Tier 3 Templates

Tier 3 notices are required for the following violations or situations:

-   **Monitoring violations** (except for the following: failure to
    monitor for fecal coliform or *E. coli* when repeat samples are
    positive for coliform, failure to take a confirmation sample for
    nitrate or nitrite within 24 hours, and failure to take required
    samples for chlorine dioxide in the distribution system, which
    require Tier 1 notice; failure to collect 3 or more samples for
    *Cryptosporidium*, which requires Tier 2 notice; and any monitoring
    violations elevated to Tier 1 or 2 by the primacy agency);

-   **Testing procedure violations**, except where elevated to Tier 2 by
    the primacy agency;

-   Operation under a **variance or exemption**;

-   Special notice for **availability of unregulated contaminant
    monitoring data**; and

-   Special notice for **fluoride** secondary maximum contaminant level
    (SMCL) exceedances.

The pages that follow contain templates for Tier 3 violations and
situations. Along with the templates are instructions, including the
required method of delivery and suggestions for completing individual
sections of the notices. These instructions are designed to supplement
Chapter 7, so you may see much of the information repeated here.

**Mandatory language on unknown risk for monitoring violations, which
must be included as written with blanks filled in, is presented in
italics (141.205(d)). All the language in the fluoride SMCL template
(except the language discussed below) is mandatory (141.208).**

You must also include the following italicized language in all notices,
where applicable (141.205(d)). Use of this language does not relieve you
of your obligation to take steps reasonably calculated to notify all
persons served:

> *Please share this information with all the other people who drink
> this water, especially those who may not have received this notice
> directly (for example, people in apartments, nursing homes, schools,
> and businesses). You can do this by posting this notice in a public
> place or distributing copies by hand or mai*l.

**Templates**

Monitoring Violations Annual Notice--Template 3-1A 101

Monitoring Violations Annual Notice--Template 3-1B 103

Failure to Comply with a Testing Procedure Notice -- Template 3-2 105

Operating Under an Exemption Notice -- Template 3-3 107

Special Notice for Availability of Unregulated Contaminant Monitoring
Data -- Template 3-4 109

Fluoride SMCL Notice--Template 3-5 111

**Template on Reverse**

If you are required to provide Tier 3 notification, you must provide
public notice to persons served within one year after you learn of the
violation (141.204(b)). Multiple monitoring violations can be serious,
and your primacy agency may have more stringent requirements. Check with
your primacy agency to make sure you meet its requirements.

Community systems must use one of the following (141.204(c)):

-   Hand or direct delivery

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-   Mail, as a separate notice or included with the bill

Non-community systems must use one of the following (141.204(c)):

-   Posting in conspicuous locations

-   Hand delivery

-   Mail

In addition, both community and non-community systems must use another
method reasonably calculated to reach others if they would not be
reached by the first method (141.204(c)). Such methods could include
newspapers, e-mail, or delivery to community organizations. If you post
the notice, it must remain posted until the violation is resolved. If
the violation has been resolved, you must post the notice for at least
seven days (141.204(b)). If you mail, post, or hand deliver, print your
notice on letterhead, if available.

The notice on the reverse is appropriate for insertion in an annual
notice or the Consumer Confidence Report (CCR), as long as public
notification timing and delivery requirements are met (141.204(d)). You
may need to modify the template for a notice for individual monitoring
violations. This example presents violations in a table; however, you
may write out an explanation for each violation if you wish. For any
monitoring violation for volatile organic compounds (VOCs) or other
groups, you may list the group name in the table, but you must provide
the name of every chemical in the group on the notice, e.g., in a
footnote.

You may need to modify the notice if you had any monitoring violations
for which monitoring later showed a maximum contaminant level or other
violation. In such cases, you should refer to the public notice you
issued at that time.

Include in your notice the standard language for monitoring and testing
procedure violations in italics (141.205(d)(2)). If you modify the
notice, you may not alter this mandatory language.

**Corrective Actions**

In your notice, describe corrective actions you took or are taking.
Listed below are some steps commonly taken by water systems with
monitoring violations. You can use the following language, if
appropriate, or develop your own:

-   We have since taken the required samples, as described in the last
    column of the table above. The samples showed we are meeting
    drinking water standards.

-   We have since taken the required samples, as described in the last
    column of the table above. The sample for \[contaminant\] exceeded
    the limit. \[Describe corrective action; use information from public
    notice prepared for violating the limit.\]

-   We plan to take the required samples soon, as described in the last
    column of the table above.

**After Issuing the Notice**

Make sure to send your primacy agency a copy of each type of notice and
a certification that you have met all the public notice requirements
within ten days after issuing the notice (141.31(d)).

**IMPORTANT INFORMATION ABOUT YOUR DRINKING WATER**

**Monitoring Requirements Not Met for \[System\]**

Our water system violated drinking water standards over the past year.
Even though these were not emergencies, as our customers, you have a
right to know what happened and what we did to correct these situations.

*We are required to monitor your drinking water for specific
contaminants on a regular basis. Results of regular monitoring are an
indicator of whether or not our drinking water meets health standards.
During \[compliance period\] we \[\'did not monitor or test\' or \'did
not complete all monitoring or testing\'\] for \[contaminant(s)\] and
therefore cannot be sure of the quality of our drinking water during
that time.*

**What should I do?**

There is nothing you need to do at this time.

The table below lists the contaminant(s) we did not properly test for
during the last year, how often we are supposed to sample for \[this
contaminant/these contaminants\] and how many samples we are supposed to
take, how many samples we took, when samples should have been taken, and
the date on which follow-up samples were (or will be) taken.

  ----------------- -------------- ------------- -------------- --------------
  **Contaminant**   **Required     **Number of   **When samples **When samples
                    sampling       samples       should have    were taken**
                    frequency**    taken**       been taken**   

  VOCs[^1]          1 sample every 0             2000-2002      February 2003
  (example)         three years                                 

                                                                

                                                                
  ----------------- -------------- ------------- -------------- --------------

**What is being done?**

\[Describe corrective action.\]

For more information, please contact \[name of contact\] at \[phone
number\] or \[mailing address\].

*Please share this information with all the other people who drink this
water, especially those who may not have received this notice directly
(for example, people in apartments, nursing homes, schools, and
businesses). You can do this by posting this notice in a public place or
distributing copies by hand or mail.*

This notice is being sent to you by \[system\]. State Water System ID#:
\_\_\_\_\_\_\_\_\_\_\_.

Date distributed: \_\_\_\_\_\_.

**Template on Reverse**

The template on reverse is another example of a monitoring violation.
The example in this template is for Bromate under the Stage 2 DBPR. All
the instructions of Template 3-1A apply.

**IMPORTANT INFORMATION ABOUT YOUR DRINKING WATER**

**Monitoring Requirements Not Met for \[System\]**

On \[give date\] we became aware that our system recently failed to
collect the correct number of drinking water samples. Although this
incident was not an emergency, as our customers, you have a right to
know what happened and what we did (are doing) to correct this
situation.

*We are required to monitor your drinking water for specific
contaminants on a regular basis. Results of regular monitoring are an
indicator of whether or not our drinking water meets health standards.
During \[compliance period\] we \[\'did not monitor or test\' or \'did
not complete all monitoring or testing\'\] for bromate and therefore
cannot be sure of the quality of our drinking water during that time.*
We were allowed to take 1 sample per quarter rather than 1 sample per
month. In \[give date\], we no longer qualified for reduced quarterly
bromate monitoring. Beginning in \[give date\], we failed to begin
monitoring monthly for bromate.

**What should I do?**

There is nothing you need to do. You do not need to boil your water or
take other corrective actions. You may continue to drink the water. If a
situation arises where the water is no longer safe to drink, you will be
notified within 24 hours. We will announce any emergencies on \[give TV
and/or radio stations where they can get additional information\]. We
will also post this information on our web site at
www.ourwatersystem.com.

**What is being done?**

\[Describe corrective action.\] We began monitoring monthly for bromate
on \[give date\] and will continue to monitoring on this schedule until
(unless) we qualify for reduced monitoring.

For more information, please contact \[name of contact\] at \[phone
number\] or \[mailing address\].

*Please share this information with all the other people who drink this
water, especially those who may not have received this notice directly
(for example, people in apartments, nursing homes, schools, and
businesses). You can do this by posting this notice in a public place or
distributing copies by hand or mail.*

This notice is being sent to you by \[system\]. State Water System ID#:
\_\_\_\_\_\_\_\_\_\_\_. Date distributed: \_\_\_\_\_\_.

**Template on Reverse**

Failure to comply with a testing procedure requires Tier 3 notification.
You must provide public notice to persons served within one year after
you learn of the violation (141.204(b)). Multiple testing violations can
be serious, and your primacy agency may have more stringent
requirements. Check with your primacy agency to make sure you meet its
requirements.

Community systems must use one of the following (141.204(c)):

-   Hand or direct delivery

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-   Mail, as a separate notice or included with the bill

Non-community systems must use one of the following (141.204(c)):

-   Posting in conspicuous locations

-   Hand delivery

-   Mail

In addition, both community and non-community systems must use another
method reasonably calculated to reach others if they would not be
reached by the first method (141.204(c)). Such methods could include
newspapers, e-mail, or delivery to community organizations. If you post
the notice, it must remain posted until the violation is resolved. If
the violation has been resolved, you must post the notice for at least
seven days (141.204(b)). If you mail, post, or hand deliver, print your
notice on letterhead, if available.

The notice on the reverse is appropriate for insertion in an annual
notice or the Consumer Confidence Report (CCR), as long as public
notification timing and delivery requirements are met (141.204(d)).

This example is for a holding time violation. It will need to be
modified for other types of testing violations. However, you must
include in your notice the standard language for monitoring and testing
procedure violations in italics (141.205(d)(2)). If you modify the
notice, you may not alter this mandatory language.

**Corrective Actions**

In your notice, describe corrective actions you took or are taking.
Listed below is a step commonly taken by water systems with a holding
time violation. You can use the following language, if appropriate, or
develop your own that is specific to your testing violation:

-   On (date) we collected (will collect) a new sample of our finished
    water in order to have it analyzed for (contaminant). We sent (will
    send) the sample to the certified laboratory via courier to ensure
    that the sample arrived within the allowed holding time.

**After Issuing the Notice**

Make sure to send your primacy agency a copy of each type of notice and
a certification that you have met all the public notice requirements
within ten days after issuing the notice (141.31(d)).

**IMPORTANT INFORMATION ABOUT YOUR DRINKING WATER**

**Failure to Comply With a Testing Procedure**

Our water system \[name of system\] recently failed to comply with a
required testing procedure. Even though this was not an emergency, as
our customers, you have a right to know what happened and what we did to
correct the situation.

*We are required to monitor your drinking water for specific
contaminants on a regular basis. Results of regular monitoring are an
indicator of whether or not our drinking water meets health standards.
During \[compliance period\] we did not complete all monitoring or
testing for \[contaminant(s)\] and therefore cannot be sure of the
quality of our drinking water during that time.* Any sample we collect
must be sent and analyzed by a certified laboratory within a specified
amount of time. We collected the sample on \[give date\], but did not
get our sample to the laboratory within the allowed holding time.

**What should I do?**

-   There is nothing you need to do. You do not need to boil your water
    or take other corrective actions. You may continue to drink the
    water and use it for cooking and bathing. If a situation arises
    where the water is no longer safe to drink, you will be notified
    within 24 hours. We will announce any emergencies on \[give TV
    and/or radio stations where they can get additional information\].

**What is being done?**

On (date) we collected (will collect) a new sample of our finished water
in order to have it analyzed for (contaminant). We sent (will send) the
sample to the certified lab via courier to ensure that the sample
arrived within the allowed holding time. (The sample was analyzed and
(contaminant) was not found at detectable levels.)

For more information, please contact \[name of contact\] at \[phone
number\] or \[mailing address\].

*Please share this information with all the other people who drink this
water, especially those who may not have received this notice directly
(for example, people in apartments, nursing homes, schools, and
businesses). You can do this by posting this notice in a public place or
distributing copies by hand or mail.*

This notice is being sent to you by \[system name\]. State Water System
ID# \_\_\_\_\_\_\_.

Date distributed: \_\_\_\_\_\_\_

**Template on Reverse**

If you are operating under a variance or exemption, you are required to
provide Tier 3 notification. You must provide public notice to persons
served within one year after you begin operating under a variance or
exemption (141.204(b)). Systems operating under a variance or exemption
are required to include the following information in their notice
(141.205(b)):

-   An explanation for the reasons for the variance or exemption;

-   The date on which the variance or exemption was issued;

-   A brief status report on the steps the system is taking to install
    treatment, find alternative sources of water , or otherwise comply
    with the terms and schedules of the variance or exemption; and

-   A notice of any opportunity for public input in the review of the
    variance or exemption.

Your primacy agency may require additional information. Check with your
primacy agency to make sure you meet its requirements. Failure to comply
with a variance or exemption is a Tier 2 violation. Use Template 2-13
for this type of violation.

Community systems must use one of the following (141.204(c)):

-   Hand or direct delivery

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-   Mail, as a separate notice or included with the bill

Non-community systems must use one of the following (141.204(c)):

-   Posting in conspicuous locations

-   Hand delivery

-   Mail

In addition, both community and non-community systems must use another
method reasonably calculated to reach others if they would not be
reached by the first method (141.204(c)). Such methods could include
newspapers, e-mail, or delivery to community organizations. If you post
the notice, it must remain posted until the violation is resolved. If
the violation has been resolved, you must post the notice for at least
seven days (141.204(b)). If you mail, post, or hand deliver, print your
notice on letterhead, if available.

The notice on the reverse is appropriate for insertion in an annual
notice or the Consumer Confidence Report (CCR), as long as public
notification timing and delivery requirements are met (141.204(d)).

**Corrective Actions**

In your notice, describe corrective actions you took or are taking.
Listed below is one action commonly taken by water systems that have
been granted an exemption. You can use the following language, if
appropriate, or develop your own:

-   We have begun the process to secure the necessary funding for a new
    treatment process. We have \[explain steps taken thus far\] and
    anticipate having funding secured by \[date\]. At that time we will
    \[explain the next step, such as purchase and begin installation of
    the selected treatment technology\].

**After Issuing the Notice**

Make sure to send your primacy agency a copy of each type of notice and
a certification that you have met all the public notice requirements
within ten days after issuing the notice (141.31(d)).

**IMPORTANT INFORMATION ABOUT YOUR DRINKING WATER**

**Operating Under an Exemption**

Our water system has been granted an exemption from \[primacy agency\]
for \[contaminant\] on \[give date\]. An exemption allows eligible
systems additional time to comply with a drinking water standard. \[Name
of system\] was granted an exemption for (contaminant) so that we could
raise funds for a new treatment process to remove (contaminant) from our
drinking water.

**What should I do?**

\[Provide information about any actions customers or you are required to
take as a condition of the exemption. For example if you are required to
provide bottled water explain where, when and how customers will receive
bottled water. If you are not required to provide bottled water or there
are no corrective actions customers should take, you may state that
here\].

**What does this mean?**

This is not an emergency. If it had been, you would have been informed
within 24 hours.

\[Consider including health effects language specific to the contaminant
for which the exemption applies\]

**What is being done?**

We have begun the process to secure the necessary funding for a new
treatment process. We have \[explain steps taken thus far\] and
anticipate having funding secured by \[date\]. At that time we will
\[explain the next step, such as purchase and begin installation of the
selected treatment technology\].

\[Our exemption will be reviewed by \[primacy agency\] on \[date\]. As
our customer you have the opportunity to provide input if you wish.\]

For more information, please contact \[name of contact\] at \[phone
number\] or \[mailing address\].

*Please share this information with all the other people who drink this
water, especially those who may not have received this notice directly
(for example, people in apartments, nursing homes, schools, and
businesses). You can do this by posting this notice in a public place or
distributing copies by hand or mail.*

This notice is being sent to you by \[system name\]. State Water System
ID# \_\_\_\_\_\_\_. Date distributed: \_\_\_\_\_\_\_

**Template on Reverse**

If you are required to monitor under 141.40 for unregulated
contaminants, you must provide Tier 3 notification to persons served
within one year after you receive the monitoring results (141.207(a)).
Check with your primacy agency to make sure you meet its requirements.

Community systems must use one of the following (141.204(c)):

-   Hand or direct delivery

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```
-   Mail, as a separate notice or included with the bill

Non-community systems must use one of the following (141.204(c)):

-   Posting in conspicuous locations

-   Hand delivery

-   Mail

In addition, both community and non-community systems must use another
method reasonably calculated to reach others if they would not be
reached by the first method (141.204(c)). Such methods could include
newspapers, e-mail, or delivery to community organizations. If you mail,
post, or hand deliver, print your notice on letterhead, if available.

The notice on the reverse is appropriate for insertion in an annual
notice or the Consumer Confidence Report (CCR), as long as public
notification timing and delivery requirements are met (141.207(a)).

**After Issuing the Notice**

Make sure to send your primacy agency a copy of each type of notice and
a certification that you have met all the public notice requirements
within ten days after issuing the notice (141.31(d)).

**IMPORTANT INFORMATION ABOUT YOUR DRINKING WATER**

**Availability of Monitoring Data for Unregulated Contaminants for
\[System\]**

Our water system has sampled for a series of unregulated contaminants.
Unregulated contaminants are those that don't yet have a drinking water
standard set by USEPA. The purpose of monitoring for these contaminants
is to help EPA decide whether the contaminants should have a standard.
As our customers, you have a right to know that this data is available.
If you are interested in examining the results, please contact \[name of
contact\] at \[phone number\] or \[mailing address\].

This notice is being sent to you by \[system\]. State Water System ID#:
\_\_\_\_\_\_\_\_\_\_\_.

Date distributed: \_\_\_\_\_\_.

**Template on Reverse**

For any exceedance of the fluoride secondary maximum contaminant level
SMCL, you must provide public notice to persons served as soon as
practical but within 12 months after you learn of the exceedance
(141.208), using the provided mandatory language and filling in the
blanks. Your primacy agency may have more stringent deadlines or other
requirements. Because fluoride at levels above the SMCL can permanently
discolor children\'s teeth, you are urged to issue this notice as soon
as practical. Non-community systems that monitor for fluoride (federal
law does not require non-community systems to monitor) are encouraged to
notify their consumers if they exceed the SMCL, especially at water
systems serving children. If you exceed the MCL of 4 mg/l, you must
provide notice within 30 days of learning of the violation (141.203(a)).
See Template 2-4.

Community systems must use one of the following (141.204(c)):

-   Hand or direct delivery

-   Mail, as a separate notice or included with the bill

In addition, you must use another method reasonably calculated to reach
others if they would not be reached by the first method (141.204(c)).
Such methods could include newspapers, e-mail, or delivery to community
organizations. If you post the notice, it must remain posted until the
exceedance is resolved. If the exceedance has been resolved, you must
post the notice for at least seven days (141.204(b)). If you mail, post,
or hand deliver, print your notice on letterhead, if available.

The notice on the reverse is appropriate for insertion in an annual
notice or the CCR, as long as public notification timing and delivery
requirements are met (141.204(d)), as well as for a separate individual
notice. The language on the template is mandatory and may not be
modified, although you may add to the notice, as suggested below
(141.208).

**Explaining the Situation**

Use the following language, if applicable:

-   Fluoride contamination is rarely due to human activity. Fluoride
    occurs naturally in some areas and is found in high concentrations
    in the aquifer in our source water.

If the fluoride levels in the water have returned to below the SMCL, be
sure to make this clear in your notice.

**Corrective Actions**

In your notice, you should describe corrective actions you took or are
taking, if any. The bullet below describes one action commonly taken by
water systems with fluoride SMCL exceedances. You can use this language,
or develop your own:

-   We are continuing to monitor fluoride levels. We will inform you if
    they exceed the limit of 4 mg/l.

**After Issuing the Notice**

Make sure to send your primacy agency a copy of each type of notice and
a certification that you have met all the public notice requirements
within ten days after issuing the notice (141.31(d)).

**IMPORTANT INFORMATION ABOUT YOUR DRINKING WATER**

**Elevated Fluoride Levels Detected**

This is an alert about your drinking water and a cosmetic dental problem
that might affect children under nine years of age. At low levels,
fluoride can help prevent cavities, but children drinking water
containing more than 2 milligrams per liter (mg/l) of fluoride may
develop cosmetic discoloration of their permanent teeth (dental
fluorosis). The drinking water provided by your community water system
\[name\] has a fluoride concentration of \[insert value\] mg/l.

Dental fluorosis in its moderate or severe forms, may result in a brown
staining and or pitting of the permanent teeth. This problem occurs only
in developing teeth, before they erupt from the gums. Children under
nine should be provided with alternative sources of drinking water or
water that has been treated to remove the fluoride to avoid the
possibility of staining and pitting of their permanent teeth. You may
also want to contact your dentist about proper use by young children of
fluoride-containing products. Older children and adults may safely drink
the water.

Drinking water containing more than 4 mg/l of fluoride (the U.S.
Environmental Protection Agency\'s drinking water standard) can increase
your risk of developing bone disease. Your drinking water does not
contain more than 4 mg/l of fluoride, but we\'re required to notify you
when we discover that the fluoride levels in your drinking water exceed
2 mg/l because of this cosmetic dental problem.

For more information, please call \[name of water system contact\] of
\[name of community water system\] at \[phone number\]. Some home water
treatment units are also available to remove fluoride from drinking
water. To learn more about available home water treatment units, you may
call NSF International at 1-877-8-NSF-HELP.

*Please share this information with all the other people who drink this
water, especially those who may not have received this notice directly
(for example, people in apartments, nursing homes, schools, and
businesses). You can do this by posting this notice in a public place or
distributing copies by hand or mail.*

This notice is being sent to you by \[system\]: .

State Water System ID#: \_\_\_\_\_\_\_\_.

Date distributed: \_\_\_\_\_\_\_\_\_.

[^1]: VOCs, also know as volatile organic compounds, are tested by
    collecting one sample and testing that sample for all the VOCs. VOCs
    are commonly used in industrial and manufacturing processes. VOCs
    include benzene, carbon tetrachloride, chlorobenzene,
    1,2-dichlorobenzene, 1,4-dichlorobenzene, 1,2-dichloroethane,
    cis-dichloroethane, trans-dichloroethane, dichloromethane,
    1,2-dichloropropane, ethylbenzene, styrene, tetrachloroethylene,
    1,1,1-trichloroethane, trichloroethylene, toluene,
    1,2,4-trichlorobenzene, 1,1-dichloroethylene, 1,1,2-trichloroethane,
    vinyl chloride, and xylene.