Looking for Relocated Forms?
Updated October 2021
- Capacity Assessment
- Construction of Public Water Systems and Drinking Water Facilities
- Data Locations Submittal
- Deficiency Reporting (Sanitary Survey)
- Disinfection By-products (DBP) Rule
- Operator Certification
- Financial Assistance
- GRAMA Information Requests
- Groundwater (GW) Rule
- Lead and Copper Sampling
- Public Notification
- Update to Source Protection Template
- Water Treatment Facilities (Operational Reports)
Capacity Assessment Worksheets for Public Water Systems
Can be submitted online. Print out your form for your records before submitting online. Alternatively, this form can be mailed to our office or faxed to (801) 536-4211, Attn: Nagendra Dev
Contact Nagendra Dev (email@example.com) if you have questions.
Construction of Public Water Systems and Drinking Water Facilities – Plan Review
Application for a New Public Water System
Capacity Evaluation – Source and Storage
- PWS Capacity Calculations Spreadsheet (protected)
- PWS Capacity Calculations Spreadsheet (unprotected)
- Hydraulic Analysis Certification Form
- Hydraulic Model Design Elements & System Capacity Expansion Report Form
- Hydraulic Model Design Elements Report Form
- Hydraulic Modeling Rule Summary
Plan Review Checklists
- Alternative Surface Water Treatment
- Conventional Surface Water Treatment
- Disinfection – Chlorine
- Disinfection – Chlorine Dioxide
- Disinfection – Ozone
- Disinfection – UV
- Distribution Systems
- Miscellaneous Treatment Methods
- Pump Stations
- Spring Sources
- Surface Water Sources
- Water Storage Tanks
- Well Sources
Plan Review – Other Documents
- Chlorine Dose Calculator (Protected)
- Chlorine Dose Calculator (Unprotected)
- Disinfection CT Calculator
- Inorganics and Organics Treatment – Internal Review Checklist
- Policy for Dichlor and Trichlor Disinfection
- Project Notification Form
- Public Drinking Water Project Definition
- Surface Water Treatment – Internal Review Checklist
- Water/Sewer Separation – Plan Review & Exceptions
Water Line Installation Standards
Data Locations Submittal
Location Data for Public Water Systems
Can be submitted online by clicking the Submit Form button in Adobe Acrobat (Reader or Pro versions). Note: open the PDF in Adobe Acrobat directly. Alternatively, this form can be mailed to our office or faxed to (801) 536-4200.
Contact Deidre Beck (firstname.lastname@example.org (email@example.com)) with questions.
Deficiency Reporting (Sanitary Survey)
IPS Deficiency Correction Notice
Adobe Reader Users Fill out the form, select the “Submit by Email” button, and Email the xml file to DDWIPS@utah.gov using the Wizard to create the xml file. Note: If you are using the Chrome browser, the Adobe Reader plug-in won’t work. Use Internet Explorer or open the PDF in Adobe Reader directly.
Adobe Pro Users Fill out the form, save the PDF, then Email the PDF file to DDWIPS@utah.gov (using the Wizard to create the xml file). Note: If you are using the Chrome browser, the Adobe Reader plug-in won’t work. Use Internet Explorer or open the PDF in Adobe Reader directly.
Contact us at DDWIPS@utah.gov (DDWIPS@utah.gov) with questions.
Disinfection By-Products (DBP) Rule
The EPA has a Quick Reference Guide available for Stage 2.
- To Update Contact Info: For operators and water systems. If you have a new phone number, email address, or have recently moved, use this form to let us know how best to reach you. We require written notification of contact info changes. Reach us at (801) 536-4200 to get started.
- Individual CEU Application
- Course CEU Application: PDF | XLSX
- Exam Application
- Reinstatement Application
- Renewal Application
- Unrestricted Certificate Application
- Citizenship Certification Form
A combined form in MS Excel for both State and federal SRF; Email to DDW (firstname.lastname@example.org) once complete.
Division of Water Resources Conservation Program
To receive funding, a water management and conservation plan must be submitted.
EPA/WBE Utilization Under Federal Grants and Cooperative Agreements
Utilization under federal grants, cooperative agreements, and interagency agreements form.
Pre-Award Compliance Review Report
For all applicants requesting federal financial assistance.
State Revolving Fund | Drinking Water Board Schedule
To present a project to the Utah Drinking Water Board in a particular month, certain deadlines apply.
See also Construction Assistance.
GRAMA Information Requests
See Records Request.
Groundwater (GW) Rule
Lead and Copper Sampling
- Consumer Notice Lead and Copper Water Sample Results:
- Creating a Lead and Copper Sample Site Plan
- Lead and Copper Certification: Online Form
- Lead and Copper Consumer Notice Certification Form:
- Lead in Schools Checklist
- Public Education Requirements for AL Exceedance
- Sampling Procedure Guidance for Homeowners
- Sampling Procedure Guidance for Homeowners (Spanish)
- Summary Sheet & 90th Percentile Calculator
If you have an updated source protection plan to prepare, the following links for a template and for waiver forms to use to reapply for Use and Susceptibility Waivers are available:
- Groundwater Plan Checklist
- Surface Water Update Template
- Surface Water PER Checklist
- Surface Water Plan Checklist
- Ground Water Update Template
- Susceptibility Waiver Statement
- Use Waiver Statement
- Waiver Checklist
Water Treatment Facilities (Operational Reports)
For complete treatment plants:
- Disinfection Profiler Spreadsheet
This spreadsheet calculates a disinfection profile for one month. Allows for up to 20 disinfection sequences. It can be used for the following disinfectants: chlorine; chloramines; chlorine dioxide; and ozone.
- Interim Enhanced Surface Water Treatment Rule (IESWTR)
For plants on systems serving 10,000 or more.
- Monthly Electronic Report (03/14/2016)
This is an electronic form for operators of complete treatment plants. It can be completed and Emailed back to the Division