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SURFACE WATER SOURCES

16.

What are impacts to the source water?

□ Industrial

□ Agricultural

□ Forest

□ Residential

□ Other __________________________

17.

Are pre-treatment measures necessary? □ Yes     □ No     □ Not Sure

18.

Has pre-treatment process been approved by Kentucky Division of Water?  

□ Yes     □ No     □ Not Sure

19.

Are intake structures and screens inspected at regular intervals?

□ Yes     □ No     □ Not Sure

20.

Are multiple intake levels being utilized to enhance raw water quality?

□ Yes     □ No     □ Not Sure

21.

What conditions cause changes to water quality? __________________________

_________________________________

_________________________________

22.

Is lightning protection provided?

□ Yes     □ No   □ Not Sure

23.

Do you have on file approved plans, specifications, and maps for the water system, including any expansions or modificaitons?

□ Yes     □ No    □ Not Sure

24.

Is backup power provided for emergency situations such as flood, ice storm, tornado, etc.?

□ Yes     □ No    □ Not Sure

25.

Do chemicals and lubricants meet the standards of the American National Standards Institute (ANSI) and the National Sanitation Foundation (NSF)?

□ Yes     □ No    □ Not Sure

26.

Are the facilities adequately secured?

□ Yes     □ No    □ Not Sure

27. Is the site subject to flooding?

□ Yes     □ No    □ Not Sure

28.

Is the emergency spill response plan adequate?

□ Yes     □ No    □ Not Sure

29. Have all local, state, and federal agencies been informed of the emergency response plan provisions?

□ Yes     □ No    □ Not Sure

30.

Does your county have an approved water supply plan?

□ Yes     □ No    □ Not Sure

31.

Date of last sanitary survey? _________

□ Not Sure

Comments: __________________________

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