Iowa DNR's Twitter Iowa DNR's Flicker Iowa DNR's YouTube Iowa DNR's Pinterest Iowa DNR's Facebook | Iowa Outdoors Magazine | News | Contact Us

Site Search  search button

Public Drinking Water Program Forms

Public Drinking Water Program
Public Water Supply Operation
Anne Lynam, Environmental Specialist Senior
Telephone: 515-725-0280, anne.lynam@dnr.iowa.gov

 

IDNR Public Water Supply Report forms:
Listed below are the monthly operation report templates, sampling plan templates, and other forms and guidance documents used by public water supplies to report information to IDNR's Water Supply Operation Section and Environmental Field Offices.  Several of the forms and templates are based upon the population served in the system and the source water type: groundwater (GW), surface water (SW), or groundwater under the direct influence of surface water (also called influenced groundwater, or IGW). 

Monthly Operation Reports (MORs): Form # *.xls *.pdf
Large (>10,000 people served) surface water or influenced groundwater system monthly operation report form 542-8030 thru 34 Large SW/IGW monthly operation reporting form, 542-8030 in xls format Large SW/IGW monthly operation reporting form, 542-8030 in pdf format
Small (<10,000 people served) surface water or influenced groundwater system monthly operation report form 542-8100 thru 07 Small SW/IGW monthly operation report form, 542-8100 in xls format Small SW/IGW monthly operation report form, 542-8100 in pdf format
Consecutive surface water or influenced groundwater system monthly operation report form 542-8110 SW/IGW consecutive monthly operation report form, 542-8110 in xls format SW/IGW consecutive monthly operation report form, 542-8110 in pdf format
Membrane filtration monthly operation report form for SW/IGW systems  542-8109  SW/IGW membrane filtration monthly operation report form, 542-8109 in xls format  SW/IGW membrane filtration monthly operation report form, 542-8109 in pdf format
Groundwater system monthly operation report form 542-3104 GW monthly operation report form, 542-3104 in xls format GW monthly operation report form, 542-3104 in pdf format
Groundwater system monthly operation report form where system has been approved for 4-log virus inactivation under the Groundwater Rule  542-0038 

Groundwater Monthly Operation Report for 4-log, 5420038 in xls format

Groundwater Monthly Operation Report for 4-log, 5420038 in pdf format

Consecutive groundwater system monthly operation report form 542-8099 GW consecutive monthly operation report form, 542-8099 in xls format GW consecutive monthly operation report form, 542-8099 in pdf format


Sampling Plans: *.doc *.pdf
Lead and Copper sampling plan template from IRWA/IDNR IRWA/IDNR lead and copper sampling plan, in .doc format IRWA/IDNR lead and copper sampling plan, in pdf format
Stage 2 DBPR groundwater system serving 25-9,999 people monitoring plan DBPR GW 25-9,999 sampling plan, in .doc format DBPR GW 25-9,999 sampling plan, in .pdf format
Stage 2 DBPR groundwater system serving 10,000-99,999 people monitoring plan DBPR GW 10,000+ sampling plan, in .doc format DBPR GW 10,000+ sampling plan, in .pdf format
Stage 2 DBPR surface water or IGW system serving 25-499 people monitoring plan  DBPR SW/IGW 25-499 sampling plan, in .doc format DBPR SW/IGW 25-499 sampling plan, in .pdf format
Stage 2 DBPR surface water or IGW system serving 500-3,300 people monitoring plan  DBPR SW/IGW 500-3,300 sampling plan, in .doc format DBPR SW/IGW 500-3,300 sampling plan, in .pdf format
Stage 2 DBPR surface water or IGW system serving 3,301-9,999 people monitoring plan  DBPR SW/IGW 3,301-9,999 sampling plan, in .doc format DBPR SW/IGW 3,301-9,999 sampling plan, in .pdf format
Stage 2 DBPR surface water or IGW system serving 10,000-49,999 people monitoring plan  DBPR SW/IGW 10K-49,999 sampling plan, in .doc format DBPR SW/IGW 10K-49,999 sampling plan, in .pdf format
Stage 2 DBPR surface water or IGW system serving 50,000-249,999 people monitoring plan DBPR SW/IGW 50K-249,999 sampling plan, in .doc format DBPR SW/IGW 50K-249,999 sampling plan, in .pdf format
Stage 2 DBPR - Change of Sampling Site form DBPR change of sampling site form, in .doc format DBPR change of sampling site form, in .pdf format
Stage 2 DBPR - Operational Evaluation Level Insert for IDSE-SMP systems DBPR OEL insert page for IDSE-SMP systems, in .doc format DBPR OEL insert page for IDSE-SMP systems, in .pdf format
Stage 2 DBPR - Operational Evaluation Level Report Form DBPR OEL Report, in .doc format DBPR OEL Report, in .pdf format
TCR Bacteria Sampling Plan Template for system collecting one bacteria sample per month TCR bacterial sampling plan, in doc format TCR bacterial sampling plan, in pdf format
TCR Sampling Plan - Groundwater Rule Supplement TCR sampling plan GWR supplement, in doc format TCR sampling plan GWR supplement, in pdf format
TCR Sampling Plan - Groundwater Rule Supplement for Consecutive Systems TCR sampling plan GWR supplement for cc systems, in doc format TCR sampling plan GWR supplement for cc systems, in pdf format


Other Forms and Guidance: *.doc *.pdf
Groundwater Rule 4-Log Virus Inactivation Application 4-log application, in doc format 4-log application, in pdf format 
IDNR Groundwater Rule Quick Reference Guide    IDNR Ground water rule quick reference guide, in pdf format 
Lead Consumer Notice for Community Systems lead consumer notice for community, in doc format lead consumer notice for community, in pdf format 
Lead Consumer Notice for Nontransient Noncommunity Systems lead consumer notice for NTNC, in doc format lead consumer notice for NTNC, in pdf format
Lead and Copper Consumer Notice for Community Systems lead and copper consumer notice for community, in doc format lead and copper consumer notice for community, in pdf format
Lead and Copper Consumer Notice for Nontransient Noncommunity Systems lead and copper consumer notice for NTNC, in doc format lead and copper consumer notice for NTNC, in pdf format
Lead and Copper 90th Percentile Calculation Form lead and copper 90th form, in doc format lead and copper 90th form, in pdf format
Water well abandonment reporting form: Abandoned Water Well Plugging Record, Form# 542-1226 well plugging form, 542-1226 in doc format well plugging form, 542-1226 in pdf format

 



Consumer confidence report guidance and templates:
  • US EPA has designed software applications to help water suppliers create their consumer confidence reports; CCRWriter (off-site)
     
  • To obtain a copy of IAMU's template, contact Anne.Lynam@dnr.iowa.gov

 

Menu