CONSUMER CONFIDENCE REPORT TEMPLATE INSTRUCTIONS

(Please read all of these instructions carefully)

Prior to preparing your Consumer Confidence Report (CCR) Template, you should obtain:

(1) water testing results,

(2) violation information (if applicable), and

(3) waiver information (if applicable).

The CCR Template form is primarily intended for the smaller community water systems, serving 500 or fewer persons. Larger community water systems are encouraged to develop their own CCR format.

I. Owner/Operator of Public Water System

Please fill in the owner/operator's name, the public water system's name, Public Water System Identification Number (PWSID #), mailing address (i.e. street or P.O. Box, City, State and Zip Code) telephone number and fax number (if available).

(If applicable) In communities with a large proportion of non-English speaking residents (e.g. French Canadian's), the report must contain information in the appropriate language regarding the importance of the report or contain a telephone number or address where such residents may contact the system to obtain a translated copy of the report or assistance in the appropriate language.

The systems must also include information about opportunities for public participation, such as time and place of regularly scheduled meetings. Otherwise, indicate: "Upon request".

Each report must contain data collected during the previous calendar year (January - December).

II. Water Source

Please fill in the source(s) of the water delivered by the community water system. Indicate the depth and location of each well. If the source is a waterbody, please fill in commonly used name and the location. Attach a Delorme Atlas, U.S.G.S. topographic map or sketch a site map on the reverse side. (If applicable) Describe water treatment and filtration, e.g. chlorination and carbon filter.

Describe water system's susceptibility to potential sources of contamination. The report must notify consumers of the availability of the source water assessment information and the means to obtain it. For more information about the source water assessment, you may contact the DWP at telephone (207) 287-3194.

III. Variance, Exemption and/or Waiver(s)

Please complete this section of the report only if it applies to your water system. If your water system has no variance, exemption and/or waiver -- please indicate "N/A". If a water system has been granted a variance, exemption and/or waiver, the report must contain:

(1) the start and end dates;

(2) a brief description variance, exemption and/or waiver;

(3) a 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 for the variance, exemption and/or waiver; and

(4) a notice of any opportunity for public input in the renewal of the variance, exemption and/or waiver. In lieu of this description, you may attach the "Waiver Summary" provided by the DWP.

IV. Compliance Violations

Please complete this section of the report only if it applies to your water system.If your water system has no violations -- please indicate "Not Applicable" or delete this section. Describe violations of:

(1) monitoring and reporting requirements;

(2) treatment techniques requirements:

(i) filtration and disinfection;

(ii) lead and copper control requirements;

(iii) treatment techniques for Acrylamide and Epichlorohydrin;

(3) public notification/record keeping requirements;

(4) special monitoring requirements; and

(5) any administrative or judicial orders imposed by the DWP.

Include the date of violation(s), a clear explanation of the violation(s), the steps the system has taken to correct the violation(s), and any potential adverse health effects (refer to Appendix B).

Filtration and Disinfection Violations: For systems which have failed to install adequate filtration or disinfection equipment processes, the CCR Template must include the following:

"Inadequately treated water may contain disease causing organisms. These organisms include bacteria, viruses, and parasites which can cause symptoms such as nausea, cramps, diarrhea, and associated headaches."

V. Definitions

These five definitions in the CCR Template meet the minimum requirements of the Consumer Confidence Report. The wording must be used as presented.

VI. Health Information

Inclusion of this health information statement is a mandatory requirement of the Consumer Confidence Report.

VII. Level of Detected Contaminants

Please report lab data from the calendar year the CCR covers (e.g. 1998 test results for the 1998 CCR) or, if there are no lab results available, go back to the last available test result no older than five years. List the detected amount for each of the regulated contaminants in Appendix A, below the column labeled “Test Results”. Alternatively, you may attach “Water Test Results” provided by the DWP. Any contaminant which exceeds the Maximum Contamination Level (MCL) must be clearly identified or highlighted. If the contaminant was below detection limit (BDL), less than (<), or zero - then indicate "BDL" or line out the corresponding row.

Include the following contaminants in the table only if applicable, as follows:

Cryptosporidium: If the system has performed any monitoring for Cryptosporidium which indicates that it may be present in the source water or the finished water, the report must include:

(1) a summary of the results of the monitoring; and

(2) an explanation of the significance of the results.

Radon: If the system has performed any monitoring for Radon which indicates that it may be present in the finished water, the report must include:

(1) the results of the monitoring;

an explanation of the significance of the results; and
the following statement:

"Radon is a naturally occurring radioactive 4 gas that may cause cancer, and may be found in drinking water and indoor air. You should test your house and fix it if you find a level of 4 pCi/L or higher. Some states and water suppliers are now working on programs that will reduce your exposure to radon both in air and drinking water. You can help develop the program for your area. For more information, call EPA's Radon Hotline at (1-800-SOS-RADON) or visit the web site at http://www.epa.gov/iaq/radon/."

Arsenic: A system which detects Arsenic at levels above 25 ppb, but below the MCL, must include the following statement:

" U.S. EPA is reviewing the drinking water standard for Arsenic because of special concerns that it may not be stringent enough. Arsenic is a naturally occurring mineral known to cause cancer in humans at high concentrations."

If test results are between 6 ppb and 10 ppb, then the following informational statement is required:

“While your drinking water meets EPA’s standard for arsenic, it does contain low levels of arsenic. EPA’s standard balances the current understanding of arsenic’s possible health effects against the costs of removing arsenic from drinking water. EPA continues to research the health effects of low levels of arsenic, which is a mineral known to cause cancer in humans at high concentrations and is linked to other health effects such as skin damage and circulatory problems.”

Nitrate: A system which detects Nitrates at levels above 5 ppm, but below the MCL, must include the following statement:

"Nitrate in drinking water at levels above 10 ppm is a health risk for infants of less than six months of age. High nitrate levels in drinking water can cause blue baby syndrome. Nitrate levels may rise quickly for short periods of time because of rainfall or agricultural activity. If you are caring for an infant you should ask advice from your health care provider."

Lead: A system which detects Lead above the action level in more than 5%, and up to and including 10% of the homes sampled, must include the following statement:

"Infants and young children are typically more vulnerable to Lead in drinking water than the general population. It is possible that Lead levels at your home may be higher than other homes in the community as a result of materials used in your home's plumbing. If you are concerned about elevated Lead levels in your home's water, you may wish to have your water tested and flush your tap for 30 seconds to 2 minutes before using tap water. Additional information is available from the Safe Drinking Water Hotline (1-800-426-4791)."

Other Unregulated Contaminants: If the system has performed additional monitoring which indicates the presence of other contaminants in the finished water, the system must determine if the U.S. EPA has proposed a National Primary Drinking Water Regulation (NPDWR) or issued a health advisory for that contaminant by calling the Safe Drinking Water Hotline (800-426-4791). If an NPDWR has been proposed or a health advisory has been issued, the report may include:

(1) the results of the monitoring; and

(2) an explanation of the significance of the results noting the existence of a health advisory or a proposed regulation.

Additional monitoring results may be displayed on 8 ½" x 11" sheets attached to Appendix A.

VIII. Health Effects Language

For each regulated contaminant which exceeds the MCL, the system must make the appropriate reference in Appendix B to describe the potential health effects. *Note: If there were no MCL exceedances, or violations then you may detach and discard Appendix B.*

IX. Certification

The owner/operator must type or print (legibly) his/her first and last name. The owner/operator’s signature is required below the certification statement to certify delivery of the CCR to all of the users. Certification is due within 3 months of report delivery.

X. Report Delivery

Each community water system must mail the Drinking Water Program a copy of the report to be distributed to your customers. Please send report to:

Attn: Scott Whitney

State of Maine Dept. of Human Services

Drinking Water Program

11 State House Station

Augusta, Maine 04333-0011

Basic Delivery Requirements: Each community water system must mail (or hand deliver) one copy of the report to each person served by the water system. In addition, the system must make a good faith effort to reach consumers who do not get water bills, using means recommended by the State Drinking Water Program. Each community water system must make its reports available to the public upon request.

Record Keeping: Any system subject to this subpart must retain copies of its CCR for no less than 5 years.

DWP INFORMATION