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Instructions 9/30/15 <br /> Water Supply Plan Checklist <br /> All sections of the plan must be completed in order for the plan to be approved.The following <br /> checklist can be used to make sure all elements of the plan have been completed. <br /> Part 1.Water Supply System Description and Evaluation <br /> ❑ Table 1.DNR Water Appropriation Permit Number&Utility Contact Information <br /> ❑ Table 2. Historic Water Demand (Part 1,A) <br /> ❑ Table 1. Large volume users (Part 1,A) <br /> ❑ Table 2.Water treatment capacity and treatment processes (Part 1, B <br /> ❑ Table 3.Storage capacity,as of the end of the last calendar year(Part 1,B) ) &discussion <br /> of current and future storage capacity needs <br /> ❑ Table 4.Water sources&status (Part 1, C) &discussion of limitations <br /> Table S. Projected annual water demand (Part 1, D) &discussion of water use trends& <br /> ❑ projection method <br /> ❑ Table 6.Source water quality monitoring(Part 1, E) <br /> ❑ Table 9.Water level data (Part 1, E) <br /> ❑ Table 10. Natural resource impacts (Part 1, E) <br /> ❑ Table 11. Status of Wellhead Protection and Source Water Protection Plans (Part 1,E) <br /> ❑ Table 12.Adequacy of Water Supply System (Part 1, F) <br /> ❑ Table 13. Proposed future installations/sources (Part 1, F) <br /> ❑ Table14.Alternative water sources (Part 1,F) <br /> ❑ Appendix 1: Well records and maintenance summaries <br /> ❑ Appendix 2: Water level monitoring plan <br /> ❑ Appendix 3:Water level graphs for each water supply well <br /> ❑ Appendix 4: Capital Improvement Plan <br /> Part 2.Emergency Planning and Response Procedures <br /> ❑ Table 1S. Emergency response plan contact information (Part 2,A) &Y/N questions <br /> Table 16. Interconnections with other water supply systems to supply water in an <br /> ❑ emergency(Part 2, C) &Y/N questions <br /> ❑ Table 17.Utilizing Surface Water as an Alternative Source (Part 2, C) &discussion of <br /> additional emergency water provisions <br /> ❑ Table 18.Water use priorities (Part 2, C) <br /> ❑ Table 19. Emergency demand reduction conditions,triggers and actions (Part 2, C) <br /> ❑ Table 20. Plan to Inform Customers Regarding Conservation Requests,Water Use <br /> Restrictions, and Suspensions (Part 2,C) &discussion of restriction authority <br /> ❑ Appendix S: Emergency Telephone List <br /> ❑ Appendix 6: Cooperative Agreements for Emergency Services <br /> ❑ Appendix 7: Municipal Critical Water Deficiency Ordinance <br /> 4 <br />