567—40.3 (17A,455B) Forms. The following forms are used by the public to apply for department approvals and to report on activities related to the public water supply program of the department. All forms may be obtained from the Environmental Services Division, Administrative Support Station, Department of Natural Resources, Henry A. Wallace Building, 502 East Ninth Street, Des Moines, Iowa 50319-0034. Properly completed application forms shall be submitted to the Water Supply Section, Environmental Services Division. Water Supply System Monthly and Other Operation Reporting forms shall be submitted to the appropriate field office (see 567—subrule 42.4(3)). Properly completed laboratory forms (reference 567—Chapter 83) shall be submitted to the State Hygienic Laboratory or as otherwise designated by the department.
	 40.3(1) Construction permit application forms. Schedules “1a” through “16d” are required.

<fo:wrapper font-size="10pt">Schedule No.</fo:wrapper>	<fo:wrapper font-size="10pt">Name of Form</fo:wrapper>	<fo:wrapper font-size="10pt">Form Number</fo:wrapper>	
<fo:wrapper font-size="10pt">“1a”</fo:wrapper>	<fo:wrapper font-size="10pt">General Information</fo:wrapper>	<fo:wrapper font-size="10pt">542-3178</fo:wrapper>	
<fo:wrapper font-size="10pt">“lb”</fo:wrapper>	<fo:wrapper font-size="10pt">Minor Water Main Construction Permit</fo:wrapper>	<fo:wrapper font-size="10pt">542-3151</fo:wrapper>	
<fo:wrapper font-size="10pt">“lc”</fo:wrapper>	<fo:wrapper font-size="10pt">Fee Schedule</fo:wrapper>	<fo:wrapper font-size="10pt">542-3179</fo:wrapper>	
<fo:wrapper font-size="10pt">“2a”</fo:wrapper>	<fo:wrapper font-size="10pt">Water Mains, General</fo:wrapper>	<fo:wrapper font-size="10pt">542-3030</fo:wrapper>	
<fo:wrapper font-size="10pt">“2b”</fo:wrapper>	<fo:wrapper font-size="10pt">Water Mains, Specifications</fo:wrapper>	<fo:wrapper font-size="10pt">542-3031</fo:wrapper>	
<fo:wrapper font-size="10pt">“2c”</fo:wrapper>	<fo:wrapper font-size="10pt">Notification of Minor Water Main Construction</fo:wrapper>	<fo:wrapper font-size="10pt">542-3152</fo:wrapper>	
<fo:wrapper font-size="10pt">“3a”</fo:wrapper>	<fo:wrapper font-size="10pt">Water System, Preliminary Data</fo:wrapper>	<fo:wrapper font-size="10pt">542-3032</fo:wrapper>	
<fo:wrapper font-size="10pt">“3b”</fo:wrapper>	<fo:wrapper font-size="10pt">Water Quality Data</fo:wrapper>	<fo:wrapper font-size="10pt">542-3029</fo:wrapper>	
<fo:wrapper font-size="10pt">“3c”</fo:wrapper>	<fo:wrapper font-size="10pt">Surface Water Quality Data</fo:wrapper>	<fo:wrapper font-size="10pt">542-3028</fo:wrapper>	
<fo:wrapper font-size="10pt">“4”</fo:wrapper>	<fo:wrapper font-size="10pt">Site Selection</fo:wrapper>	<fo:wrapper font-size="10pt">542-3078</fo:wrapper>	
<fo:wrapper font-size="10pt">“5a”</fo:wrapper>	<fo:wrapper font-size="10pt">Well Construction</fo:wrapper>	<fo:wrapper font-size="10pt">542-1005</fo:wrapper>	
<fo:wrapper font-size="10pt">“5b”</fo:wrapper>	<fo:wrapper font-size="10pt">Well Appurtenances</fo:wrapper>	<fo:wrapper font-size="10pt">542-3026</fo:wrapper>	
<fo:wrapper font-size="10pt">“5c”</fo:wrapper>	<fo:wrapper font-size="10pt">Well Profile</fo:wrapper>	<fo:wrapper font-size="10pt">542-1006</fo:wrapper>	
<fo:wrapper font-size="10pt">“5d”</fo:wrapper>	<fo:wrapper font-size="10pt">Surface Water Supply</fo:wrapper>	<fo:wrapper font-size="10pt">542-3139</fo:wrapper>	
<fo:wrapper font-size="10pt">“6a”</fo:wrapper>	<fo:wrapper font-size="10pt">Distribution Water Storage Facilities</fo:wrapper>	<fo:wrapper font-size="10pt">542-3140</fo:wrapper>	
<fo:wrapper font-size="10pt">“6b”</fo:wrapper>	<fo:wrapper font-size="10pt">Distribution Pumping Station</fo:wrapper>	<fo:wrapper font-size="10pt">542-3141</fo:wrapper>	
<fo:wrapper font-size="10pt">“7”</fo:wrapper>	<fo:wrapper font-size="10pt">Schematic Flow Diagram</fo:wrapper>	<fo:wrapper font-size="10pt">542-3142</fo:wrapper>	
<fo:wrapper font-size="10pt">“8”</fo:wrapper>	<fo:wrapper font-size="10pt">Aeration</fo:wrapper>	<fo:wrapper font-size="10pt">542-3143</fo:wrapper>	
<fo:wrapper font-size="10pt">“9”</fo:wrapper>	<fo:wrapper font-size="10pt">Clarification/Sedimentation</fo:wrapper>	<fo:wrapper font-size="10pt">542-3144</fo:wrapper>	
<fo:wrapper font-size="10pt">“10”</fo:wrapper>	<fo:wrapper font-size="10pt">Suspended Solids Contact</fo:wrapper>	<fo:wrapper font-size="10pt">542-3145</fo:wrapper>	
<fo:wrapper font-size="10pt">“11”</fo:wrapper>	<fo:wrapper font-size="10pt">Cation Exchange Softening</fo:wrapper>	<fo:wrapper font-size="10pt">542-3146</fo:wrapper>	
<fo:wrapper font-size="10pt">“12”</fo:wrapper>	<fo:wrapper font-size="10pt">Filters</fo:wrapper>	<fo:wrapper font-size="10pt">542-3147</fo:wrapper>	
<fo:wrapper font-size="10pt">“13a”</fo:wrapper>	<fo:wrapper font-size="10pt">Chemical Addition</fo:wrapper>	<fo:wrapper font-size="10pt">542-3141</fo:wrapper>	
<fo:wrapper font-size="10pt">“13b”</fo:wrapper>	<fo:wrapper font-size="10pt">Dry Chemical Addition</fo:wrapper>	<fo:wrapper font-size="10pt">542-3130</fo:wrapper>	
<fo:wrapper font-size="10pt">“13c”</fo:wrapper>	<fo:wrapper font-size="10pt">Gas Chlorination</fo:wrapper>	<fo:wrapper font-size="10pt">542-3131</fo:wrapper>	
<fo:wrapper font-size="10pt">“13d”</fo:wrapper>	<fo:wrapper font-size="10pt">Fluoridation</fo:wrapper>	<fo:wrapper font-size="10pt">542-3132</fo:wrapper>	
<fo:wrapper font-size="10pt">“13e”</fo:wrapper>	<fo:wrapper font-size="10pt">Sampling and Tests</fo:wrapper>	<fo:wrapper font-size="10pt">542-3133</fo:wrapper>	
<fo:wrapper font-size="10pt">“14”</fo:wrapper>	<fo:wrapper font-size="10pt">Pumping Station</fo:wrapper>	<fo:wrapper font-size="10pt">542-3134</fo:wrapper>	
<fo:wrapper font-size="10pt">“15”</fo:wrapper>	<fo:wrapper font-size="10pt">Process Water Storage Facilities</fo:wrapper>	<fo:wrapper font-size="10pt">542-3135</fo:wrapper>	
<fo:wrapper font-size="10pt">“16a”</fo:wrapper>	<fo:wrapper font-size="10pt">Wastewater, General</fo:wrapper>	<fo:wrapper font-size="10pt">542-3136</fo:wrapper>	
<fo:wrapper font-size="10pt">“16b”</fo:wrapper>	<fo:wrapper font-size="10pt">Waste Treatment Ponds</fo:wrapper>	<fo:wrapper font-size="10pt">542-3137</fo:wrapper>	
<fo:wrapper font-size="10pt">“16c”</fo:wrapper>	<fo:wrapper font-size="10pt">Filtration and Mechanical</fo:wrapper>	<fo:wrapper font-size="10pt">542-3138</fo:wrapper>	
<fo:wrapper font-size="10pt">“16d”</fo:wrapper>	<fo:wrapper font-size="10pt">Discharge to Sewer</fo:wrapper>	<fo:wrapper font-size="10pt">542-3103</fo:wrapper>	
	 40.3(2) Operation permit application forms.
	  a.   	 Form 13-1 — community water supply
	  b.   	 Form 13-2 — noncommunity water supply
	 40.3(3) Water supply reporting forms.
	  a.   	 Form 14 — plant operation	542-3104
	  b.   	 Form 15 — analyses by certified laboratories
	 (1) 	 Individual bacterial analysis reporting — Form 15-la	542-3195
	 (2) 	 Summary bacterial analysis reporting — Form 15-lb	542-3196
	 (3) 	 Chemical analysis reporting — Form 15-2	542-3166
	 (4) 	 Corrosivity analysis reporting — Form 15-3	542-3193
	 40.3(4) Laboratory certification application forms. Reserved.
[ARC 9915B, IAB 12/14/11, effective 1/18/12]