Massachusetts Department Of Environmental Protection - Drinking Water Program Dbpr Tt Compliance Report
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1Massachusetts Department of Environmental Protection - Drinking Water Program
TT
DBPR TT Compliance Report
I. PWS INFORMATION:
PWS ID #:
City / Town:
PWS Name:
PWS Class:
COM
NTNC
TNC
DEP
DEP Location Name
Date Collected
Collected By
LOCATION (LOC) ID#
SAMPLE NOTES
II. COMPLIANCE CALCULATIONS:
B: Required % Removal
Alternative Criteria
Month
Met Alternative
4
¹
# of Paired Samples
A: % Removal of TOC
A ÷ B
(mm/yy)
²
Compliance Criteria
³
of TOC
Result(s)
(See Below)
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Sum of Past 12 Months:
Compliance Value (Sum of Past 12 Months/ 12):
PWS Authorized Signature:
I certify under penalties of law that I am the person
authorized to fill out this form and the information contained herein
is true, accurate and complete to the best extent of my knowledge.
Date:
In accordance with 310 CMR 22.15(2), if mailing paper reports, ONE copy of this report must be received by your MassDEP Regional Office no later than 10 days after the
end of the month in which the results are received or no later than 10 days after the end of the monitoring period, whichever is sooner. Please note: Electronic reporting
(eDEP) deadline is the same as above.
¹ Percent Removal: (1 – (Treated Water TOC Raw Water TOC)) x 100. If > 1 paired sample sets in any month report the average of all
individual percent TOC removals (Example: % TOC Removal = (Average of Set 1 + Average of Set 2) 2).
² From table at 310 CMR 22.07E(10)(b)2.
³ As listed at 310 CMR 22.07E(10)(a)2 and 310 CMR 22.07E(10)(a)3, summarized as follows:
Result(s) to Report
(RAA = Running Annual
Alternative Compliance Criteria
Code Value
Average)
Source Water TOC <2.0 mg/L
SWTOC
RAA of source water TOC
Treated Water <2.0 mg/L
TWTOC
RAA of treated water TOC
Source Water TOC < 4.0 mg/L AND Alkalinity >60 mg/L (as CaCO
)
RAA of source water TOC, RAA of source water
3
COMBO
AND TTHM/HAA5 0.040/0.030 mg/L
alkalinity, RAA of TTHM and HAA5
TTHM/HAA5 0.040/0.030 mg/L AND only using chlorine
TTHM/HAA5
RAA of TTHM and HAA5
Source Water SUVA 2.0 L/mg-m
SWSUVA
RAA of treated water SUVA
Treated Water SUVA 2.0 L/mg-m
TWSUVA
RAA of treated water SUVA
Softening that lowers alkalinity to < 60 mg/L (as CaC0
)
SOFT60
RAA of treated water alkalinity
3
Softening that removes 10 mg/L (as CaCO
SOFT10
RAA of hardness (as CaCO
) removal
) of hardness
3
3
Note: All supplemental measurements and calculations used to meet the alternative criteria must be attached to this report.
4
For any month where the system met an alternative compliance criteria a value of 1.0 may be inserted.
DEP REVIEW STATUS (Initial & Date)
Review
Comments
Accepted ___________
Disapproved __________
v 1.1 12_2014
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