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Ellsworth Sourcewater Protection Plan, Appendix B December, 2004 Page 29 of 63

Location of water bodies: N/A_______________________________________________________________________________

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Is site accessible in winter? ( ) Yes ( ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ N e a r e s t h y d r a n t t o w a t e r s o u r c e ? _ _ _ _ _ _ In spring? ( ) Yes ( ) No No feet _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Do you have an interconnection with another system? ( ) Yes ( x ) No

If yes, name of other PWS_______________________ L o c a t i o n o f i n t e r c o n n e c t _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

If needed; can a temporary interconnection be established with a near by system? ( ) Yes ( ) No

If yes, name of system and distance

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Note It is possible to use an alternate water body, in an emergency, as a source of water for fire protection and sanitary needs. Go to the emergency supply location with a fire pumper truck, drop in a hose, and pump it through the fire truck and into a hydrant. This will supply your system with pressure and water. NOTIFY THE DRINKING WATER PROGRAM!!!

Source of backup/emergency pump (e.g. rental agency, fire department, large contractors):

Name Address Telepho

ne

Ellsworth Fire Department Church St., Ellsworth, Maine (207) 667-8666

Name

EJ Prescott, Inc.

Address

Bangor, ME

Tel.

(207)_582-1851

Emer. Tel

(207) 990-5000

( x ) No

Do you have a formal (written) agreement with this backup pump supplier? (

) Yes

The source of repair materials for the system are (other utility or vendors):

Name

Maine Waterworks

Address

Oakland, ME

Tel.

(207) 465-2116

Emer. Tel.

-

-

_____ _____ __________

Do you have any emergency response plan if your source/system becomes contaminated?

(x) Yes

( ) No

If yes, where is the plan located: Treatment Plant Do you have a sample boil order notice prepared to notify customers about contamination of the water

system? (x) Yes

( ) No

If your billing system is down, can you handle bill payments manually? ( ) Yes

( ) No

MRWA Contingency Plan Template 4/03

Page 4

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