EPA
8327
1994.2
c.l
OMBNe.20MHn71i
United States
Environmental Protection Agency
SURVEY OF PUBLIC
COMMUNITY WATER SYSTEMS
Library
Recycfed/Recyclabto
-------
Please return this questionnaire in the enclosed postage-paid envelope
or mail to:
EPA Community Water Systems Survey
1650 Research Boulevard
Room GA 45
Rockvilte. MD 20850-9973
ThD following qatttianuin h eomutad to nqoto 4S-ttiautef to ubourlocorapku.
TOfinciad«limefoic*iB*iivimMMXicM|0hg^
ScaJcammatt»ragirtintiticbimko«tini^ar«iiyod>CT»s»arfaii»«^^
Chief, Infonn.tion Policy Branch, 2136 » U.S.Envi»omedt«lPtato9iooA^acy • 401M SttMt, S.W. • W^ingtoo,DC M460.«nd
D-kOffimfbrEPA • OfficerffafonnrtionBKtReguaMOfyAl&iM » Office«fMn«gai«««mlB«lg«t • WohingtocOX: 20503.
-------
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, D.C. 20460
Dear Community Water System Owners and Operators:
OFFICE OF
WATER
You and the owners and operators of approximately 3,500 other
water systems across the country have been selected at random to
participate in a survey of drinking water systems conducted
periodically by the U.S. Environmental Protection Agency (EPA).
The purpose of the Survey is to help us better understand
what it is like to operate a water system, to get a more accurate
picture of your problems, and to discover opportunities for
improvement. The Survey findings will help us do a better job in
assessing the cost impacts and the benefits of future EPA
regulations. The findings will also help us determine how
affordable our regulations may be to water systems of different
sizes.
Your responses to these questions will be combined with the
responses of other water systems in your size and ownership
categories and will be used only in presenting categorical
information. Your name or the name of your water system will not
be identified.
By participating in this effort, you will not only benefit
EPA's national drinking water program, but you will ultimately be
helping yourselves and the people you serve, as well as the
thousands of other water systems across the country who will
benefit from a more accurate and sensitive regulatory development
process. The answers to the attached questions will give us a much
of the information we need to identify lower cost regulatory
options and better understand current water system capabilities and
constraints.
Thanks once again for your help. If you should have any
questions, please feel free to contact me in the Drinking Water
Standards Division of EPA at (202) 260-7785, or call Michelle Kiser
of Westat, Inc., the contractor who is assisting EPA in conducting
this survey, at 1-800-276-2952.
Brian C. Rourke,
Program Analyst
Printed on Recycled Paper
-------
-------
1994 Community Water Systems Survey:
Public Systems Questionnaire
GENERAL INSTRUCTIONS
This questionnaire asks three preliminary questions and then is divided into two major parts:
PART I - OPERATING CHARACTERISTICS (Questions 4-26); and
PART II - FINANCIAL CHARACTERISTICS (Questions 27-41).
Please complete the questionnaire as follows:
• In Question 1, provide the best contact person for each part (I and II);
• In Question 2, indicate the latest full-year reporting periods for which your operating information,
and financial information are available;
• In Part I of the questionnaire, use the period indicated in Question 2(A) to report "last year's"
operating data; and in Part II, use the period indicated in Question 2(B) to report "last year's"
financial data; and
. Please record your answers for the questionnaire by filling in the blank(s)
or circling the appropriate number(s) for each item.
Please provide the name, title and telephone number of the most knowledgeable person to
contact for information on:
T
(A) PART I - OPERATING CHARACTERISTICS:
Name: Title:
Tel. No. (
)
Fax No..
(B) PART II - FINANCIAL CHARACTERISTICS
(Write "SAME' if same as above)
Name:.
Title:
Tel. No. (
Fax No.
Please specify the end date of the most recent 12-month reporting period for which your
drinking water system can provide operating and financial information.
T
Can be reported
for the
12 months ending
(A) Operating information / /
(B) Financial information / /
-------
3. Please indicate, by circling the appropriate numbers, whether the organizations or people listed
below provide your drinking water system with:
(A) Information on drinking water requirements and guidance;
(B) Operator training; and
(C) Technical assistance.
(Circle alt numbers that apply for each information source)
INFORMATION SOURCE
T
(A)
Source providing
Information
on drinking
water requirements
and guidance
State Department of Natural Resources, state
Health Department, or state EPA. . . 1
Other state government departments or
extension services 1
U.S. Environmental Protection Agency 1
Other federal agencies or extension services
(e.g., FmHA, Rural Development Administration) 1
County government 1
Local government 1
State rural water associations 1
Other associations 1
Rural community assistance program 1
Contracted engineering services 1
Citizen volunteers 1
Electronic bulletin boards 1
Technical publications 1
Radio or television 1
Local newspapers 1
Federal register 1
Any other (Specify) 1
1
1
(B)
Source
providing
operator
training
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
(C)
Source
providing
technical
assistance
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
-------
PART I - OPERATING CHARACTERISTICS
For each type of water source listed below, please indicate which ones you use and:
(A) the number of gallons pumped in the last year (i.e., the amount of water to the
distribution system);
(B) the number of disinfection points; and
(C) the number of points where other types of treatment are provided.
WATER SOURCE
Ground water
Surface water
Water purchased from
CE
Do you obtain water
from this source?
YES NO
1 2
1 2
If YES,
(A)
Gallon* pumped
In the last year
enter the number of:
(B) (C)
Number of dis-
infection point*
Number of other
treatment point*
other systems
What was your system's peak daily production of non-purchased drinking water during the past
year, and what is its maximum daily treatment design capacity?
T
Gallons
per day
(A) Peak daily production
(8) Maximum daily treatment design capacity
Do you have treated water storage?
T
1 Yes
2 No —> Go to Question 8
-------
7. Please indicate whether you have the following types of storage listed below; and if so, for each
type of storage:
(A) how many tanks do you have;
(B) what is their storage capacity; and
(C) do you disinfect water in these tanks during storage?
TYPE OF STORAGE
Uncovered (e.g., reservoirs):
Steel
Concrete or Other. . . . ,
Does your water
system have this
type of storage?
YES NO
If YES, complete the following:
(A)
Number
OlMltKB
m\
\PI
Total
•forage capacity
In gallons
tCA
\*»J
Disinfect during
storage?
YES NO
Covered:
Steel
Concrete or Other.
2
2
2
2
2
2
2
2
IHSTRIBUTIGN
8. Please indicate whether your distribution system has the types of pipe listed below; and if so, for
each type of pipe what is the number of:
(A) miles (or feet) of existing pipe;
(B) miles (or feet) of pipe replaced in the last year;
(C) water main repairs in the last year; and
(D) number of months between flushes for entire system.
TYPE OF PIPE
Iron:
w/ Cement Lining
w/o Cement Lining . . . .
Asbestos:
w/ Vinyl
w/o Vinyl ....
PVC
Other Plastic
Other (Specify)
Does your
distribution
system
have this
type of
pipe?
YES NO
1
1
1
1
1
1
2
2
2
2
2
2
Does your
distribution
system
have this
type of
pipe?
YES NO
(A)
Mile* (or
feet) of
existing Unite
pip* (MorF)
if YES, enter the
(B)
Miles (or
feet) (specify
which) of
pipe replaced
in the Unit*
number of:
(C)
Water
main
repair*
in the
last
last year (MorF) year
(0)
Number of
months
between
flushes for
entire system
-------
9. How many miles (or feet) of new pipe (for expansion purposes) have you installed in the last 5
years?
(If zero, enter "0")
.MILES OF NEW PIPE OR
FEET OF NEW PIPE
10. How many people does your system currently serve with piped drinking water, and how many
did it serve 5 years ago?
(Please estimate if you dont know the exact number)
NOTE:
1. If you do not know the number of people served, you may indicate the number of
active connections in the appropriate space below.
2. If your system serves a population that changes on a seasonal basis (for example, a
winter or summer resort area), please indicate the highest seasonal number of people
served or active connections.
V
Currently
T
5 years ago
PEOPLE SERVED WITH PIPED DRINKING WATER
OR
ACTIVE CONNECTIONS WITH PIPED
DRINKING WATER
11. What are the ZIP codes of your service area?
(If more than 5 ZIPS, attach an extra sheet and enter the total number of ZIPS served here.
OPERATOR TRAINING
12. Do you have any drinking water treatment plant operators currently employed by your system?
T
1 Yes
2 No —> Go to Question 15
-------
13. Please indicate whether you employ treatment plant employees at any of the training level
categories listed below, and provide the number of operators and average operator work week
(in hours) at each training level category:
TRAINING LEVEL CATEGORY
STATE CERTIFIED (i.e., with state-approved
certified training for drinking water)
- Full time operator(s) [Definition:
Works at least 35 hours a week]
- Part time operator(s) who also operate other
drinking water plants (e.g., 'circuit riders') .
- Other part time, state certified
operators
Do you employ
drinking water
treatment
operator* at thl*
training level
category?
YES NO
H "YES"
Average hours per week
per operator
Other
How many Drinking
operators Treatment Water
do you have? Duties Duties
(f) (Hr») (Hrs)
2
2
2
TRAINED THROUGH A NATIONAL OR STATE
PROGRAM, BUT NOT STATE CERTIFIED
- Full time operator(s) (see definition above). .
- Part time operator(s) who also operate other
drinking water plants (e.g., 'circuit riders') .
- Other part time, trained operators
2
2
OTHER TRAINING LEVEL
(e.g., on-the-job training)
- Full time operator(s) (see definition above). . 1
- Part time operator(s) who also operate other
drinking water plants (e.g., "circuit riders') . 1
- Other part time operators not
classified above 1
2
2
2
IF YOU HAVE NO 'STATE CERTIFIED' OPERATORS, GO TO QUESTION 15.
14. What is the highest class or level at which at least one of your drinking water treatment plant
operators has been certified by the State? (Enter letter, number, or numeral indicating class or level.)
HIGHEST CLASS OR LEVEL
-------
WATER SOURCES AND TREATMEm
I - ..:.. •; tl
15. Is your water system interconnected to another system that you can use for emergency
purposes (e.g., hot summers)?
T
1 Yes
2 No
16. Please indicate if you would adopt any of the solutions listed below, if your primary source of
drinking water became permanently unusable due to contamination:
SOLUTION
If primary water
sources became
unusable, would you
adopt this solution?
YES NO
Draw more heavily upon other sources on the present system 1
Draw upon another system to which you are now connected 1
Draw upon alternative sources (e.g., hook up to another system) . . .
Implement a water management plan (e.g., rationing)
Drill new well(s).
Curtail service
Other (Specify)
2
2
2
2
2
2
2
17. What is the name of your long term alternate source and how many miles is it from the nearest
distribution point on your current system?
(If you have none, write "none")
V T
Distance
from
Name of long term system
alternate water sources) {to nearest mile)
1.
2.
3.
4.
18. Do you boost chlorine residuals in your distribution system?
1 Yes —> If yes, at how many sites?
2 No —
Go to instruction box at the bottom of this page
IF THE ANSWER TO QUESTION 4 INDICATES THAT YOU HAVE A GROUNDWATER SOURCE,
ANSWER QUESTION 19 NEXT; OTHERWISE GO TO QUESTION 20.
-------
i!!
I
!!
•2
g-
i
D.
Q.
: >•
lit III
is
-I HI
a
I
I
I
fi
O)
m co
o
O> T-
CD O) O ^- CM CO
-------
10
i!
t 5
I
0)
i
K
I
1
I
*- 01 m
Ill
8 CM CM CM CM CM CM
CM CM CM CM CO 5 W C? 3 CO CO CO
UJ
Q
O
O
-------
SOURCE WATER PROTECTION
21. Does your drinking water system participate in a source-water or wellhead protection program?
V
1 Yes
2 No —>
Go to Question 24
22. Who leads or manages this program?
(Circle only one number)
T
1 Local government
2 Regional authority (e.g., Section 208 Agency)
3 State agency
4 Other? (Specify)
23. How is the management area delineated?
(Circle all numbers that apply and fill in the blanks if 3, 4 or 5 is circled)
T
1 By watershed boundaries
2 By aquifer boundaries
3 By a fixed radius around well of feet
4 By a fixed distance from a surface water body of feet
5 Other (Specify)
10
-------
24. Please indicate if any of the sources of contamination listed below exist within 2 miles of your
water supply:
25.
26.
SOURCE OF CONTAMINATION
Industrial runoff or spills. .
Agricultural runoff.
Urban runoff
Sewage discharge
Solid waste disposal
Lead .
Nitrates
Pesticides, rodenticides, fungicides . .
Petroleum products
Solvents ... ....
Cross-connections . . .... ....
Other (Specify)
Who performs laboratory analysis on your drinking water?
LAB ANALYSIS PROVIDER
The state
A private firm .
In-house employees
Other (Specify)
How do you pay for your laboratory analysis?
PAYMENT METHOD
Direct payment for tests to state or private lab
Included as part of state permit
Dont pay.
Other (Specify)
Does this source of contamination exist within 2
miles of your water supply?
YES NO
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
T
Does this provider perform your lab analysis?
YES NO
1 2
1 2
1 2
1 2
V
Do you use this payment method?
YES NO
1 2
1 2
1 2
1 2
11
-------
PART II - FINANCIAL INFORMATION
REVENUES AN0 EXPENSES
27. Are your income and expense statements for your drinking water system completed in
accordance to Generally Accepted Accounting Principles (GAAP)?
(Circle one number)
T
1 Yes
2 No
3 Dont have separate income and expense
statements for our drinking water system
4 Don't know
PROVIDING ESTIMATES:
The following questions ask for information on drinking water supply operations, exclusive of other
activities with other types of operations. Where possible, please provide exact information from
your system's records. Otherwise provide your best estimate of financial information that is
applicable to your drinking water system only. Circle the number 1 or 2 in the last column (where
provided) to indicate whether your answer was based on records or not.
Example: Exclude the estimated sewer portion of combined water-sewer operation or other
extraneous municipal budget items, and indicate your answer is an estimate by circling "2. *
28. During the last year [as defined in your response to Question 2(B)] what were your drinking
water system's revenues from water sales for each of the following customer categories:
(If zero, enter'O*)
T T T
CUSTOMER CATEGORIES Revenues
Residential customers $
Commercial customers $
Industrial customers $
Wholesale customers (i.e., those
who redistribute your water
to other users) $
Local municipal government $
Other government customers $
Agricultural customers $
Other (Specif/) $
Gallons delivered
(in millions)
Based on
system's Best
records estimate
2
2
2
2
2
2
2
2
12
-------
29. Please indicate your drinking water system's revenues during the last year from the other water-
related revenue sources listed below.
(If zero, enter "0")
REVENUE SOURCE
Connection fees $_
Revenues
Inspection fees $_
Developer fees $_
Other fees $_
General fund revenues $_
Interest earnings (on water fund, etc.) . $_
Fines/penalties .....$_
Other revenues (not elsewhere classified) ........$_
Based on
system's
records
1
1
1
1
1
1
1
1
Best
estimate
2
2
2
2
2
2
2
2
13
-------
30. For each customer category listed below, please identify your drinking water system's billing
structure, indicate the year and percent of the two most recent rate increases, and provide the
number of metered and unmetered active connections.
(If zero, enter "0")
V V T
CUSTOMER CATEGORY
Residential customers
Commercial customers
Industrial customers
Wholesale customers (i.e., those who
redistribute your water to other users). .
Local municipal government
Other government customers
Agricultural customers
Other (Specify)
Billing
structure
(Circle all
code(s)
from Box 3
that apply)
1234567
1234567
1234567
1234567
1234567
1234567
1234567
1234567
Year and percent of
two most recent rate
increases
YR. % YR. %
Number
of active
connections
Metered/Unmetered
Metered Charges
CODE Billing Structure
1 Uniform rate
2 Declining block rate
3 Increasing block rate
4 Peak period rate
(e.g., seasonal)
BOX 3 - BILLING STRUCTURE
Unmetered Charges
CODE Billing Structure
5 Separate flat rate for water
6 Combined flat rate lor water and other services
(e.g., rental fees, association fees, pad fees)
Other Type of Charges
CODE Billing structure
7 Other (Specify)__
14
-------
31.
How many gallons (or dollar equivalents) of uncompensated usage did your water system have
in the last year for each of the usage categories listed below:
32.
u
F
F
L
U
O
Pie
the
Uncompens
(Enter eithe
NCOMPENSATED USAGE CATEGORY or dollar eq
ree service to municipal buildings and Darks . . . qal.
re protection, street cleaning,
hydrant flushing gal.
saks. breaks, failed meters gal.
ncollected bills gal.
ther (Specify) aal.
tated usage Based on
r gallons system's Best
uwatent) records estimate
or $ 12
or $ 12
or $ 12
or $ 12
or $ 12
ase enter the operating expenses of your drinking water system in the last year, according to
operating expense categories listed below:
T T
Last ye
OPERATING EXPENSE operating a
Direct compensation (wage, salary, bonus, etc.):
Managers $
Operators $
Others $
Benefits (health & insurance premiums,
pension contributions) $
Energy costs:
Electricity $
Other energy {gas, oil. etc.) $
Chemicals:
Disinfectants $
Precipitant chemicals $
Other chemicals $
Materials and supplies $
Research $
Outside analytical lab services $
Other outside services $
Depreciation expenses $
Payments in lieu of taxes or other
cash transfer to general lund $
Other operating expenses (do not include
interest or principal repayment) $
TOTAL ALL OPERATING EXPENSES $
. Based on
a™ system's Best
xpenses records estimate
1 2
1 2
1 2
1 2
1 2
1 2
1 2
2
2
2
2
2
2
2
1 2
1 2
1 2
15
-------
33. Please enter the amount of debt service expenses for your drinking water system in the last
year. (Include both interest and principal repayment.)
T
$.
. DEBT SERVICE EXPENSE
34. Please enter the amount of all other expenses (i.e., total expenses excluding your operating and
debt service expenses) of your drinking water system in the last year.
T
$.
OTHER EXPENSES
35. Please provide the following information on your drinking water system's total assets and
liabilities, outstanding debt, and total capital reserve fund.
TOTALASSETS
TOTAL LIABILITIES
$
$
Amount at end
of last year
Based on
system's
records
1
1
Best
estimate
2
2
TOTAL DEBT OUTSTANDING:
Direct Net Debt {see definition below):
Due within 5 years $_
Longer than 5 years £_
Self Supporting Debt (see definition below) $_
All Other Debt $_
TOTAL CAPITAL RESERVE FUND $_
2
2
2
2
2
DEFINITIONS:
Direct Net Debt - Gross direct debt (owed directly by a jurisdiction) less debt that is self-supporting
(revenue bonds) and double-barreled bonds (general obligation bonds secured by earmarked revenues
which flow outside the general fund).
Self Supporting Debt - Debt the repayment of which is secured by the revenues from the indebted
entity (through a revenue stream rather than by general fund revenues).
16
-------
36. Have you paid for capitalized water system improvements, repairs or expansion since January
1,1987?
V
1 Yes
2 No —»
Go to Question 41
37. What sources of funds did you use to pay for these capitalized improvements, repairs, or
expansion?
SOURCE OF FUNDS FOR
CAPITAL INVESTMENT
Debt Financing
Revenue bond
General obligation bond
Bank loan
STATE OR FEDERAL SUBSIDIZED LOAN:
Rural Development
Administration (RDA) ....
Farmers Home
Administration (FmHA) ....
State Agencies (Specify)
Other Sources of Funds
Payment from capital reserve
fund
Special assessment
Cash How from current revenues .
Was this source of
funds used since
1/1/87?
YES NO
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
tf YES, how much was secured
or provided for
each of the following?
Water quality
improvement
£
$
$
$
s
$
$
s
s
Replacement
or major repair*
$
s
$
$
s
$
$
$
$
System
expansion
s
£
S
S
$
S
s
s
s
STATE OR FEDERAL SUBSIDIZED GRANT:
Rural Development
Administration (RDA) ....
Farmers Home
Administration (FmHA) ....
1 2
1 2
$
$
$
s
$
$
Other (Specify
17
-------
38. Have you ever had to reduce or cancel plans for capitalized improvements, repairs, or
expansion of your drinking water system because you were unable to secure an adequate loan
from any source; and if so, what was the amount of the loan sought?
1 Yes
2 No
Amount of Loan
$
Reason for Denial (if known)
IF YOU HAVE NOT USED BONDS FOR FINANCING, GO TO QUESTION 41.
39. Have your bonds ever been rated by a rating service?
T
1 Yes
2 No —»
Go to Question 41
40. What was your system's latest bond rating?
RATING SERVICE
T
Rating
Moody-s
Standard and Poor's
Other (Specify
(e.g., Baal)
(e.g., BBB+)
18
-------
41. What is your system's latest credit rating and who provided it?
(Enter 'DK* if you dont Anon)
V
Rating
Rated by
Check here if your system does not have a credit rating:
COMMENTS:
THANK YOU FOR COMPLETING THIS QUESTIONNAIRE. YOUR
TIME AND EFFORT ARE GREATLY APPRECIATED.
MAILING INSTRUCTIONS ARE INSIDE THE FRONT COVER.
19
-------
-------
-------
fflm
------- |