Water Supply Permits

             Consecutive System Exemption Application:    PDF Document  78KB

Operating Permit Application for a Public Water System: MS WORD 103KB PDF Document 98KB

Water System Officials Contact Form: MS WORD 103KB   PDF Document 82KB

Public Water Supply Survey Form (Green Form): MS Word 160KB PDF Document 104KB

Public Notice Certification Form  MS Word 152KB PDF Document 76KB

Monthly Water System Operations Report for Filtered Water Systems:  MS Word 179KB PDF Document 164KB

Instructions for Monthly Water System Operations Report Form for Filtered Water Systems: MS Word 51 KB  PDF Document 37 KB

NEW Monthly Water System Operations Report for

Groundwater Systems:  MS Word 228KB PDF Document 129KB

U.S. EPA Information on Consumer Confidence Reports

Monitoring Waiver Application Form:  MS Word 52KB 3 pages   PDF Document 45KB 3 pages

Monitoring Waiver Renewal Application Form:  MS Word 36KB 2 pages   PDF Document 53KB 2 pages

Permit to Construct - This is a required permit for any existing public water system making improvements, major repairs or expansion to their water system. All proposed new water systems are also required to obtain this permit. If you have any questions, please contact the Water Supply Division, 241-3400.
Construction Permit Application Form: MS Word 111KB 1 page  PDF Document 101KB 1 page

NEW  Engineer’s Certification for Water Line Replacement and Extension Projects:  When an application for a construction permit is submitted, it has been the practice of the Water Supply Division for the engineering staff to conduct a detailed technical review. The Water Supply Division is now modifying that approach for certain types of low risk projects. At the option of the applicant and the applicant’s professional engineer, the engineer may include a statement (see below) with the application for the permit to construct if the application is for a permit that would only approve certain types of distribution system projects, such as line replacement and extensions that consist only of piping and valving. If the statement is included with the application, the Water Supply Division may waive a detailed technical review of the application; provided the Division has determined that a waiver is appropriate because of the simplicity of the engineering design.

“I hereby certify in the exercise of my reasonable professional judgment, the design-related information submitted with this application is true and correct, and the design included in this application for a permit complies with the Vermont Water Supply Rules.”

GWUDI Exemption - This application is required to qualify for a Groundwater Under the Direct Influence of Surface Water (GWUDI) exemption from performing a microscopic particulate analysis (MPA) test.  If you have any questions please contact Rodney Pingree, 241-3418

GWUDI Exemption Application: MS Word 152KB  PDF Document 132KB and Guidance Document: MS Word 89KB  PDF Document 80KB

Avoiding FIltration of Surface Water and GWUDI of Surface Water in Vermont  PDF

Water Quality Monitoring Requirements for Transient Non-Community Water Systems (TNCs) - TNCs must ensure that the system's drinking water quality is monitored according to federal and state requirements.  Monitoring is necessary to help demonstrate that the water provided to customers is safe to drink.  Monitoring requirements for TNCs can be divided into two general categories - testing for source permitting and routine monitoring.

Prior to constructing a new source or using an existing source to serve a TNC, the land owner must obtain a source and construction permit from the Water Supply Division (see source permit process #3) .  The system must test the source for specific contaminants.  Once the source is permitted and is used to serve water to customers, the system must conduct ongoing routine monitoring.  The link below is to a fact sheet that describes testing requirements for source permitting and routine monitoring.

Guidance Document: PDF Document 99KB 2 pages

General Operating Permit for Transient Non-Community Drinking Water Systems (TNCs) - Vermont statute requires all TNCs to have an operating permit.  The WSD recently issued a new the general operating permit for Class 1A and 1B TNCs using only groundwater sources.  If your system does not have an operating permit, please read the permit, and if the system meets the eligibility requirements, complete the notice of intent form and send it to our office.  There is no application fee, but you will be billed each year for the $45 annual permit fee.  Systems not eligible for the general permit must obtain an individual permit from the WSD.

General Operating Permit Language - PDF

Notice of Intent Form (Application) - PDF 

Notice of Termination - PDF

Source Permit Process

 

A) Public Water Source Permits

All Public Water Supply Systems require a source permit for any new source, deepening of an existing source or any increase in withdrawal of an existing source. 

Please find below the application form based on your water system type (Public Community, NTNC, TNC, or Interim Groundwater Withdrawal)

1. Source Permit - This application starts the review process for Public community and domestic bottled/bulk water supply sources.  If you have any questions please contact Rodney Pingree, 241-3418
Source Permit Application Form:
MS Word Form 152KB 4 pages  PDF Document 83KB 4 pages

2. Source Testing Review - This application initiates the review and approval process for studies and testing to be conducted on source(s) to serve Proposed or Existing Public Water Supplies.  The list of required chemicals to be tested for is included below.  If you have any questions please contact Rodney Pingree, 241-3418

Source Testing Review Application Form:

MS Word Form 141KB 3pages PDF Document 109KB 3pages

3. NTNC Source and Construction Permit -This application starts the review process for a non-transient, non-community public water supply source.  If you have any questions, please contact Rodney Pingree, 241-3418

NTNC Source and Construction Permit Application Form:

MS Word Form  226 KB    PDF Document  147 KB

4. TNC Source and Construction Permit - This application starts the review process for a transient, non-community public water system source.  If you have any questions please contact Rodney Pingree, 241-3418

TNC Source and Construction Permit Application Form:

MS Word Form  237 KB     PDF Document   153 KB

5. Certification of Water Source Likely Affected By Agricultural Lands - This form is to be completed and submitted by the source permit applicant for any new public water source if there are any agricultural lands in the area that may affect the proposed water source.  If you have any questions please contact Rodney Pingree, 241-3418

Certification of Water Source Likely Affected by Agricultural Lands Form:

PDF Document 1page

NEW  Well ID Sheets-For Use When Pump Testing a Well 

• Well ID Sheet-Production Well    MSWord
• Well ID Sheet-Observation Well   MSWord

Home Owner Letter:  Available for consultants when setting up source pumping test program PDF Document 1 page

B) Large Groundwater Withdrawal Permits

These Application forms initiate the permitting process for a non-potable water supply source, typically for industrial or commercial uses, where the withdrawal will be more than 57,600 gallons per day.  If the source will also be used for potable water use, then additional permits may also be required from the Department. Large Groundwater Withdrawal Permit Program Factsheet:   PDF   88 KB

Act 199: An Act Relating to a Groundwater Withdrawal Permit Program: MS Word Form 60 KB  PDF Document 38KB

Large Groundwater Withdrawal - This application starts the review process for the Large Groundwater withdrawal permit process.  If you have any questions please contact Rodney Pingree, 241-3418

Large Groundwater Withdrawal Permit Application Form:

Pending-Under Development

Source Testing Review for Large Groundwater Withdrawls - This application initiates the review and approval process for required studies and testing to be conducted on sources proposing to withdraw more than 57,600 gallons per day.  The list of required chemicals to be tested for is included below.  If you have any questions please contact Rodney Pingree, 241-3418

Source Testing Review for Large Groundwater Withdrawal Permit Application Form:

Pending-Under Development

REVISED Initial Source Water Quality Testing List - This table lists the water quality chemicals required for Public Community and Non-Transient Non-Community Water Supplies to be sampled to complete the source permitting process:

PDF Document 172KB 4 pages

REVISED Imported Bottled Water Operating Permit (Bottled water from sources located outside of Vermont) - If you have any questions, Please contact Dennis Nealon, 802-241-3411

Imported Bottled Water Operating Permit Application Form:  PDF Document 72KB 2 pages

Vermont Monthly Bacteriological Results for Bottled Water Facilities report - If you have any questions, please contact Dennis Nealon , 802-241-3411
Bacteriological Report Form:  MS Word 250KB 2 pages  PDF Document 145KB 2 pages

For more information, please also see the Source Water Protection Program page.

Water System Operator Certification:

Applicant's Statement Regarding Child Support & Taxes: 
MS Word 8KB 2 pages    PDF Document 23KB 2 pages

Water System Operator Certification Class (2,3,4, D& OIT) Application: 
MS Word 165KB  3 pages  PDF Document 87KB 3 pages
-Application includes address update section, child support, and tax statement form.  Please include, along with the application, a letter from the operator you are working under approving technicial knowledge at the water system and experience time at the water system (only if you are upgrading to a full certified operator).

Water System Operator Certification TNC Class 1A/1B Application: 
PDF Document 39KB 2 pages
- includes application form, instructions, child support and taxes statement form, and fee information

Renewal for Water System Operator Certification Class (2,3,4 & D) Application: 
PDF Document 95 KB   MS Word 139 KB
- Application includes address update section, child support, and tax statement form.  Please include, along with the application, any certificates of completion of completed credit hours for the renewal period.

For more information, please also see the Water System Operators page.

Well Driller License:

Well Drillers License Application & Instructions:  MS Word 102KB 9 pages PDF Document 84KB 9 pages
- includes application form, instructions, child support and taxes statement form, and 'qualifying individual agreement' information for first time water well drillers, monitoring well drillers or both

Well Drillers License Renewal Application:  MS Word 190KB 5 pages PDF Document 121KB 5 pages

For more information, please also see the Well Driller & Well Location Program page.