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.