3930-FM-BSDW0528
Form
Rev. 8/2015
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF SAFE DRINKING WATER
Interim Final
SEASONAL SYSTEM START-UP PROCEDURE FORM
Date Procedures Updated:
Part 1: General System Information
Water System Name:
PWSID:
Mailing Address:
Contact Person:
Phone #:
Email:
Population Served:
Season Begin Date:
Source Types: (check all that apply)
Season End Date:
Surface Water
Groundwater
Purchased
GUDI (Groundwater under direct influence of surface water)
Disinfection Treatment: (check all that apply)
Chlorine
Ultraviolet
None
Other (
)
Other Treatment:
Certified Operator Name:
Certified Operator Phone:
Certified Operator’s Signature:
Date:
Responsible Official Name:
Responsible Official Phone:
Responsible Official’s Signature:
Date:
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Part 2: Seasonal System Start-Up Procedure
Total Time: The seasonal system start-up procedure takes
days to complete.
Note: Procedures should address the following:
A. Source protection - Systems should inspect the areas around their sources for any new sources of contamination
B. System “Shock” disinfection (if applicable) – Systems should shock chlorinate the system unless already treating
the water with a chlorination system.
C. Disinfection Treatment (if applicable) – Systems should perform routine maintenance on all disinfection treatment
equipment.
D. Other Treatment (if applicable) – Systems should perform routine maintenance on all water treatment equipment.
E. System flushing – Systems should flush the distribution system to pressurize and clean all lines.
F. Storage (if applicable) – Systems should inspect storage tanks for cleaning and/or repair as needed.
G. Coliform Sampling – Systems are required to collect coliform samples and verify with the laboratory that coliforms
are not present.
Start-Up Procedure: Identify the steps to follow prior to serving water each season. It is recommended to print out a
copy each year and check the boxes as each step is completed.
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Step
Rev. 8/2015
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Use page 4 to list additional start-up procedure steps that occur before collecting coliform samples.
Step
: Collect total coliform sample(s) at the location(s) specified below. Samples should be collected
1-3 weeks prior to opening.
Location ID
Site location (address and tap location)
Step
: Confirm with laboratory that the set of samples was absent of coliform bacteria; if not, collect
another set of total coliform samples.
Step
: Prior to serving water to the public, send a completed Seasonal Water System Certification form
(3930-FM-BSDW0532) to PA DEP.
Note: District Office mailing addresses may be found in the instructions.
Explanation of Procedures Not Included in this Plan: Provide an explanation for why any start-up procedure(s)
applicable for your system were omitted.
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Note: Use this page for additional steps. Make sure additional steps occur before collecting coliform samples.
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