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Drinking Water Programs

Forms and Information

The Northeast District has created this page to provide a centralized location for frequently used forms, rules and guidance documents. Additional information may be found at the Department's Water Resource Management website.  If you have any additional questions a Northeast District Drinking Water Inspector will be glad to assist you.



Bacteriological Information
1 Monthly Sample Plan PDF Word
2 Quarterly Sample Plan PDF Word
3 Precautionary Boil Water Notice Guidelines PDF
Website
 
4 Precautionary Boil Water Notice Model Word
5 Precautionary Boil Water Notice Rescission Model   Word
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Capacity Analysis Report

1 Capacity Analysis Report Guideline PDF  
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Capacity Development

1 New Water System Capacity Development Manual PDF
Website
 
2 Capacity Development Plan - 62-555.900(20) PDF Word
3 Alternate Capacity Development Plan – 62-555.900(2) PDF Word
4 Capacity Development Worksheet PDF Word
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Chemical Information

1 Asbestos-Free Certification or Asbestos Sampling Plan for Drinking Water Systems - 62-555.900(10) PDF Word
2 Certified Laboratories Website  
3 Drinking Water Maximum Contaminant Levels List PDF Excel
4 Synthetic Organic Contaminants Waiver - 62-560.545(2) PDF Word
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Consumer Confidence Reports

1 Consumer Confidence Report Template Website  
2 Certification of Delivery of Consumer Confidence Report - 62-555.900(19) PDF Word
3 Certification of Delivery of Consumer Confidence Report Information to Supplied Systems - 62-555.900(21) PDF Word
4 Consumer Confidence Report Rule - 40 CFR 141, Subpart O Website  
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Cross Connection Control

1 Plan Samples PDF Word
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Disinfection Byproducts

1 Disinfectant Residual Report Format PDF Word
2 Disinfection Byproducts Report Format (Large Systems) PDF Word
3 Stage 1 D/DBPR Monitoring Plan Example PDF Word
4 Stage 2 D/DBPR Monitoring Plan Format PDF Word
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Ground Water Rule
1 Bact GWR Triggered and Rep Guidance Manual PDF  
2 Four-Log Virus Treatment Guidelines PDF  
3 Cover Sheets for Demonstration of Four-Log Virus Treatment of Ground Water Guidelines PDF Word
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Lab Reporting Forms

1 Bacteriological Lab Reporting Forms PDF Word
2 Chemical Lab Reporting Forms PDF Word
3 Chemical Lab Reporting Forms (cover sheet only) PDF Word
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Lead and Copper

1 Sampling Plan for Lead and Copper Tap Samples and WQPs - 62-555.900(12) PDF Word
2 Lead and Copper Rule 40 CFR 141, Subpart I Website  
3 Lead and Copper Tap Sample Analysis and Result Ranking 62-550.730(4)(a) PDF Word
4 Water Quality Parameters Reporting Format - 62-550.730(4)(c) PDF Word
5 Lead Public Education Program Report 62-555.900(17) PDF Word
6 Certification of Notification of Lead and Copper Tap Sample Results 62-555.900(16) PDF Word
7 Community Water System Lead Public Education   Word
8 Non-transient non-community water system
Lead Public Education
Word
9 Community Water System Lead Consumer Notice -
Sampling Site above AL, 90th above AL
  Word
10 Community Water System Lead Consumer Notice -
Sampling Site above AL, 90th below AL
  Word
11 Community Water System Lead Consumer Notice -
Sampling Site below AL, 90th above AL
  Word
12 Community Water System Lead Consumer Notice -
Sampling Site below AL, 90th below AL
  Word
13 Non-transient non-community Water System Lead Consumer
Notice 90th above AL
  Word
14 Non-transient non-community Water system Lead Consumer
Notice 90th below AL
  Word
15 Non-transient non-community Water System Lead Consumer
Notice - Sampling Site above AL, 90th below AL
  Word
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Monthly Operation Reports

1 Consecutive Systems (no treatment) - 62-555.900(4) PDF Word
2 Consecutive from a Subpart H - 62-555.900(6) PDF Word
3 Flouridation - 62-555.900(5) PDF Word
4 Raw Ground Water or Purchased Finished Water - 62-555.900(3) Word
Excel
5 Subpart H - 62-555.900(2)   Excel
6 Summation for Multiple Plants - 62-555.900(11) PDF Word
7 Four Log MOR with coversheet   Excel
8 MOR Turbidity   Word
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Operation and Maintenance

1 Operation and Maintenance Manual Guidance PDF Word
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Permit Forms

1 Application to Construct Drinking Water System Components -
62-555.900(1)
PDF Word
2 Application for Transfer of a Drinking Water System Construction Permit - 62-555.900(8) PDF Word
3 Certification of Construction Completion Form - 62-555.900(9) PDF Word
4 General Permit for Corrosion Control, or Sequestration -
62-555.900(18)
PDF Word
5 General Permit for Water Main Extensions for Drinking Water Systems - 62-555.900(7) PDF Word
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Public Notifications
1 Public Notification Certificate of Delivery PDF Word
2 Public Notification Handbook PDF  
3 Public Notification Rule 40 CFR 141, Subpart Q Website  
4 Standard Health Effects Language for Public Notification 40CFR141 Subpart Q, App.B PDF  
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Rules

1 62-4: Permits PDF  
2 62-521: Wellhead Protection PDF  
3 62-532: Water Well Permitting and Construction Requirements PDF  
4 62-550: Drinking Water Standards, Monitoring, and Reporting PDF  
5 62-555: Permitting and Construction of Public Water Systems PDF  
6 62-560: Requirements for Public Water Systems that are Out of Compliance PDF  
7 62-602: Drinking Water and Domestic Wastewater Treatment Plant Operators PDF  
8 62-699: Treatment Plant Classification and Staffing Website  
9 Lead and Copper Rule 40 CFR 141, Subpart I Website  
10 Consumer Confidence Report Rule - 40 CFR 141, Subpart O Website  
11 Public Notification Rule 40 CFR 141, Subpart Q Website  
12 Standard Health Effects Language for Public Notification 40CFR141 Subpart Q, App.B PDF  
13 FS403 Part VI: Drinking Water Website  
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Systems Information / Requirements
1 Public Drinking Water System (PWS) Update Form   Word
2 Community Water System Minimum Requirements PDF Word
3 Non-Transient Non-Community Minimum Requirements PDF Word
4 Transient Non-Community Minimum Requirements PDF Word
5 Inspection Response Form   Word
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 Test Kit and Equipment Suppliers

Non-endorsement note:
The following is a partial list of companies that provide test kits and equipment for drinking water. DEP does not endorse any of the companies listed below, and a company’s absence from this list does not imply prejudice.
Test Kits Equipment

 

 

     Request DEP Compliance Assistance

 

 

 

 

Water Resource Program Highlights


Last updated: November 12, 2013
  FDEP - Northeast District - Contact

8800 Baymeadows Way West, Suite 100, Jacksonville, Florida 32256   904-256-1700 (phone) / 904-256-1588 (fax)
NED Contacts

For critical after hours emergencies call the State Warning Point Number:  1-800-320-0519 

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