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  **TEMPLATES FOR NON-COMMUNITY SYSTEMS**

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> The pages that follow contain templates for use by non-community
> systems. They are generally designed for posting, and their
> instructions to consumers are tailored to systems where consumers will
> not be able to boil or otherwise treat their water. Along with each
> template are instructions, including the required method of delivery
> and instructions for completing individual sections of the notice.
> These instructions are designed to supplement Chapter 8, so you may
> see much of the information repeated here.
>
> Templates for other violations can be found in Chapters 5-7 and are
> listed in the table of contents of this handbook. Most of those
> templates are appropriate for hand delivery but would need to be
> modified for posting.
>
> **Mandatory language on health effects, which must be included exactly
> as written, is presented in *italics*** (141.205(d)).
>
> You must include the following italicized language in all notices,
> where applicable. If you post the notice, this language would not be
> appropriate, since the message would be available to anyone who passes
> it; in such cases you may omit the language from your notice. Use of
> this language does *not* relieve you of your obligation to take steps
> reasonably calculated to notify persons served (141.205(d)):
>
> *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.*

**Templates**

Nitrate NoticeBTemplate NC-1

Fecal Coliform or *E. coli* Notice\--Template NC-2

Unresolved Total Coliform NoticeBTemplate NC-3

Monitoring Violation NoticeBTemplate NC-4

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  **Instructions for Nitrate NoticeBTemplate NC-1**

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**Template on Reverse**

Since exceeding the nitrate maximum contaminant level is a Tier 1
violation, you must provide public notice to persons served as soon as
practical but within 24 hours after you learn of the violation
(141.202(b)). During this time period, you must also contact your
primacy agency. **This template is also applicable to nitrite and total
nitrate and nitrite violations.** It can also be used by non-community
systems allowed by their primacy agency to exceed the limit without
incurring a violation but still required to post. You must use one or
more of the following methods to deliver the notice to consumers
(141.202(c)):

-   Posting in conspicuous locations

-   Hand or direct delivery

-   Radio

-   Television

You may need to use additional methods (e.g., newspaper, delivery of
multiple copies to hospitals or clinics), since notice must be provided
in a manner reasonably calculated to reach all persons served.

The language to encourage distribution of the notice is included on this
notice; however, if you post this notice, omit the mandatory language to
encourage distribution, as it is not needed since posting makes the
notice available to everyone who passes by. If you modify the notice,
you must leave the health effects language in italics unchanged. This
language is mandatory (141.205(d)). See Template 1-1 for a more detailed
notice.

**Alternative Sources of Water**

If you are selling or providing bottled water, your notice should say
where it can be obtained. Remember that bottled water can also be
contaminated. If you are providing bottled water, make sure it meets the
standard for nitrates by contacting the bottler and asking for the most
recent test results.

**Repeat Notices**

If this is a repeat notice (as required by your primacy agency), or if
your system=s nitrate levels fluctuate around the MCL, you may wish to
include an explanation similar to the following:

As you may recall, on \[date\], you were also notified of high nitrate
levels that occurred during the \_\_\_\_ quarter of the year. Since that
time the water system has been monitoring the nitrate concentration
every three months. Seasonal fluctuations in nitrate concentrations have
been observed, due to nitrates contained in fertilizer. It appears the
high nitrates occur during the later summer and fall. Note that previous
tests prior to \[year\] show that we were meeting drinking water
standards for nitrate.

**Corrective Action**

In your notice, describe corrective actions you are taking. Listed below
are some steps commonly taken by water systems with nitrate/nitrite
violations. Use the following language, if appropriate:

-   We are investigating water treatment and other options. These may
    include drilling a new well or mixing the water with low-nitrate
    water from another source.

**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 notification
requirements within ten days after issuing the notice (141.31(d)).

It is a good idea to inform your consumers when the violation has been
resolved, especially if you have regular customers. See Template 1‑6 for
a Aproblem corrected@ notice template.

**DRINKING WATER WARNING**

FOR PARENTS OF INFANTS 6 MONTHS AND YOUNGER

DO NOT USE THE WATER FOR INFANT FORMULA

High nitrate levels were detected on \[date\]

Bottled water should be used. \[We are providing bottled water for
infants and their families at \_\_\_\_\].

Adults and children older than 6 months can drink the water

A routine sample on \[date\] showed a nitrate concentration in the
drinking water of \[level and units\]. This is above the nitrate
standard, or maximum contaminant level, of \[state/federal MCL\].

**Possible Health Effects**

*Infants below the age of six months who drink water containing nitrate
in excess of the maximum contaminant level could become seriously ill
and, if untreated, may die. Symptoms include shortness of breath and
blue baby syndrome.* Blue baby syndrome is indicated by blueness of the
skin. Nitrate is a concern for infants because they can=t process
nitrates in the same way adults can.

Symptoms in infants can develop rapidly, with health deteriorating over
a period of days. If symptoms occur in a child less than 6 months old,
seek medical attention immediately.

If you are pregnant or have specific health concerns, you may wish to
consult your doctor.

**Steps We Are Taking**

\[Describe corrective action.\]

We anticipate resolving the problem within \[estimated time frame\]. We
will inform you when this problem has been corrected. For more
information, please contact \[name of contact\] of \[system\] at \[phone
number\] or \[location/address\].

> *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.*

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

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  **Instructions for Fecal Coliform or *E. coli* Notice\--Template NC‑2**

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**Template on Reverse**

This template is intended for systems where consumers will not be able
to boil water. See the instructions below on how to modify this template
for other situations. Since exceeding the fecal coliform or *E. coli*
maximum contaminant level is a Tier 1 violation, you must provide public
notice to persons served as soon as practical but within 24 hours after
you learn of the violation (141.202(b)). During this time period you
must also contact your primacy agency. You must use one or more of the
following methods to deliver the notice to consumers (141.202(c)):

-   Posting in conspicuous locations

-   Hand or direct delivery

-   Radio

-   Television

You may need to use additional methods (e.g., newspaper, delivery of
multiple copies to hospitals or clinics), since notice must be provided
in a manner reasonably calculated to reach all persons served.

The language to encourage distribution of the notice is included on this
notice; however, if you post this notice, omit the mandatory language to
encourage distribution, as it is not needed since posting makes the
notice available to everyone who passes by. If you modify the notice,
you must leave the health effects language in italics unchanged. This
language is mandatory (141.205(d)). See Template 1-2 for a more detailed
template appropriate for hand delivery (but with different instructions
to consumers).

**Instructions to Consumers**

You may need to modify the instruction based on your system type. For
instance, at a campground, you might tell consumers to boil the water
before drinking or using for food preparation. Instructions also should
depend on whether your system has elevated nitrate levels.

**Alternative Sources of Water**

If you are selling or providing bottled water, your notice should say
where it can be obtained. Remember that bottled water can also be
contaminated. If you are providing bottled water, make sure it meets the
standard for bacteria and other contaminants by contacting the bottler
and asking for the most recent test results.

**Corrective Action**

In your notice, describe corrective actions you are taking. Listed below
are some steps commonly taken by water systems with fecal coliform
violations. Use one or more of the following actions, if appropriate:

-   We are chlorinating and flushing the water system.

-   We are increasing sampling for coliform bacteria.

-   We are repairing the wellhead seal.

-   We are repairing the storage tank.

**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 notification
requirements within ten days after issuing the notice (141.31(d)).

It is a good idea to inform your consumers when the violation has been
resolved, especially if you have regular customers. See Template 1‑6 for
a Aproblem corrected@ notice template.

**WARNING**

DO NOT DRINK THE WATER

Fecal coliform \[or *E. coli*\] bacteria were found in the water supply
on \[date\]

Bottled water is available from \_\_\_\_\_\]

**Possible Health Effects**

*Fecal coliforms and E. coli are bacteria whose presence indicates that
the water may be contaminated with human or animal wastes. Microbes in
these wastes can cause diarrhea, cramps, nausea, headaches, or other
symptoms. They may pose a special health risk for infants, young
children, some of the elderly, and people with severely compromised
immune systems.*

People at increased risk should seek advice about drinking water in
general from their health care providers.

**Steps We Are Taking**

\[Describe corrective action.\]

We will inform you when additional samples show no coliform bacteria and
you may drink the water. We anticipate resolving the problem within
\[estimated time frame\]. For more information, please contact \[name of
contact\] of \[system\] at \[phone number\] or \[location/address\].

> *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.*

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

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  **Instructions for Unresolved Total Coliform Notice\--Template NC‑3**

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**Template on Reverse**

This template is intended for systems where consumers will not need to
boil their water or where they will not have the facilities to do so.
Since exceeding the total coliform bacteria maximum contaminant level is
a Tier 2 violation, you must provide public notice to persons served as
soon as practical but within 30 days after you learn of the violation
(141.203(b)). **Persistent total coliform problems can pose a serious
health risk, and your primacy agency may elevate such situations to
Tier 1. Check with your primacy agency to make sure you meet all its
requirements.** You must issue a repeat notice every three months for as
long as the violation persists. Alternative language for systems
required to take more than 40 samples a month is provided below.

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

-   Posting in conspicuous locations

-   Hand delivery

-   Mail

You must also use *another* method reasonably calculated to reach others
if they would not be reached by the first method (141.203(c)). In
addition to the methods above, such methods could include newspapers,
e-mail, or delivery to community organizations.

The language to encourage distribution of the notice is included on this
notice; however, if you post this notice, omit the mandatory language to
encourage distribution, as it is not needed since posting makes the
notice available to everyone who passes by. If you modify the notice,
you must leave the health effects language in italics unchanged. This
language is mandatory (141.205(d)).

**Description of the Violation**

The template on the reverse is intended for use by systems taking fewer
than 40 samples a month. Use the following language if you are required
to take 40 or more samples per month:

-   We routinely monitor for the presence of drinking water
    contaminants. During \[month\], \_\_\_\_ percent of our samples
    showed the presence of total coliform bacteria. The standard is that
    no more than 5 percent of samples may do so.

**Corrective Action**

In your notice, describe corrective actions you are taking. If you know
what is causing the coliform problem, explain this in the notice. Listed
below are some steps commonly taken by water systems with total coliform
violations. Use one or more of the following actions, if appropriate, or
develop your own:

-   We are chlorinating and flushing the water system.

-   We are increasing sampling for coliform bacteria.

-   We are repairing the wellhead seal.

-   We are repairing the storage tank.

-   We will inform you when additional samples show no coliform
    bacteria.

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

It is a good idea to inform your consumers when the violation has been
resolved, especially if you have regular customers. See Template 1‑6 for
a Aproblem corrected@ notice template.

**DRINKING WATER NOTICE**

Tests show presence of coliform bacteria in water

We routinely monitor for the presence of drinking water contaminants. We
took \[number\] samples during \[month\]. \[Number\] of those samples
showed the presence of total coliform bacteria. The standard is that no
more than one sample per month may do so.

**What This Means**

This is not an emergency. Total coliform bacteria are generally not
harmful themselves.

*Coliforms are bacteria which are naturally present in the environment
and are used as an indicator that other, potentially-harmful, bacteria
may be present. Coliforms were found in more samples than allowed and
this was a warning of potential problems.* Usually, coliforms are a sign
that there could be a problem with the system=s treatment or
distribution systems.

**You may drink the water.** However, if you have specific health
concerns, consult your doctor.

People with severely compromised immune systems, infants, and some
elderly may be at increased risk. These people should seek advice about
drinking water from their health care providers.

**Steps We Are Taking**

\[Describe corrective action.\]

We will inform you when additional samples show no coliform bacteria. We
anticipate resolving the problem within \[estimated time frame\]. For
more information, please contact \[name of contact\] of \[system\] at
\[phone number\] or \[location/address\].

> *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.*

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

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  **Instructions for Monitoring Violation NoticeBTemplate NC-4**

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**Template on Reverse**

Since most monitoring violations are included in Tier 3, 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.

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

-   Posting in conspicuous locations

-   Hand delivery

-   Mail

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 newsletters, e-mail, or
delivery to community organizations. The language to encourage
distribution of the notice is included on this notice; however, if you
post this notice, omit the mandatory language to encourage distribution,
as it is not needed since posting makes the notice available to everyone
who passes by.

You must post the notice until the violation is resolved. If the
violation has been resolved, you must post the notice for at least one
week (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 an annual notice combining
notification for several violations, as well as for notices for
individual violations. This example presents violations in a table;
however, you may write out an explanation for each violation if you
wish.

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. Choose the appropriate language, 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)).

**DRINKING WATER NOTICE**

Monitoring requirements not met for \[system\]

We violated a drinking water standard. Even though this was not an
emergency, as our customers, you have a right to know what happened and
what we 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 \[\'did not monitor\' or \'did not
complete all monitoring\'\] for \[contaminant(s)\] and therefore cannot
be sure of the quality of our drinking water during that time.*

**What This Means**

**There is nothing you need to do at this time.** The table below lists
the contaminant(s) we did not properly test for, how often we are
supposed to sample for \[it/them\] 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 all      **When samples
                    sampling      samples     samples should  were or will be
                    frequency**   taken**     have been       taken**
                                              taken**         

  **Coliform        twice per     1           July 1, July    July 1, August
  (example)**       month                     15, August 1    1

                                                              

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

**Steps We Are Taking**

\[Describe corrective action.\] For more information, please contact
\[name of contact\] of \[system\] at \[phone number\] or
\[location/address\].

> *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.*

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