Permit, Certification
& License Application Forms & Information
Water
Supply Permits
NEW Tier 3 Public Notice Template: PDF Document 32KB
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 115KB
PDF
Document 103KB
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
Monthly
Water System Operations Report for Groundwater Systems:
MS Word
205KB PDF
Document 123KB
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
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
finalized 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 WordForm
Notice of Termination - PDF
Source
Permit Process
A) Public Water Source Permits
Public
Community and Non-Transient Non-Community (NTNC) Water Supply Systems require
a source permit for any new source, deepening of an existing source
or any change in use of an existing source. The permit process
has three steps and 2 applications, 1 and 2 below.
The
Source Permit Application for Transient Non-Community Water Supplies is located below in section 3.
1. Source Permit
- This application starts the review process for the Public Community
and Non-Transient Non-Community sources. If you have any questions
please contact Rodney Pingree,
241-3418
Source Permit Application Form:
MS Word Form 152KB 4pages
PDF Document 83KB
4pages
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. 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 Construction Permit Application Form:
PDF Document 6pages
4. 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
Home Owner Letter: Available for consultants when setting up souce pumping test program PDF Document 1 page
B) Interim 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 50,000 gallons or more per day. If the source will also be used for potable water use, then additional permits may also be required from the Department. Interim Groundwater Withdrawal Permit Program Factsheet
Interim Groundwater Withdrawal - This application starts the review process for the Interim Groundwater withdrawal permit process. If you have any questions please contact Rodney Pingree, 241-3418
Interim Groundwater Withdrawal Permit Application Form:
MS Word Form 138kb PDF Document 77kb
Source Testing Review - This application initiates the review and approval process for required studies and testing to be conducted on sources proposing to withdraw 50,000 gallons per day or greater. 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 Interim Groundwater Withdrawal Permit Application Form:
MS Word Form 135kb PDF Document 78kb
Initial
Source Water Quality Testing List - This table lists the water quality chemicals
required for Public Commuity, Non-Transient Non-Community Water Supplies and Interim Groundwater withdrawals
to be sampled to complete the source permitting process:
PDF Document
175KB 4 pages
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
- includes application form, instructions, child support and taxes
statement form, and fee information
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
- includes application form, instructions, child support and taxes
statement form, and approved education credit hours information
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 196KB 5 pages
PDF Document 130KB 5 pages
For more
information, please also see the Well Driller &
Well Location Program page.
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