Iowa Admin. Code r. 567-40.3

Current through Register Vol. 47, No. 11, December 11, 2024
Rule 567-40.3 - Forms

The following forms are used by the public to apply for department approvals and to report on activities related to the public water supply program of the department. All forms may be obtained from the department's website atwww.iowadnr.gov (water supply pages) or from the Environmental Services Division, Administrative Support Station, Department of Natural Resources, Henry A. Wallace Building, 502 East Ninth Street, Des Moines, Iowa 50319-0034. Properly completed application forms shall be submitted to the Water Supply Section, Environmental Services Division. Water supply system monthly and other operation reporting forms shall be submitted to the appropriate field office (see 567-subrule 42.4(3)). Properly completed laboratory forms (reference 567-Chapter 83) shall be submitted to the State Hygienic Laboratory or as otherwise designated by the department.

(1)Construction permit application forms. Schedules "la" through "16d" are required.

Schedule No.

Name of Form

Form Number

"1a"

General Information

542-3178

"1b"

Minor Water Main Construction Permit

542-3151

"1c"

Fee Schedule

542-3179

"2a"

Water Mains, General

542-3030

"2b"

Water Mains, Specifications

542-3031

"2c"

Notification of Minor Water Main Construction

542-3152

"3a"

Water System, Preliminary Data

542-3032

"3b"

Water Quality Data

542-3029

"3c"

Surface Water Quality Data

542-3028

"4"

Site Selection

542-3078

"5a"

Well Construction

542-1005

"5b"

Well Appurtenances

542-3026

"5c"

Well Profile

542-1006

"5d"

Surface Water Supply

542-3139

"6a"

Distribution Water Storage Facilities

542-3140

"7"

Schematic Flow Diagram

542-3142

"8"

Aeration

542-3143

"9"

Clarification/Sedimentation

542-3144

"10"

Suspended Solids Contact

542-3145

"11"

Cation Exchange Softening

542-3146

"12"

Filters

542-3147

"13a"

Chemical Addition

542-3241

"13b"

Dry Chemical Addition

542-3130

"13c"

Gas Chlorination

542-3131

"13d"

Fluoridation

542-3132

"13e"

Sampling and Tests

542-3133

"14"

Pumping Station

542-3134

"15"

Process Water Storage Facilities

542-3135

"16a"

Wastewater, General

542-3136

"16b"

Waste Treatment Ponds

542-3137

"16c"

Filtration and Mechanical

542-3138

"16d"

Discharge to Sewer

542-3103

(2)Operation permit application forms.
a. Form 13-2 - application for a new water supply 542-1300
b. Form 13-3 - renewal application for an existing water supply 542-1301
(3)Water supply reporting forms. The monthly water supply operation report forms are available from the department's water supply operations section website. The laboratory analyses for compliance samples are reported via electronic means directly to the department by each certified laboratory.
(4)Laboratory certification application forms. Reserved.

Iowa Admin. Code r. 567-40.3

ARC 9915B, IAB 12/14/11, effective 1/18/12
Amended by IAB April 11, 2018/Volume XL, Number 21, effective 5/16/2018