lead and Copper 5 every 6 months Distribution
Nitrate 1 every year Well
Arsenic 1 every 3 years Well

5
Sodium 1 every 3 years Well
IOCs 1 every 3 years Well
Radium 226 1 every 9 years Well
Radium 228 1 every 9 years Well
Gross Alpha 1 every 9 ears Well
Nitrite 1 eve 9 years Well
Uranium 1 every 9 years Well
Application to waive monitoring for the following chemical contaminants: inorganic chemicals
(IOCs), asbestos, cyanide, volatile organics (VOCs), synthetic organics (SOCs), and dioxin was
received on March 3, 2009. The following waivers have been granted for Well 41:
Contaminate Next monitoring due Waiver renewal Duration
Asbestos none this period 1/1/2011 9 yr
Cyanide none this period 1/1/2011 9 yr
SOCs none this period 1/1/2011 3.yr
Dioxin none this period 1/1/2011 3 yr
Financial & Management Capacity
Bear Claw Subdivision is privately owned by the James.E. White Trust; the administrative
contact is Jay White. The designated operator in charge of the water system is Chad 'Mike"
Vandyken who holds VSWS and Drinking Water Treatment Level 1 licensures with Idaho
Bureau of Licensures. This meets operator requirements for this water system. The.
Department recommends an operation and maintenance manual be provided for the drinking
water system. Operation and maintenance manuals should include daily operating instructions,
trouble shooting, operator safety procedures, location of valves and other key system features,
parts list and parts order forms and information for contacting the water system operator.
Source Water Assessment and Drinking Water Protection Plan
A Source Water Assessment report for the Bear Claw Subdivision has not been completed.
The Department will compile the Source Water Assessment and provide a copy to.Bear Claw
Subdivision in the future. DEQ recommends that the water system pursue a Drinking Water
Protection Plan to establish further protective measures against contamination in the watershed.
Yvonne Pettit, DEQ Drinking Water Protection Coordinator may be contacted at 208-769-1422
for further information regarding the plan.
Conclusion
At the time of the survey it was evident that Jay White and Chad "Mike"Vandyken take the
responsibility of providing safe drinking water to the users seriously; their efforts are appreciated
by DEQ. The water system was found to be operating in compliance with the Idaho Rules for
Public Drinking Water Systems.
Deficiencies
No significant deficiencies were found at the time of the survey.

Additional Requirements
1. DEQ requires that all dead end mains are flushed at a velocity of 2.5 fUsec every 6
months.
1 Within 60 days Bear Claw Subdivision must submit a.Total Coliform Sample Plan to the
Department.
3. The sanitary cap for the well does not provide a vent for the well. Within 60 days Bear
Claw Subdivision must install a sanitary cap that vents the well.
4. Provide the Department within 60 days information on the number of metered
connections, size of piping on the fire hydrants and the rates that water users are
charged.
5. .Within 60 days the Department requires that Bear Claw Subdivision develop and actively
enforce a cross connection ordinance by implementing a cross connection control
program. Also provide an approved copy of a cross connection control ordinance within
60 days. Bear Claw Subdivision must have all backflow assemblies inspected on an
annual basis by a certified backflow tester
6. Provide the Department within 60 days verification that the three hydrants on the system
are installed on a 6-inch main.
7. At the time of the survey the Department observed a hole near the hatch of the reservoir
where some wiring enters the reservoir. Within 60 days this hole needs to be filled in
with silicone to prevent contaminants and insects from contaminating the reservoir.
Follow up Items
1. Within 60 days Bear Claw Subdivision must provide the Department with verification of
how the reservoir is connected to the water system.
Recommendations
1. The Department recommends all valves are exercised on an annual basis.
2. The Department recommends the storage tank be inspected and cleaned every 5 years.
3. DEQ recommends that the water system pursue a Drinking Water Protection Plan to
establish further protective measures against contamination in the watershed.. Yvonne
Pettit, DEQ Drinking Water Protection Coordinator may be contacted at 208.769-1422
for further information regarding the implementation of the plan.
4. The Department recommends an operation and maintenance manual be provided for the
PWS.
Troy Wassink, Drinking Water Analyst Date

State of Idaho Public Water SystE ^ Enhanced Sanitary Survey
WATER SYSTEM INVENTORY INFORMATION SURVEY DATE PWS#
3/18/2009 (mm/dd/ ID1090231
Name of Public Water System-. #of Groundwater Sources: 1 #of Storage Facilities: 1
Total
Bear Claw Subdivision #of Surface Water Sources: 0 storage(gel) 50,000
Date of Last Survey: Wealth District: N/A 17EC!Region:_ ❑N/A County:
N/A CDARO Bonner
Numhgr of Service Connections: Residential Population: Status: Water Purchased From: N/A Walgr Sold To: N/A
15 37 0 Approved Name: Name:
❑Disapproved pWS#: PWS#:
Combined Sources? Seasonal Operation
Owner Type: Legal Entity: Water System Classification: ❑Yes 2 No S stem Classification: Dates: NIA
Private Trust Community Water System If yes, ElWell Field Distribution: u'i t, _;:= Date Open:
❑Manifold/Spring Box VSWS
❑Nontransient Noncommunity Sources Combined: Treatment: 0 N/A Date Closed:
❑Transient Noncommunity-NC
Responsible Charge Operator(DO): U No DO U N/A-Identify Operator for GW-NC PWS) Legal Owner's Name:
0 Mr. ❑Ms. Chad"Mike"Vand ken ❑Mr. ❑Ms. James E. White Trust
DO Properly Licensed? a Yes ❑No ❑N/A-GW-NC License'VSWS ❑N/A Mailing Address:
Mailing Address: PO Box 5099
6907 Atlanta St City,State, Zip Code: Telepnoin
City,State, Zip Code: Telephone Coeur d'Alene, ID 83815- Day:
Bonners Ferry, ID 83805 1951
Day: [phone] Night:
Night: Fax:
E-mail: Fax: E-mail;
Substitute Responsible Charge Operator(OP): C1 No OP N/A for GW-NC PWS
❑Mr. ❑Ms. Jay White Individuals present during inspection:
OP Pro arty Licensed? El Yes ❑ N/A GW NC License"type: ❑N/A Name: Chad"Mike"Vand ken Title: Operator
Mailing Address: Name: Jay White Title: Administative
PO Box 528 Name: Title:
City,State, Zip Code: Telephone
Clark Fork, ID 83811 Day: [phone] Physical location of the PWS(Township,Range,Section):
Night:
E-mail: Fax:
Samples taken at the time of survey by inspector? Survey performed by: _ •-,. '. _ Agency;
2 Yes ❑No Name: Troy Wassink D IDEQ
If yes,what: Total Coliform Tille: Drinking Water Analyst ❑Health Dept.
Phone#: [phone] ❑other;
yes no n/a unk note General Information Senhaty Survey Index
❑ ❑ 0 ❑ ❑ 1, Have previously required Significant Deficiencies&Deficiencies been addressed? Modules_used:
❑ ❑ El ❑ ❑ 2. Have modifications been made to the PWS since the last ESS? ❑� General Information
❑ ❑ EZ ❑ ❑ 3. If yes,are the modifications considered to be significant? ❑r Groundwater Source
❑ ❑ 21 ❑ ❑ 4. If yes,were plans and specs submitted to and approved by DEQ? 2 Storage
Comments:
❑ Hydropneumatic Tanks
2 Distribution
El Pumping
❑✓ Financial Capacity
El Managerial Capacity
❑ Treatment Application
❑ Disinfection
❑ Notes
❑ Photo Lop
Total Modules 10
Page_ Of
IDEQ-Enhanced Sanitary Survey-4124/07 General Information

GROUNDWATER SOURCE - PGA SURVEY DATE PWS#
A separate sources form must be filled out for each groundwater source in the PWS. 3/18/2009 (MrWdd/ ) ID1090231
Tag#: Common Name of Source: Source: Is this Source Treated? Yes No
Well#1 ❑Well — 0 ❑Manifold Treatment Objective: ❑N/A
Physical Location: ❑Spring ❑Spring Box
Located on the Southeast corner of lot number 16 in the Bear Claw Subdivision.
Ld N/A
(Identify Treatment Train in Comments)
Is there a well log for the groundwater source? 0 Yes 0 No 0 N/A U Unk
Pump Capacity(GPM) Casing Size(In) Date Drilled: Well Depth(Ft) Casing Depth(Ft) Grout Depth(Ft) Static Water Depth(Ft)
30 ❑Unk 8 518 ❑Unk 1995 ❑Unk 1 141.5 ❑Unk 1 139.5 ❑Unk 40 ❑Unk 89.5 ❑Unk
Is the Casing Screened? Screen Depth(Ft): N/A LJ Unk Is the Casing Perforated? Perforation Depth(Ft): 0 N/A
❑Yes El No ❑Unk From: ❑Yes El No ❑Unk From: ❑Unk
❑N/A To: ❑N/A To:
Latitude(Decimal):
Longitude(Decimal):
{+)IF A GROUNDWATER SOURCE HAS BEEN DETERMINED TO FALL UNDER THE DIRECT INFLUENCE OF SURFACE WATER,THE SURFACE WATER SYSTE
INSPECTION RESULTS AND TURBIDITY SECTIONS MUST BE FILLED OUT IN ADDITION TO THE GROUNDWATER SYSTEM INSPECTION RESULTS SECTION,
All Sources COMMENTS:
1. This source is: (Please indicate question number)
E Active ❑Proposed
yes no We unk note ❑Inactive ❑Emergency(<60 days per year)
❑ Q ❑ ❑ ❑ 2. Has there been a Source Water Assessment conducted for the source?
Date:
❑ ❑� ❑ ❑ ❑ 3. Has a final GWUDI determination been done for this source?
Date:
es no nwa unk note WELL INFORMATION
4, Is the well on a separate lot that is large enough to provide a minimum
❑Significant ❑Deficiency distance of 50 feet between the well and the nearest property line?
(applicable if constructed after 11/1/77)
Q ❑ ❑ ❑ ❑ 5. Is the well lot owned in fee simple by the supplier of water or controlled
by lease or easement with a term of not less than the useful life of the well?
6. Are the following minimum distances from the PWS well being met?
Q ❑ ❑ ❑ ❑ -Gravi sewer line...........................................50 Ft.
❑ ❑ ❑ ❑ ❑ Pressure sewer line.......................................100 Ft.
❑ ❑ ❑ ❑ ❑ Individual home septic tank..............................100 Ft.
Q ❑ ❑ ❑ ❑ -Individual home disposal field...........................100 Ft.
E ❑ ❑ ❑ ❑ -Individual home seepage pit.............................100 Ft,
0 ❑ ❑ ❑ ❑ Privies.........................................................100 Ft.
0 ❑ ❑ ❑ ❑ -Livestock......................................................50 Ft.
0 ❑ ❑ ❑ ❑ Canals,streams,ditches,lakes,ponds and
tanks used to store nonpotable substances.........50 Ft.
❑ ❑✓ ❑ ❑ ❑ 7. Are pesticides,herbicides,fertilizers,portable containers of petroleum
products,or other toxic or hazardous materials stored on the well lot?
❑ E ❑ ❑ ❑ 8. Are pesticides,herbicides,or fertilizers applied to the well lot?
❑ M ❑ ❑ ❑ 9. Is the well in a pit? If yes,Date constructed:
❑ ❑ Q ❑ ❑ 10. Was the well that Is located in a pit installed after 11/5/647
❑ ❑ Q ❑ ❑ 11. If pit was installed prior to 11/5/64—Has DEQ granted an exception and
does the pit have water tight construction of pit walls and floor,a Floor
yes no We unk note drain and an acceptable pit cover?
❑ ❑ ❑ ❑ ❑ 12. Is the well protected from unauthorized entry?(Recommended)
13. Does the casing extend a minimum of 18 inches above the final ground
❑Significant ❑Deficien surface and/or 12 inches above the pump house floor?
14. Is the well vented with the open end of the vent screened and
terminated downward at least 18 inches above the final ground surface?
❑✓ ❑ ❑ ❑ ❑ 15. Is the well provided with a sanitary cap that prevents surface water entry?
M ❑ ❑ ❑ ❑ 16. Is the well cased and sealed in such a manner that surface water
cannot enter the well?
Page Of
IDEQ-Enhanced Sanitary Survey-4124/07 Groundwater Source

Common Name SURVEY DATE PWS#
GROUNDWATER SOURCES-PG,2 Well#1 8/18/2000 (mrNdd/yyyy) ID1090231
yes no We unk note WELL INFORMATION(cunt.) COMMENTS:
❑ ❑ ❑ ❑ 17. Is there a smooth nosed sample tap provided on the well discharge pipe (Please indicate.question number)
,prior to treatment?(Threaded tap is approved with backflow preventer) 1.7-20.)The area around the well and
L!rJ. LJ 118. Is an instantaneous and totalizing Row meter equipped with nonvolatile vault was covered by snow..DEQ will
❑Unnece nary memory installed on the pump distribution line of the well:and[sit visit the.water system to inspect the areas
mainlained'.and working properly? gallons covered by snow in the spring.
El ❑ ❑ 0 ❑ 19. Is a pressure gauge provided at all installations and is it maintained
and working properly? =psi.
❑ ❑ ❑ 0 ❑ 20.. Can the well be pumped to waste at the design capacity of the well via
an,approved air gap at a location prior to the first service connection?
❑ 0 ❑ ❑ ❑ 21. Has the source been known to have.raving or sand problems7
yes no We unk note PUMP NflUSE(Any structure containing important wafersystem components)
❑ ✓❑ ❑ ❑ ❑ 22. Is the,source located in a pump house?
❑ El El El ❑ 23. Is the pump house kept clean and in good repair?(Floor cracks?)
❑ ❑ [D ❑ ❑ 24. Is the pump house protected from unauthorized personnel?
❑ ❑ El ❑ ❑ 25. Does:the pump house have:adequate lighting throughout?(Recommended)
[] ❑ 0 ❑ ❑ 261 Are all non-sample taps installed in the pump house equipped with an
appropriate backflcw prevention device?'
27. Is adequate ventilation provided in the pump house for dissipation of
❑significant ❑Deficiency excess heat and moisture from the equipment?
28. Is adequate heating provided in the pump house to provided safe and
❑Significant ❑Deficiency efficient operation of equipment to prevent freezing?
29. Is the pump house protected from flooding,have adequate drainage,
is the floor surface at least six(6)inches above the final ground surface,
and is the ground surface graded so as to lead surface water away from
the pump house?
El ❑ 0 ❑ ❑ 30, Is the sump for pump house Floor drains closer than 30 feet from the well?
❑ El El ❑ ❑ 31, is the floor drain connected to sewer,storm drains,chlorination room
drains.or any other source of contamination?
yes: no n1a unk note SPRING INFORMATION
❑ ❑ Q ❑ ❑ 32. Is the entire area within one hundred(100)feet of the spring owned by
the.supplier'or controlled by a long term tease?
❑ ❑ Q ❑ ❑ 33. Is the entire area within a one hundred(100)foot radius of the spring box
fenced to prevent trespassing of livestock and void of buildings,dwellings
and sources of contamination?
❑ ❑ Q ❑ ❑ 34. is surface water diverted from the 100 foot protection zone around
the spring?
❑ ❑ ❑ ❑ ❑ 35. Is the.spring housed In a permanent stricture and protected from
contamination including'the entry of surface water,animals and dust?
❑ ❑ [D ❑ ❑ 36. Is there a smooth nosed sample tap provided on the sprin..g discharge pipe
prior to treatment?(Threaded tap is approved with backflow preventer)
❑ ❑ E ❑ ❑ 37. is a Flow meter or other flow measuring device provided?
yes no rita unk note SPRING BOX INFORMATION(Not'aft axisung springs have a spring box)
❑ ❑ ❑r ❑ ❑ 38 Is the spring box equipped with a screened overflow?
❑ ❑ ❑ ❑ 39, Is the supply intake located above the floor of the collection chambeR
❑ ❑ ❑ ❑ 40, Is the spring box protected from contamination Including the entry of
surface water,animals,and dust?
❑ ❑ 0 ❑ ❑ 41. is the access port watertight and locked?
❑ ❑ Q ❑ ❑ 42. Is the access port-elevated at least twenty-four(24)inches above the top
of the box or covering sod,whichever is higher?
Page Of
iDEQ-Enhanced Sanitary Survey-4/24107 Groundwater Source%

STORAGE F—'_?vEY DATE PWS#
A separate storage form must be filled out for each storage unit in the PWS. _11812009 (mm/dd/yyyy) I ID1090231
Storage Structure Name: Storage Structure ID#: COMMENTS:
Reservoir T1090231S1 (Please indicate question number)
Physical Location: Date in service: ❑Unk 9& 10.)The Department
7/1/1996 recommends the storage
Volume(gal): ❑Unk I tank be inspected and
50,000 cleaned every 5 years to
Storage Type: Construction: ❑Elevated Type of material: ensure the roof is not
El Reservoir/Tank ❑Above Ground ElPlastic ❑Wood allowing contaminates into
❑Standpipe F/I Partially Below Ground ❑Fiberglass ❑Metal the reservoir.
❑Below Ground ❑concrete ❑Naturally contained 18. The sanitary cap for the
Total Days Supply(This structure): I Date Last_ Inspected: F�j Unk Cleaned: Unk well does not provide a vent
[l Unk for the well. Bear Claw
How is the water level measured? Unk Subdivision must install a
Float S stern sanitary cap that vents the
yes no nla unk note ALL STORAGE STRUCTURES Well.
❑ ❑ ❑ ❑ ❑ 1. Is the storage structure safely accessible to the inspector?
❑ ❑� ❑ ❑ ❑ 2. Is the PWS storage tank located within 500 feet of any municipal or
Industrial wastewater treatment plant or any land which is spray irrigated
with wastewater or used for sludge disposal?
0 ❑ ❑ ❑ ❑ 3. Is there a minimum distance of 50 feet between the reservoir and any
sewer,drain,standing water or other possible source of contamination?
❑ 4. Are any of the storage structure drains directly connected to a sewer or storm drain?
❑✓ ❑ ❑ ❑ ❑ 5. Is an overflow provided that discharges to daylight In a way that will preclude the
possibility of backflow to the reservoir and,where practical,provided with an expanded
metal screen installed within the pipe that will exclude rodents and deter vandalism?
✓❑ ❑ ❑ ❑ ❑ 6. Are overflows brought down to an elevation between 12 and 24 inches above
the ground surface?(2X The diameter of the discharge pipe above a basin rim)
0 ❑ ❑ ❑ ❑ 7. Do overflows discharge over a drainage Inlet structure or splash plate?(storm or sanitary)
0 ❑ ❑ ❑ ❑ 8. Is the storage structure secure from unauthorized access?
9. Does the storage reservoir have a watertight roof or cover and Is it
sloped to facilitate drainage?
10. Is the storage water protected from contamination?
❑ ❑ ❑ ❑ ❑ 11. Is the storage structure structurally sound?
❑ ❑✓ ❑ ❑ ❑ 12. Could vegetation in the area potentially impact the storage structure?(Recommended)
13. Is the storage structure designed so that it can be isolated from the distribution
system without necessitating loss of pressure in the distribution system?
❑ 0 ❑ ❑ ❑ 14, Is leakage evident at time of inspection?
❑ ❑� ❑ ❑ ❑ 15. Is the storage structure Interior coating or liner peeling or cracked?
'❑ ❑ ❑ ❑ ❑ 16. Is the storage structure used to store finished water?
yes no n/a unk note ELEVATED,ABOVE;GROUND,and PARTIALLY ABOVE GROUND STORAGE
Q ❑ ❑ ❑ ❑ 17. Are access manhole openings for the storage structure 4 inches or greater above the
reservoir roof surface,with a lid 2 inches overlapping,water tight,and locked?
18. Are all other manhole lids bolted and gasketed to make them water tight?
(� ❑ ❑ ❑ ❑ 19. Are all vents extended 12 inches above the roof and constructed to exclude potential
sources of contamination?(The overflow pipe shall not be considered a vent)
20. Do all vents open downward and are they fitted with a 4 mesh non-corrodible screen?
yes no n/a unk note ABOVE GROUND,PARTIALLY ABOVE GROUND and BELOW GROUND STORAGE
❑ ❑ ❑ ❑ ❑ 21. Does the overflow for the storage structure open downward,provided with either a
24 mesh non-corrodible screen installed within the pipe when practical,or an expanded
metal screen Installed within the pipe plus a weighted flapper?
yes no nla unk note BELOW GROUND LEVEL STORAGE
❑ ❑ ❑✓ ❑ ❑ 22, Is the area surrounding the below ground level storage structure graded in a manner
that will prevent surface water from standing within 50 feet of it?
❑ ❑ 21 ❑ ❑ 23. Are"ALL-manholes for below around level storage elevated 24 inches above
the top of tank/covering sod,with a 2 inches overlapping lid,water tight,and locked?
❑ ❑ i] ❑ ❑ 24. Are all vents for below ground level storage open downward with the opening at
least 24 Inches above the roof or sod and covered with 24 mesh non-corrodlble
screen to exclude potential contamination?
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IDEQ-Enhanced Sanitary Survey-4/24/07 Storage

DISTRIBUTION SURVEY DATE PWS#
One form for all distribution systems In the PWS. 3/18/2009 (mm/dd/yy y) F ID1090231
What are water lines made of: {�,,,�-! COMMENTS:
Material Unk '•i Sizes : Unk /' -' (Please Indicate the question number)
2",4 &6'
El Steel ❑HDPE(black) ❑Asbestos/Cement
❑� PVC ❑Ductile Iron ❑Copper
❑Other:
How many services are metered? Number of Fire Hvdranls:
out of 3
yes no n/a unk note DISTRIBUTION
❑ 2 ❑ ❑ ❑ 1, Have there been any interruptions in service during the past year?(including
pressure loss)
❑ ❑ n ❑ ❑ 2. If a loss of pressure occurred(>20 psi),did the PWS provide public notice
and disinfect the system?(Reminder)
Q ❑ ❑ ❑ ❑ 3.Is the PWS able to maintain a minimum pressure of twenty(20)psi throughout
the distribution system(including fire flow),or forty(40)psi for PWSs
constructed after 7/1/1985(excluding fire flow),during maximum hourly
demand conditions?
❑ ❑� ❑ ❑ ❑ 4. Was the pressure observed at a service connection?
5. if yes: psi.
Location:
yVs no n/a unk note Time: ❑A.M. ❑P.M.
6. Do all water mains that provide fire flow have a diameter of at least 6 inches?
❑ ❑ ❑ Q ❑ 7. Are valves exercised regularly?(Recommended)
If yes,how often?
❑ ❑ ❑ Q ❑ 8. Is there a leak detection program?(Recommended)
❑ ❑ ❑ ❑ ❑ 9. Is 15%or more of the water unaccounted for?
L] Q 0 ❑ ❑ 10. Is a water conservation program in effect?(Recommended)
Q ❑ ❑ ❑ ❑ 11. Is an adequate map of the distribution system maintained?(Recommended)
❑ [] ❑ ❑ ❑ 12, Does the system flush all main lines annually?(Recommended)
L] ❑ ❑ ❑ ❑ 13. Are all dead end water mains equipped with a means to flush?
14, If yes,are the deadends flushed at least semiannually?
❑ 21 ❑ ❑ ❑ 15. Are there any distribution materials used that should not be In contact with
the drinking water? If yes,explain in comments section,
❑ ❑ ❑ ❑ ❑ 16, Is the system adequately protected from freezing?
❑ ❑ ❑ Q ❑ 17. Is there a cross connection control program? (Community PWSs Only)
❑ ❑ ❑ ❑ 18. Is the operator trained in cross connection control?(Recommended)
❑ 0 ❑ ❑ ❑ 19. Is the operator aware of any cross connections or were any cross
connections observed during the course of the survey?
❑ ❑ ❑✓ ❑ ❑ 20. If a separate non-potable Irrigation system is provided for the consumer,
are all mains,hydrants,and appurtenances easily identified as non-potable?
(Purple Tape or other)(Recommended)
yes no nle unk note Air/Vacuum Relief Valves-Placed at high points in wafer mains.
❑ El 21 ❑ ❑ 21. Are all automatic air relief valves equipped with a means of backflow
protection?
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IDEO-Enhanced Sanitary Survey-4/24/07 Distribution

PUMPING -:PG. 1 SURVEY E PWS#
One form For all Purrips. 3N812009 (mm/d&ym) ID1090231
PUMPS,PUMPHOUSES,AND CONTROLS
Pump ID#, Physical Location, Type of Pump: Brand: Model; Horsepower [Purpose:
Well##1 Submersible Gould 70LG75432 7.5 H
COMMENTS:
yes no nla unk note ALL PUMPS (Please indicate the question number)
21 ❑ ❑ ❑ ❑. 1. Are all pumps capable of providing the maximum pumping demand of the system?
❑ 21 ❑ ❑ ❑ 2. Does the pump(s)cycle excessively?(Recommended)
0 ❑ ❑ ❑ ❑. 3, Are,all pumps provided with readily available spare parts and tools?
❑ ❑ 0 ❑ ❑ 4.. Is a water pressure relief valve installed where the pump is directly
connected to the distribution system?
❑ ❑ ❑ 0 ❑ 5. Is a standard pressure gauge Installed on the discharge line?
0 ❑ ❑ ❑ ❑ 6: Do all pumps maintain an operating pressure of 20 psl or.greater?
yes no nle unk note WELL PUMPS
❑ ❑ ❑ 2 ❑ 7. is there an accessible check valve Installed In the discharge line of each well.
❑ ❑ 2 ❑ ❑ 8, If the system has a vertical turbine motor dd.ven pump(s),is an air
release-vacuum relief valve located upstream from the.check valve,with
exhaustlrelW piping terminating in a down-turned position at least 18 Inches
above the floor and covered with a 24 mesh corrosion resistant screen?
❑ ❑ ❑ ❑ 9. IFlhe pumps}Is"oil lubricated",is the oil NSF approved and suitable for
human donsumptlon?
yes no n/a unk note WATER PUMPS (not well pumps)
❑ ❑ ❑ ❑ ❑ 10. Is a positive-actifig check valve on the discharge side between the pump
and the shut-off valve?
yes no We unk We AUXILIARY POWER
✓ 0 11_ Is there auxlllary poweron-site?
❑Significant ❑Deficiency
12, Is auxiliary power tested?(Recommended)
❑ [] 0 ❑ ❑ 13. If a diesel or gasoline fueled engine is used on the well lot;is the fuel tank
and connecting piping double walled?
❑ ❑ Q ❑ ❑ 14. Is the fuel tank above ground?
❑ ❑ ❑-i ❑ ❑ 15. Is a certified operator present during the filling of the fuel tank?
If the engine is 1n the well house•
❑ ❑ 2 ❑ ❑ 16. is the engine exhaust directly discharged outside the Well house?
❑ ❑ [21 ❑ ❑ 17. Is a spill containment structure surrounding all fuel tanks adequate?
(Secondary contakimerit-110%fuel tank volume)
Page Of
IDEQ-Enhanced Sanitary Survey-4/94107 Pumping

SURVEY, E PWS#
PUMPING -PG:2 3/18/2009 (mrn1dd/yyyy) 01090231
COMMENTS:
s no nla unk note BOOSTER PUMPS (Please Indicate the.que.stion number)
18. Is an instantaneous and totalizing now meter installed where the booster
❑Unnecessary pump is directly connected to the distribution system?
19. Are all in-line booster pumps supplied with an automatic cutoff that
activates when intake pressure is less than or equal to 5 psi?
❑ ❑ Q ❑ ❑ 20. Is the booster pump.located on a:suction line that is directly connected to
any storage reservoir?
❑ ❑ a ❑ ❑ 21, If yes,are all booster pumps protected by an automatic cutoff to prevent
pump damage and avoid excessive reservoir drawdow0
yes no n/a unk note PUMP HOUSE(Qn1y pump houses that don' contain a Groundwater.Source)
C] ❑ Q ❑ ❑ 22, is thwoomp house kept clean and in good repair?(Floor cracksP)
El 0 ❑ ❑ 23. Is the pump house protected from unauthorized personnel?
❑ ❑ E ❑ ❑ 24, Does the pump house Have adequate lighting throughout?(Recommended)
❑ ❑ 0 ❑ ❑ 25. Are all non-sample taps installed In the pump house equipped with an
appraprlate backflow prevention device?
26. is:adequate ventliatlon provided in the pump house For dissipation of
El Significant ❑Deficiency excess heat and moisture from the equipment?
J U 0 27. Is adequate heating provided in the pump house to provided safe and
❑Significant ❑Deficiency efficient operation of equipment(prevent moisture bulldup andlor:freezing)?'
✓ U U 28. Is the pump house protected from flooding;have adequate drainage,
is the floersurfaceat least six(6)Inches above the final ground surface,
and Is the ground surface graded so as to lead surface water away from
yes no nla unk note the pump house?
❑ ❑ El ❑ ❑ 29, Is the sump for pump,house floor drains closer than 30 feet from the well?
❑ ❑ 21 ❑ ❑ 30. Is the boar drain connected to sewer,storm drains,chlorination room
drains,or any other source of contamination?
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IDEA-Enhanced Sanitary Survey-4/24107 Pumping

SURVEY DATE PWS#
FINANCIAL CAPACITY 3/18/2009 (mm/dd/yyyy) ID1090231
yes no n/a unk note FINANCIAL CAPACITY COMMENTS:
❑ ❑ ❑ ❑ 1. Is the PWS current with the payment of drinking water fees? (Please indicate the question number)
❑ ❑ ❑ ❑ 2, Does the PWS charge a drinking water fee to the user?
If yes,what is the fee: $
❑ ❑ ❑ ❑ ❑ 3. Is the PWS in the business of selling water?
#3 Note: -If no,identify why in the comments section and mark
"NIA"on questions 4-19.
❑ ❑ ❑ ❑� ❑ 4. Does the PWS provide and use an annual budget?(Recommended)
❑ ❑ 2 ❑ ❑ 5. If applicable,Is the PWS fund separate from the waste water/sewer
utility fund?(Recommended)
❑ ❑ ❑ 0 ❑ 6. Do water system revenues exceed expenditures? (Recommended)
❑ ❑ ❑ Q ❑ 7. Are controls established to prevent expenditures from exceeding
revenues?
❑ U ❑ ❑ [] B. Has an independent financial audit been completed?(Recommended)
0 ❑ ❑ ❑ ❑ 9. If yes,Is a copy of the most recent balance sheet for the water system
available? (Recommended)
❑ ❑ ❑ Q ❑ 10. Does the water system Include a cash budget within its annual
budget for cash flow? (Recommended)
❑ ❑ ❑ 2 ❑ 11. Does the water system management review the user fee,user
charge,or rate system at least annually? (Recommended)
12. When was the last user fee,user charge,or rate system adjustment?
yes no nia unk note I mm/dd/yyyy
❑ ❑ ❑ ✓❑ ❑ 13. Does the water system management review financial reports at least
monthly? (Recommended)
❑ ❑ ❑ 21 ❑ 14. Does the PWS provide and use a capital budget? (Recommended)
❑ ❑ ❑ ❑ ❑ 15. Has this PWS produced and does It currently utilize a capital
improvements plan? (Recommended)
16. If yes,when was the capital improvements budget produced?
mm/dd/yyyy
❑ ❑ ❑ ED ❑ 17. Has the capital improvement budget been updated in the last
18 months? (Recommended)
❑ ❑ ❑ 0 ❑ 18. Does the water system budget provide funding for depreciation of
existing plant in service and/or for the funding of reserves for system
replacement?
❑ ❑ ❑✓ ❑ ❑ 19. Are there sufficient funds for training personnel?
Page Of
IDEQ-Enhanced Sanitary Survey-4/24/07 Financial Capacity

SURVEY r -TE PWS##
MANAGERIAL CAPACITY F 03/18/2u j (mrWddlyyyy) 101090231
yes no nta unk note MANAGERIAL CAPACITY COMMENTS:
❑� ❑ ❑ ❑ ❑ 1. is a properly licensed operator available at all times?(N/A for GW-NC PWS) (Please indicate the question number)
❑ ❑✓ ❑ ❑ ❑ 2. Is there a Certified Drinking Water Protection Plan developed for this system?
Date:
❑ ❑ ❑ ❑ 3, Does this PWS have a governing body or board of directors?
If no,please indicate:
❑ Sole Proprietorship
❑ Partnership
❑ Limited Liability Corp.
❑ Other:
4. How often does the board meet? ❑N/A
❑weekly ❑semi-annually ❑never
❑monthly ❑annually ❑unknown
❑bimonthly ❑as necessary ❑other:
yes no nra unk note 5. Are the following records maintained onsite or located near by?
❑Q ❑ ❑ ❑ ❑ Bacteriological Analysis-5 years retention.
Q ❑ ❑ ❑ ❑ - Chemical Analysis-10 years retention.
* ❑ ❑ ❑ ❑ - Records of actions taken to correct violations-3 years retention.
* ❑ ❑ ❑ ❑ Copies of reports,summaries or communication related to
sanitary surveys-10 years retention.
Q ❑ ❑ ❑ ❑ - Reports concerning variances or exemptions-5 years retention.
Q ❑ ❑ ❑ ❑ Copies of public notices Issued-3 years retention.
E ❑ ❑ ❑ ❑ - Daily free chlorine residuals(required disinfection)-1 year retention.
❑ ❑ ❑ ❑ ❑ 6, Are routine maintenance schedules established? (Recommended)
❑ ❑ ❑ ❑ ❑ 7. Is an operation and maintenance manual(s)provided for the PWS and
does it include;dally operating instructions,operator safety procedures,
location of valves and other key system features,parts list and parts
order form,and information for contacting the water system operator?
❑ ❑ ❑ ❑ ❑ 8. Is there a clear plan of organization and control among the people responsible
for management and operations of the water system?(Recommended)
yes no Na unk note 9. Are any samples of the following parameters past due?
❑ Q ❑ ❑ ❑ Comorm
❑ Q ❑ ❑ ❑ Nitrates
❑ ❑✓ ❑ ❑ ❑ Nitrites
❑ o ❑ ❑ ❑ Lead and Copper
❑ o ❑ ❑ ❑ I4Cs
❑ 0- ❑ ❑ ❑ SOCs
❑ ❑✓ ❑ ❑ ❑ Disinfection Byproducts
❑ 0 ❑ ❑ ❑ Radionuclide
MENUMENEIM3110. Is a written total coliform rule(TCR)sample site plan available
for review?
❑ ❑ 0 ❑ ❑ 11. Does the(TCR)sample site plan meet the minimum requirements?
E ❑ ❑ ❑ ❑ 12. Does the system have a sufficient supply of approved sampling
bottles properly stored? (Recommended)
o ❑ ❑ ❑ ❑ 13. Does the PWS provide stairways,ladders and handrails where needed?
Q ❑ ❑ ❑ ❑ 14. Are treads of non-slip material provided where needed?
❑ ❑� ❑ ❑ ❑ 15, Is a health concern produced from Inadequately protected electrical wiring?
0 ❑ ❑ ❑ ❑ 16. Are all confined space entry requirements considered?(Recommended)
❑ ❑✓ ❑ ❑ ❑ 17. Are there any unused subsurface water storage tanks that need to be
abandoned?
❑ El ❑ ❑ ❑ 18. Are there any water supply wells that are no longer being used that
need to be abandoned?
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IDEQ-Enhanced Sanitary Survey-4/24/07 Managerial Capacity