FS-2700-4h, Append Special Use Permit for Campground and Related Granger-Th

Authorization ID: #AUTH_ID#
Contact ID: #HOLDER_ID#
Use Code: #USE_CODE#
Expiration Date: #EXPIRATION_DATE#

FS-2700-4h, App. G (XX/202X)
OMB No. 0596-0082

U.S. DEPARTMENT OF AGRICULTURE
FOREST SERVICE
SPECIAL USE PERMIT FOR
CAMPGROUND AND RELATED GRANGER-THYE CONCESSIONS
APPENDIX G
OPERATION OF FEDERALLY OWNED DRINKING WATER SYSTEMS
Authority: Section 7 of the Granger-Thye Act, 16 U.S.C. 580d
I. INTRODUCTION
The requirements set forth in this Appendix pertain to holders of Forest Service special use permits that authorize
the holder to operate federally owned drinking water systems. This includes special use permits authorized under
Section 7 of the Granger-Thye Act, 16 U.S.C. 580d.
The requirements set forth below are derived from Forest Service Manual (FSM) 7420, which describes the
Forest Service Drinking Water Program. The objective of the Forest Service Drinking Water Program is to protect
human health by ensuring that Forest Service drinking water systems are properly operated, maintained, and
monitored and deficiencies promptly corrected. Where this objective and applicable standards as described
herein cannot be met, the Forest Service policy is to make such waters unavailable for human consumption.
"Human consumption" includes the use of water for drinking, food preparation, dishwashing, oral hygiene, or
bathing/showering.
When a permit holder operates federally owned water systems, both the Forest Service and the permit holder are
considered suppliers of the water. Therefore, permit holders authorized to operate federally owned water
systems must operate and maintain the systems to meet the objective and policy of the Forest Service Drinking
Water Program. Failure to operate these drinking water systems accordingly may result in revocation of the
permit.
In addition to fulfilling the requirements set forth below, permit holders operating federally owned water systems
must comply with all applicable federal, State, interstate, and local requirements applicable to drinking water
systems, and must follow the Operations and Maintenance (O&M) Plan developed in conjunction with the Forest
Service to address the specific system(s).
Nothing in this Appendix should be interpreted as diminishing any obligation imposed by federal, State, interstate,
or local authority.
II. APPLICABLE DEFINITIONS
A. Average Daily Population (ADP). For classification and inventory purposes, the ADP is the sum of the daily
transient and daily resident population served or having access to the drinking water system, per month, divided
by the days of the month. Where actual or sample counts are not available at recreation sites, determine ADP by
multiplying Persons-At-One-Time (PAOT) by the percentage of site use where PAOT equals five people per site.
B. Certified Operator. Qualified personnel certified by the primacy agency to operate public drinking water
systems.
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C. Condition Survey. An onsite survey of the water source, facilities, and equipment as defined in the
operations and maintenance plan for the system. Condition surveys are an integral part of the sanitary surveys.
They may be combined with the sanitary surveys or serve as a supplement and addendum to the sanitary survey.
Condition surveys are also performed to collect and document current condition and maintenance tasks for a
water system. Condition surveys are conducted by qualified personnel and documented in a brief report.
D. Consecutive Water System. A water system that buys or otherwise receives some or all of their finished
water from another public water system on a regular basis. Consecutive water systems are regulated as separate
drinking water systems if they meet the definition of a public water system under the National Primary Drinking
Water Regulations (NPDWR).
E. Drinking Water System. A public or a non-public water system for providing water suitable for human
consumption via pipes or constructed conveyances, including handpump systems).
F. E. Coli Mcl Violation. A violation that occurs when a water system has:
1. An E. coli-positive routine sample followed by a total coliform-positive repeat sample; or
2. Any E. coli-positive repeat sample; or
3. A failure to collect all required repeat samples following an E. coli-positive routine sample; or
4. A failure to test for E. coli in a total coliform-positive repeat sample.
G. Groundwater Under The Direct Influence Of Surface Water (GWUDI). Any water beneath the surface of
the ground with significant occurrence of organisms or significant and relatively rapid shifts in water
characteristics which closely correlate to climatological or surface water conditions. Direct influence is determined
by the primacy agency for individual sources in accordance with criteria established by the primacy agency.
H. Human Consumption. Use of water for drinking, food preparation, dishwashing, oral hygiene, or
bathing/showering.
I. Level 1 Assessment. An evaluation of a public water system to identify the possible presence of sanitary
defects, defects in distribution system coliform monitoring practices, and (when possible) the likely reason that the
system triggered the assessment. It is conducted by the system operator or owner in accordance with primacy
agency requirements.
J. Level 1 Assessment Trigger. An event that necessitates conducting a Level 1 Assessment. A Level 1
Assessment must be performed when:
1. Any public water system collecting fewer than 40 samples per month has greater than 1 routine/repeat sample
per month which is total coliform-positive; or
2. Any public water system collecting at least 40 samples per month has greater than 5.0 percent of the
routine/repeat samples in a month total coliform-positive; or
3. Any public water system fails to take every required repeat sample after each total-coliform routine sample.
For non-public systems, the above events trigger a condition survey.
K. Level 2 Assessment. An evaluation of a public water system to identify the possible presence of sanitary
defects, defects in distribution system coliform monitoring practices, and (when possible) the likely reason that the
system triggered the assessment. A Level 2 Assessment provides a more detailed examination of the system
(including the system's monitoring and operational practices) than does a Level 1 Assessment through the use of
more comprehensive investigation and review of available information, additional internal and external resources,
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and other relevant practices. It is conducted by an individual approved by the primacy agency in accordance with
primacy agency requirements.
L. Level 2 Assessment Trigger. An event that necessitates conducting a Level 2 Assessment. A Level 2
Assessment must be performed when:
1. Any public water system has an E. coli MCL violation.
2. Any public water system triggers a second Level 1 Assessment within a rolling 12-month period.
For non-public systems, the above events trigger a condition survey.
M. Maximum Contaminant Level (MCL). The maximum amount of a contaminant allowed in water provided to
any user of a public water system.
N. Maximum Residual Disinfectant Level (MRDL). The level of a disinfectant added for water treatment that
may not be exceeded at the consumer's tap without an unacceptable possibility of adverse health effects.
O. Non-Public Water System. A water system which provides drinking water but does not meet the definition
of a public water system as defined by the SDWA. Non-public water systems areclassified as one of the
following:
1. Non-Public,Non-Transient (NPNT) Water System. A non-public water system serving less than 25 year-round
residents or serving less than 25 of the same persons (ADP) more than 180 days per year (for example, smaller
Forest Service ranger stations or housing sites).
2. Non-Public Transient (NPT) Water System. A non-public water system serving less than 25 persons (ADP)
and not meeting the definition of NPNT water system (for example, smaller recreation sites, seasonal guard
stations, or work centers with short-term, seasonal employees).
P. Other Water System (O). A distribution system (consisting of a water meter and distribution system)
connected to a public water system (for example, connection of a Forest Service facility to a municipal water
supply), that is not considered a Consecutive Water System.
Q. Primacy Agency. The agency that has been delegated primary responsibility by the U.S. Environmental
Protection Agency for the administration and enforcement of primary drinking water regulations and related
requirements that are applicable to public water systems within a State.
R. Public Water System. As defined under the SDWA, a public water system is a system for the provision to
the public of water for human consumption through pipes or other constructed conveyances, if such system has at
least 15 service connections or regularly serves at least 25 individuals. Such term includes (i) any collection,
treatment, storage and distribution facilities under control of the operator of such system and used primarily in
connection with such system, and (ii) any collection or pretreatment storage facilities not under such control which
are used primarily in connection with such system. Public water systems are classified as one of the following:
1. Community (C) Water System. A public water system that:
(a) Serves at least 15 service connections used by year-round residents; or
(b) Regularly serves at least 25 year-round residents.
2. Non-Community Water System. A public water system that does not meet the definition of a community water
system and can be one of the following:
(a) Non-Transient Non-Community (NTNC) Water System. A public water system that is not a community water
system and that regularly serves at least 25 of the same persons over 6 months per year.
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(b) Transient Non-Community (TNC) Water System. A public water system that is not a community water system
and does not regularly serve at least 25 of the same persons over 6 months per year.
S. Qualified Person/Personnel. Person possessing appropriate training, experience, qualifications, and
certifications/licenses to perform specific technical functions with respect to the design, construction, assessment,
and operation; or monitoring and maintenance of drinking water systems.
T. Repeat Samples. A set of coliform samples taken when a previous sample is positive for total coliform .
Repeat samples must be collected within 24 hours of being notified of a positive result.
U. Routine Sample. A coliform sample that is representative of the water throughout the distribution system,
when the system is operational, and is used to determine the microbial quality of the water.
V. Sanitary Survey. An onsite review of the water source, facilities, equipment, operation and maintenance,
and overall management of a drinking water system to evaluate compliance with laws and requlations and to
evaluate the adequacy with respect to producing and distributing safe drinking water. Sanitary surveys must be
conducted no less frequently than every three years for community water systems and every five years for noncommunity and non-public water systems.
W. Service Connection. Piped connection for conveyance of drinking water from the distribution system to the
user. Examples of service connections include: an individual building (for example, residence, crew quarters,
office, or mobile home), drinkng fountains in campgrounds provided for public use, an individual campground
hydrant, a handpump on a well, and a building with toilet and wash basin or shower.
X. Special Sample. A coliform sample collected for purposes other than routine compliance monitoring (for
example, investigative samples or pre-opening/pre-season samples on seasonal systems). Special samples
must be marked as such when sent in to the laboratory for analysis. Special samples do not count in determining
assessment triggers or MCL violations, or in meeting the monthly sampling requirements.
Y. Total Coliform (TC) Sample. Group of bacteria used as an indicator of the potential fecal contamination of
drinking water. Although total coliforms are usually not pathogenic themselves, their presence in drinking water
indicates that fecal pathogens may also be present.
Z. Water System Operator. Any individual who has direct responsibility for or operates a drinking water system
or such parts of the system as would affect the quality and/or quantity of drinking water provided to consumers.
III. REQUIREMENTS FOR OPERATING FEDERALLY OWNED DRINKING WATER SYSTEMS
A. Compliance With Applicable Standards. All federally owned public water systems must be operated in
compliance with the most stringent of the following requirements:
1. The Safe Drinking Water Act, as amended (42 U.S.C. 300f et seq.);
2. The primacy agency;
3. FSM 7420 and applicable supplements; and
4. This permit.
Requirements of the Safe Drinking Water Act are further delineated in regulations, including but not limited to the
National Primary Drinking Water Regulations (NPDWR) (42 CFR Part 141) and National Secondary Drinking
Water Regulations (NSDWR) (42 CFR Part 143).
All federally owned non-public water systems must be operated in compliance with FSM 7420 and applicable
supplements, and this permit. Non-public water systems must comply with the current MCLs applicable to the
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respective public water system class identified in Exhibit 01. Contaminant monitoring for non-public systems may
be less frequent than a public water system of respective class, if permitted by the Forest Service.
Exhibit 01
Respective Public Water System Classes for Operation
of Forest Service Non-Public Water Systems
Non-Public Forest Service Class
Non-Public Transient (NPT)
Non-Public Non-Transient (NPNT)
Other (O) (municipal service connection)

Respective Public System Class
Transient Non-Community (TNC)
Non-Transient Non-Community (NTNC)
Not applicable

B. Classification. Determination of drinking water system classification (C, TNC, NTNC, NPT, NPNT) shall be
made by the regulatory authorities and the Forest Service.
C. Qualified Personnel. The permit holder shall provide qualified personnel to operate, maintain, assess, and
monitor each water system. If required by the primacy agency or Forest Service, water system operators and
sampling technicians shall be primacy agency-certified. Each water system shall have a primary and backup
water system operator. The permit holder shall provide the name of the primary and backup water system
operator for each separate water system within the scope of this permit in writing to the Forest Service, and notify
the authorized officer within 72 hours of a change in personnel. Operation, maintenance, assessment, and
monitoring tasks shall be performed by the primary or backup water system operator, or, if permitted by the
primacy agency and Forest Service, by qualified personnel working under the direct supervision of the primary or
backup water system operator.
D. Sanitary Surveys. Unless otherwise specified, sanitary surveys will be conducted by a primacy agencyapproved agent for public water systems, and by the Forest Service for non-public water systems. The Forest
Service may elect to attend sanitary surveys conducted by other agents. Where advance notice is provided by
the primacy agency-approved agent, the permit holder shall coordinate the schedule with the Forest Service.
The permit holder shall assist the primacy agency and/or Forest Service in the conduct of sanitary surveys by
locating components at the site, operating valves and equipment, and providing a copy of the water system
records if requested. Sanitary surveys may be conducted more frequently than the minimum required by
regulation or policy, at the discretion of the primacy agency or the Forest Service. The permit holder shall
coordinate with the Forest Service to ensure correction of identified deficiencies, and reporting of corrections to
the primacy agency.
E. Level 1 and Level 2 Assessments and Condition Surveys. The permit holder shall notify the Forest
Service in writing prior to conducting Level 1 and Level 2 Assessments and condition surveys. The Forest
Service may elect to attend. The permit holder shall coordinate with the Forest Service to ensure correction of
identified deficiencies.
1. Level 1 and Level 2 Assessments. Qualified personnel shall conduct Level 1 and Level 2 Assessments on
public water systems in response to specific coliform test results, E. coli test results, or failure to sample, as per
the definitions of Level 1 Assessment Trigger and Level 2 Assessment Trigger. Unless otherwise directed, the
permit holder shall be responsible for ensuring the completion of all assessments. Unless otherwise directed or
required by the primacy agency, the permit holder shall be responsible for conducting Level 1 Assessments, and
for ensuring the completion of Level 2 Assessments by coordinating with the primacy agency and the Forest
Service.
2. Condition Surveys (Operational/Other). Unless otherwise directed, the permit holder shall be responsible for
conducting these condition surveys. Qualified personnel shall conduct condition surveys whenever:
(a) A non-public system has specific coliform test results, E. coli test results, or failure to sample, that would
require a Level 1 or Level 2 Assessment for a public system, or
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(b) A closed seasonal system is opened for service, or
(c) There is a significant change in conditions that may have affected the system operation and or water quality
(for example, severe storm, earthquake, or flood event), or
(d) Prior to renewal of any special use permit involving Forest Service-owned drinking water systems.
3. Condition Surveys (Maintenance). Qualified Forest Service personnel will conduct condition surveys for
maintenance of Forest Service-owned drinking water systems, on an interval not to exceed five years. The permit
holder shall assist the Forest Service in the conduct of maintenance condition surveys by locating components at
the site, operating valves and equipment, and providing a copy of the water system records if requested.
F. Physical Protection
1. Design and Construction. The permit holder shall not make any design or construction modifications to the
system without advance authorization from the Forest Service and primacy agency.
2. Operations and Maintenance (O&M). If an O&M Plan has not been provided by the Forest Service, prepare
one for Forest Service approval. Review and modify the O&M Plan whenever operational or physical changes
are proposed, and submit proposed revisions for Forest Service approval. At a minimum, review the O&M Plan
annually and submit proposed revisions for Forest Service approval with the Annual Operating Plan.
Follow the procedures established in the O&M plans. Make no unauthorized changes that would compromise the
objectives stated in this Appendix. Obtain approval from the Forest Service prior to opening seasonal systems
each year. For seasonal systems that are public, also demonstrate compliance with primacy agency-approved
startup procedures prior to opening the system each year. Perform maintenance to ensure continued protection
of the water source and water system. When a closed system at a publicly-accessible site is being superchlorinated and/or flushed, or is being sampled prior to system opening/re-opening, deter public access to the
system via signs, barricades, and/or other measures.
3. Cross Connection Control and Backflow Prevention. Maintain cross connection control and backflow
prevention practices and devices in accordance with the Forest cross connection control and backflow prevention
plan, primacy agency regulations, and OSHA regulations at 29 CFR 1910.141(b)(2)(ii). Properly use and
maintain these devices and incorporate annual testing into the system’s cross connection control program and
O&M Manual. Maintain testing records in the water system file, and document test completion in the annual preopening condition survey.
4. Security. Maintain physical security (fences, enclosures, and locks) as necessary and practicable to deter
unauthorized access. If vandalism or intentional harm to the water system and its components (wells, springs,
treatment systems, storage tanks, and so forth) is suspected, notify law enforcement officers immediately and
consult with the Forest Service for further guidance.
G. Treatment. Public water systems must provide treatment as required by the primacy agency or Forest
Service. Non-public water systems must provide treatment as required by the Forest Service, to meet objectives
stated in this Appendix. The permit holder shall not make substantial treatment modifications without advance
authorization from the Forest Service (and primacy agency, if applicable). The permit holder shall notify, in
writing, the Forest Service (and primacy agency, if applicable) in the event of any treatment system malfunction.
H. Monitoring and Follow-up Actions. Conduct monitoring and perform follow-up actions in accordance with
this Appendix. Meet additional requirements if imposed by the primacy agency. Ensure that sample analyses are
conducted at a primacy agency-certified laboratory, and that samples are collected and handled in accordance
with laboratory requirements. Maintain and submit monitoring records in accordance with this Appendix. For
public systems, submit results to the Forest Service and primacy agency as required by regulation. For nonpublic systems, submit results to the Forest Service only. The laboratory selection, and the manner in which the
laboratory notifies the permit holder of violations, are subject to approval by the Forest Service. The permit holder
shall ensure that the laboratory reports results immediately if a test result is positive for E. coli or total coliform.
The permit holder shall also ensure that the laboratory directly notifies the Forest Service authorized officer of
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violations. If requested by the Forest Service, the permit holder shall have the laboratory send an electronic copy
of all results to the Forest Service at the same time results are sent to the permit holder. The permit holder is
responsible for providing the name and address of the authorized officer to ensure this notification and associated
sample results are sent by the laboratory to the Forest Service. The permit holder shall submit a drinking water
monitoring plan with the annual operating plan, for approval by the Forest Service. The plan must include the
contaminant list and schedule, proposed laboratory, and contacts list (permit holder, operators, and Forest
Service representative to be contacted by the laboratory). The plan must also include a sample siting plan for
coliform samples that addresses frequency and location, as described below. Each hand pump is considered as
a separate water system. Unless otherwise directed, microbiological samples must be taken in the first ten days
of the month. The permit holder shall notify and consult with the Forest Service within 24 hours after notification
by the laboratory of a sample that tests positive for microbiological contamination, a trigger of a Level 1 or Level 2
assessment or condition survey, or any violation of applicable standards.
1. Microbiological (Coliform) Monitoring
Public Water System
(a) Routine Coliform Samples. Follow NPDWR or primacy agency regulations. Unless otherwise directed by the
Forest Service, for seasonal systems, collect at least one sample for each full or partial calendar month the
system operates, even if the primacy agency allows less frequent sampling. Prepare a sample siting plan that
addresses frequency and location to ensure sampling is representative of water throughout the distribution
system. The sample siting plan must include routine and repeat sample sites in the distribution system to ensure
compliance with the Revised Total Coliform Rule. Additionally, for systems that use groundwater, the sample
siting plan must include a repeat sample site at each groundwater source to meet requirements of the
Groundwater Rule.
(b) Repeat Coliform Samples. Collect samples as required by the NPDWR or primacy agency regulations.
(c) Special Samples. Collect samples as required by the NPDWR or primacy agency regulations. Seasonal
systems may not be opened for public use until after the special samples show the systems are free from coliform
bacteria.
Non-Public Water System
(a) Routine Coliform Samples. Collect samples from non-public (NPT and NPNT) water systems at a minimum
frequency of one sample/calendar quarter for systems that are continuously operated. For seasonal systems,
collect one sample for each full or partial calendar month that the system operates. Prepare a sample siting plan
that addresses frequency and location to ensure sampling is representative of water throughout the distribution
system. The sample siting plan must include routine and repeat sample sites in the distribution system.
Additionally, for systems that use groundwater, the sample siting plan must include a repeat sample site at each
groundwater source.
(b) Repeat Coliform Samples. Within 24 hours of notification of a positive routine sample, collect one repeat
sample for each positive routine sample.
(c) Special Samples. Collect one special sample before opening any seasonal water system for use. Seasonal
systems may not be opened for public use until after the special samples show the systems are free from coliform
bacteria.
2. Microbiological Follow-up Actions. Follow up actions are based on what triggers and/or violations have
occurred.
(a) Level 1 Assessment Trigger
Public Water System
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(1) Notify the Forest Service, conduct a Level 1 Assessment, and conduct corrective actions as soon as
practicable, and coordinate with the Forest Service to submit the completed assessment form to the primacy
agency within 30 days after learning of the trigger. In the completed form, describe sanitary defects detected,
corrective actions completed, and a proposed timetable for any corrective actions not already completed.
(2) Unless otherwise directed by the primacy agency or Forest Service, after performing corrective actions, take
daily special samples until two consecutive special samples are negative for coliform. If one special sample is TC
positive, consult with the primacy agency and Forest Service on whether to implement precautionary measures
such as system closure or a boil water advisory. The Forest Service may require more conservative measures
than the primacy agency.
(3) Follow primacy agency and Forest Service directions for follow-up.
Non-Public Water System
(1) Notify the Forest Service, conduct a condition survey, and conduct corrective actions as soon as practicable,
and document the survey and actions within 30 days after learning of the trigger. In the documentation, describe
sanitary defects detected, corrective actions completed, and a proposed timetable for any corrective actions not
already completed.
(2) Unless otherwise directed by the Forest Service, after performing corrective actions, take daily special
samples until two consecutive special samples are negative for coliform. If one special sample is TC positive,
consult with the Forest Service on whether to implement precautionary measures such as system closure or a boil
water advisory.
(3) Follow Forest Service directions for follow-up.
(b) Level 2 Assessment Trigger
Public Water System (Trigger: E. coli MCL violation or second Level 1 Assessment trigger within a rolling 12month period).
(1) (For all Level 2 Assessment Triggers) Notify the Forest Service. If the trigger is caused by an E. coli MCL
violation, also notify the primacy agency, in accordance with NPDWR or primacy agency regulations. Follow
primacy agency and Forest Service direction.
(2) (For E. coli MCL violation) Close the system. (The toilet supply may be left open if all points of human
consumption, including showers, sinks, and publicly accessible hose bibs, can be isolated and shut off.)
(3) (For E. coli MCL violation) Notify the public and water users, in coordination with the Forest Service, in
accordance with NPDWR or primary agency regulations.
(4) (For E. coli MCL violation) Coordinate with the Forest Service to notify the State after completion of public
notice (with a copy of the public notice posted/delivered, and dates when the notice was posted and removed).
(5) (For all Level 2 Assessment Triggers) Coordinate with the Forest Service. Ensure that a Level 2 Assessment
is completed by the primacy agency or by a party approved by the primacy agency as soon as practicable, and
submit the completed assessment form to the primacy agency within 30 days after learning of the trigger. The
completed form must describe sanitary defects detected, corrective actions completed, and a proposed timetable
for any corrective actions not already completed.
(6) (For E. coli MCL violation) After performing corrective actions, take daily special samples. A closure order
may be lifted only after the problem has been corrected and two consecutive daily special samples are TC
negative.
Non-Public Water System (Trigger: E. coli MCL violation)
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(1) Notify the Forest Service of the violation and follow Forest Service direction.
(2) Close the system. (The toilet supply may be left open if all points of human consumption, including showers,
sinks, and publicly accessible hose bibs, can be isolated and shut off.)
(3) Coordinate with the Forest Service to notify the water users about the violation within 24 hours and in
accordance with the primacy agency requirements and guidance. Content of public notice for non-public systems
may be customized to fit a non-public system, subject to approval by the Forest Service.
(4) Coordinate with the Forest Service on conducting a condition survey and corrective actions as soon as
practicable, and document the survey and actions within 30 days after learning of the trigger. In the
documentation, describe sanitary defects detected, corrective actions completed, and a proposed timetable for
any corrective actions not already completed.
(5) After performing corrective actions, take daily special samples. A closure order may be lifted only after the
problem has been corrected and two consecutive daily special samples are TC negative.
3. Disinfectant and Disinfection By-Products. All public community and non-transient non-community water
systems that add a primary or residual disinfectant as part of their water treatment must be monitored in
accordance with NPDWR or primacy agency requirements for disinfectant residuals to demonstrate compliance
with MRDLs, and for disinfection byproducts to demonstrate compliance with MCLs. Transient non-community
systems that use chlorine dioxide as a disinfectant must also be monitored for compliance with the MRDL.
All public water systems that add a primary disinfectant to treat the source water (surface water, GWUDI, or
groundwater) must be monitored in accordance with NPDWR or primacy agency requirements for disinfectant
residuals and other parameters as necessary to demonstrate compliance with applicable pathogen inactivation
requirements. All non-public non-transient water systems that add a primary or residual disinfectant as part of
their water treatment must be monitored in accordance with NPDWR for disinfectant residual MRDLs and
disinfection byproduct MCLs. Non-public transient systems that use chlorine dioxide as a disinfectant must also
be monitored for compliance with the MRDL. All non-public water systems that add a primary disinfectant to treat
the source water (surface water, GWUDI, or groundwater) must be monitored in accordance with NPDWR for
disinfectant residuals and other parameters as necessary to demonstrate compliance with applicable pathogen
inactivation requirements.
4. Turbidity. Perform turbidity monitoring in compliance with NPDWR and primacy agency regulations for all
public systems and non-public systems using surface water sources or groundwater sources determined to be
under the direct influence of surface water, or systems designated by the primacy agency. Non-public systems
must monitor the same way as public water systems unless alternative monitoring is approved by the Forest
Service on a case-by-case basis.
5. Primary Contaminants, Secondary Contaminants, Regulated and Unregulated Organic and Inorganic
Chemicals, and Other Contaminants. For public systems, conduct monitoring of all applicable contaminants as
required by the NPDWR, NSDWR, or primacy agency regulations. For non-public systems, conduct monitoring in
the same manner and frequency as the respective public water system class, unless the Forest Service has
granted a waiver using primacy agency waiver criteria as guidance. Nitrates are typically monitored for annually,
and nitrites are typically monitored for every three years.
I. Public Notification. Notification must be performed in accordance with the requirements of NPDWR and
primacy agency regulations for public and non-public systems.
J. Recordkeeping. The permit holder shall establish a permanent file for each drinking water system, and
maintain records for both public and non-public systems per the NPDWR, primacy agency regulations, and this
Appendix. The permit holder shall also include copies of sample siting plans, condition surveys, sanitary surveys,
O&M plans, maintenance logs, records of repairs and/or modifications, and any other correspondence in the file.
The permit holder shall submit a copy of the water system file to the Forest Service upon request, and shall
surrender the file to the Forest Service upon permit termination or revocation. The permit holder shall forward
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copies of routine and repeat coliform test results to the Forest Service by the 15th of the month in which the
sample was taken. For other parameters (e.g., special coliform samples, disinfection byproducts,
organic/inorganic/other chemical samples, disinfectant residuals, turbidity, etc.), unless otherwise requested, the
permit holder shall forward copies of test results to the Forest Service by the 15th of the month following the
sampling date. Unless otherwise requested, the permit holder shall forward copies of condition surveys, sanitary
surveys, Level 1 and Level 2 Assessments, corrective action reports, correspondence, etc. to the Forest Service
within one week.
K. Undeveloped Water Sources. Where there are undeveloped sources such as roadside springs, the permit
holder shall keep such water sources in an undeveloped condition indicating the water source is unprotected.
Undeveloped water sources shall not be identified on trail guides, brochures, maps, etc. in a way that may
mislead users into believing the water is protected and safe. The permit holder shall take any additional
measures to protect the public as required by Federal, State, or local law with regard to such sources.
L. Range and Wildlife Water Systems. The requirements in this Appendix do not apply to range or wildlife
water systems if their design and construction features clearly indicate that they are not for human use. However,
if range or wildlife water systems are an integral part of a drinking water system, such integral parts shall meet the
requirements for drinking water. The Forest Service and/or primacy agency shall make the final determination of
which water systems must be treated as drinking water systems.
M. Water Conservation. The permit holder shall operate, maintain, and monitor the water systems in such a
way as to minimize the environmental footprint, including water, energy, and waste reduction. The permit holder
shall report water meter readings to the Forest Service on a monthly basis, and maintain readings in the file. The
permit holder shall promptly correct wastage or leaks that can be corrected through permit holder operations,
maintenance, reconditioning, or renovation. The permit holder shall promptly inform the Forest Service of other
wastage or leaks.
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to
respond to, an information collection request unless it displays a valid Office of Management and Budget (OMB) control number.
The valid OMB control number for this information collection request is 0596-0082. Response to this information collection request
is required to obtain or retain benefits, specifically, a special use authorization. The authority for this information collection request is
Section 7 of the Granger-Thye Act, 16 U.S.C. 580d. The time required to complete this information collection request is estimated
to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, collecting and
maintaining the data needed, and completing and reviewing the information collection request. Send comments regarding this
burden estimate or any other aspect of this information collection request, including suggestions for reducing the burden, to Forest
Service Information Collections Officer, [email protected], with OMB control number 0596-0082 in the subject line.
PRIVACY ACT STATEMENT
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act statement serves to inform you of the following concerning the collection of the
information on this form.
Purpose: The Privacy Act of 1974 requires that the Director of Recreation, Heritage, and Volunteer Resources staff and the
Director of Lands, Minerals, and Geology Management staff provide the following statements to individuals from whom they request
information.
Authority: Collection of this information solicited on this form is authorized by Section 7 of the Granger-Thye Act, 16 U.S.C. 580d.
Routine Uses: The information collected will be used by Forest Service officials to ensure that your use of National Forest System
lands is administered in accordance with applicable statutes, regulations, and directives. The information collected from you is
retained in the Special Uses Data System (SUDS) and is retrieved by the Forest Service create reports for the Agency’s Special
Uses Program, generate bills for collection of land use fees for your authorization, monitor compliance with your special use
authorization, and other matters pertaining to administration of your special use authorization. SUDS is a component of the Forest
Service’s Natural Resources Manager database (NRM). A complete list of the routine uses of NRM can be found in the system of
records notice associated with this form, FS-24.
Disclosure: The submission of this information is required to obtain or retain benefits, specifically, a special use authorization.
NONDISCRIMINATION STATEMENT

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In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the
USDA, its agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from
discriminating based on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income
derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or
activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by
program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print,
audiotape, American Sign Language, etc.) should contact the State or local Agency that administers the program or contact
USDA through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be
made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the
letter all the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit the completed
form or letter to USDA by (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400
Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected].
USDA is an equal opportunity provider, employer, and lender.

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