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Public Water Systems - Applications & Forms


Operations Permit Applications:

Consecutive System Exemption Application
Operating Permit Application

Certified Operator Application (Class 2, 3, 4 & D)
Statement regarding Child Support and VT Taxes
Certified Operator Renewal Application (Class 2, 3, 4 & D)

Phase II/V Monitoring Waiver Application
        Renewal Application

Construction Permit Application:
Construction Permit Application   UPDATED

Source Water Permit Application Process- Effective Immediately

Source Water Permit Applications:

Public Community Water System
Non-Transient Non-Community Water System
Transient Non-Community Water System

Domestic Bottled or Bulk Water System

Source Testing Review Application

Well ID Sheet-Production Well

Well ID Sheet-Observation Well

Avoidance of Filtration for Surface Water and GWUDI of Surface Water

Certification of Water Source Likely Affected by Agricultural Lands

GWUDI Exemption Application & Guidance ; Laboratories performing Microscopic Particulate Analysis (MPA) Testing

File Transfer Protocol (FTP) Instructions  NEW


Water System Officials Contact Form
Public Water Supply Survey Form
Public Notice Certification Form
Lead and Copper Sampling Plan
Lead and Copper Sampling Plan Guidance
Bulk Water Hauling as an Emergency Form and Guidance

Extended Period- Bulk Water Hauling as an Emergency Source (to submit weekly)

Monthly Operations Report for Filtered Surface Water Systems

Monthly Operations Report Instructions for Filtered Surface Water Reporting

Monthly Operations Report for Groundwater and Systems Purchasing Groundwater PDF UPDATED       MSWord Version  UPDATED 

RTCR Forms & Examples

Revised Total Coliform Rule (RTCR) Introductory Fact Sheet  NEW

RTCR Coliform Sampling Plan & Guidance 1,000 or Under Population UPDATED  (formerly called bacteriological sampling plan)
RCTR Coliform Sampling Plan & Guidance Greater than 1,000 Population UPDATED  (formerly called bacteriological sampling plan)

INSTRUCTIONAL VIDEO: RTCR Sampling Plan Form Training   NEW

Completed Examples:

PCWS - Greater than 1,000 Population

PCWS - 1,000 or Less Population

NTNC - School

TNC - Campground

TNC - Motel

TNC - Restaurant

Groundwater Seasonal Start-Up Form  NEW

Surface Water Seasonal Start-Up Form  NEW

Voluntary Coliform Response Assessment Form

Completed Examples:

Class 1A

Class 2

Class 3

Boil Water Public Notice Forms

Issuing and Rescinding a Boil Water Notice
Boil Water Notice Template for general use  UPDATED
Boil Water Notice Acute (E. coli) MCL template and Instructions  UPDATED
Boil Water Notice Non- Acute MCL Template and Instructions

Non-Boil Water Public Notice Forms

MCL Violation Non-Boil Template and Instructions UPDATED
Corrective Action Guidance
Tier 3 Public Notice Form UPDATED & Guidance 


Ultraviolet Disinfection Guidelines  (For NTNC & TNC systems)

O&M Manual


Guidance for Template




drinkingwater.vermont.gov   groundwater.vermont.gov   septic.vermont.gov wastewater.vermont.gov
VT DEC Drinking Water and Groundwater Protection Division 1 National Life Drive, Main Building, 2nd Floor  Montpelier, VT  05620-3521
Telephone toll-free in VT: 800-823-6500 or call 802-241-3400    Fax: 802-828-1541


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