2007 Drinking Water Infrastructure

Needs Survey and Assessment

U.S. Environmental Protection Agency

	Washington, DC 20460 

	

Please verify or correct the following information:

	Check if Correct as Printed	Corrected Information

(Fill in only if preprinted information is missing or incorrect)

Name of System (Community): 	(

	Name of Contact: 

Street Address:

City, State, and Zip: 	(

	Population Served (if seller, include population of systems sold to):	(

	Number of Connections (not including those in consecutive systems): 	(

	Total System Design Capacity:     ____________ MGD

Source Water Type (Ground, Surface/GWUDI, etc.): 	Check All That Apply: 
(	 Ground 			(  Surface/GWUDI

	(	 Purchased Ground 			(  Purchased Surface/GWUDI

Ownership Type: 	Check All That Apply:	(	 Public 		 (  Investor-Owned or


	(	 Federal Government  		Private Non-Profit



Public reporting burden for this collection of information is estimated
to average X hours per response. This estimate includes time for
reviewing the instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the
information collected. Burden means the total time, effort, or financial
resources expended by person(s) to generate, maintain, retain, or
disclose or provide information to or for a Federal Agency. This
includes the time needed to review instructions; develop, acquire,
install, and utilize technology and systems for the purposes of
collecting, validating, and verifying information; adjust the existing
ways to comply with any previously applicable instructions; search data
sources; complete and review the collection of information; and transmit
or otherwise disclose the information. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The
OMB control numbers for EPA’s regulations are listed in 40 CFR Part 9
and 48 CFR Chapter 15. 

Send comments on the Agency’s need for this information, the accuracy
of the provided burden estimates, and any suggested methods for
minimizing respondent burden, including through the use of automated
collection techniques to the Director, OPPI, Regulatory Information
Division, U.S. Environmental Protection Agency (1804A), Ariel Rios
Building, 1200 Pennsylvania Ave., NW, Washington, DC 20460; and Office
of Information and Regulatory Affairs, Office of Management and Budget,
725 17th Street, N.W., Washington, DC 20503.



State Use Only

Information provided for this survey can be requested by the public;
however, EPA will not release the names and addresses of respondents.
Also it is our experience that survey information is rarely requested.
Source, Treatment, Storage, and Pumping Inventory

To ensure all potential source, treatment, and storage projects are
considered, it may be helpful to complete some or all of this inventory
table.  However, completion of this table is not required. 

Source Water

Inventory	Needing Replacement	Needing Rehabilitation	New Infrastructure
Needs

Total Number and Capacity of Existing Wells or Springs: 

		Wells (including pumps) or Springs:

		Wells (including pumps) or Springs:

  

			Does your system have additional source water capacity needs to meet
the needs of current users? (check one)

Yes ___	 No ___	______

Total Number and Capacity of Existing Surface Water Sources:         
_____________________________	Existing Surface Water Intakes (excluding
pumps): 

		Existing Surface Water Intakes (excluding pumps): 

         		If yes, how many additional sources are necessary? 

Total Number and Capacity of Existing Pumps:

		Existing Pumps (but not wells): 		Existing Pumps (but not wells): 	



Existing Raw Water Pumps: 		Existing Raw Water Pumps: 	

	Treatment

Inventory	Needing Replacement	Needing Expansion/Upgrading or
Rehabilitation	New Infrastructure Needs

For the sources identified above, enter the number of locations where
the following treatment is applied:

	Disinfection (including booster 

disinfection): 		Disinfection: 	 	Disinfection:		Does your system have
additional treatment needs for provision of additional public health
protection or for aesthetic concerns? (check one) 

Yes ___ No ___

If yes, what additional treatment is necessary?

Filtration: 		Filtration:		Filtration: 	

	Chemical removal or addition: 

		Chemical treatment: 		Chemical treatment: 	

	Storage and Pump Stations

Inventory	Needing Replacement	Needing Rehabilitation	New Infrastructure
Needs

Total Number and Capacity of Existing Storage Tanks:

 		Number of Existing Elevated or Ground-Level Storage Tanks:

 	________________________	Number of Existing Elevated or Ground-Level
Storage Tanks:

 	_________________________	Does your system have additional storage
capacity and/or booster pumping needs to meet the needs of current
users? (check one) 

Yes 	   No 	_   

If yes, how much additional finished water storage or booster pumping
capacity is necessary?

Total Number and Capacity of Existing Booster Pump Stations: 

		Number of Existing Booster Pump Stations: 

	________________________	Number of Existing Booster Pump Stations: 

	_________________________

	Source, Treatment, Storage, and Pumping Projects

Project

Number	Project Name	Type of Need

(List 1)	Reason for Need

(List 2)	New,

Replace,

Re-

Habilitate, Expand	Current

or

Future	Regulation

(List 3)

(if applicable)	Design Capacity (MG, MGD, kW)	Number Needed

(if applicable)	Cost Estimate

(if available)	Date of Cost Estimate

(Month/

Year)	Documen-

tation

(List 4)

Ex. 1	Replace Wells 3 and 8	R1	A1	R	C	4A	0.5	2	-	-	6, 10

Ex. 2	Rehab Treatment Plant and Booster Station	T10	A1,A6	H	F	1A	5.0	1
$6,027,000	12/05	4

1000











	1001











	1002











	1003











	1004











	1005











	1006











	1007











	

If you have more source, treatment, storage, or pumping projects check
this box ( and continue on a supplemental sheet (included in this
package or downloadable at www.DWNeeds.com). Project numbers for these
types of projects are 1000-1999, and should be numbered in sequence.

EPA requires documentation of all projects provided.  Applicable types
of documentation are presented in List 4 of the Lists of Codes.

Use only existing documentation of cost.  We do not expect you to
develop new cost estimates.





Transmission and distribution projects are the piping needs of a water
system.  Projects for valves, hydrants, and meters that are not part of
a transmission or distribution project listed in this table should be
recorded in the table on page 7.

Transmission and Distribution Inventory

On the table below, please provide an estimate of the total feet or
miles of pipe in your system, if possible.  Completion of this table is
not required, but it may be helpful to ensure all potential transmission
and distribution pipe projects are considered.  

Note:  The total feet or miles or pipe in your system is required
information if any pipe projects are submitted based solely on
survey-generated documentation (documentation codes 10 or 11).
______________	Total feet or miles of pipe in system



	Total Pipe in System	 

 	<=6 inch

8-12 inch

15-42 inch

>=48 inch



PVC

Feet or miles

Amount of PVC by pipe size	 	feet or miles	 	feet or miles	 	feet or
miles	 	feet or miles



	% of total pipe

% of PVC currently in poor 

condition or beyond useful life	 	%	 	%	 	%	 	%

















Ductile Iron

Feet or miles

Amount of ductile iron by pipe size	 	feet or miles	 	feet or miles	 
feet or miles	 	feet or miles



	% of total pipe

% of ductile iron currently in poor 

condition or beyond useful life	 	%	 	%	 	%	 	%

















Cast Iron

Feet or miles

Amount of cast iron by pipe size	 	feet or miles	 	feet or miles	 
feet or miles	 	feet or miles



	% of total pipe

% of cast iron currently in poor 

condition or beyond useful life	 	%	 	%	 	%	 	%

















Asbestos Cement

Feet or miles

Amount of asbestos cement by pipe size	 	feet or miles	 	feet or miles
 	feet or miles	 	feet or miles



	% of total pipe

% of asbestos cement currently in poor condition or beyond useful life
 	%	 	%	 	%	 	%

















Other

Feet or miles

Amount of other by pipe size	 	feet or miles	 	feet or miles	 	feet
or miles	 	feet or miles



	% of total pipe

% of other currently in poor 

condition or beyond useful life	 	%	 	%	 	%	 	%















	

Transmission and Distribution Projects 

Project

Number	Project Name	Type of Need

(List 1)	Reason for Need

(List 2)	New,

Replace, or

Re-

Habilitate	Current

or

Future	Regulation

(List 3)

(if applicable)	Diameter of Pipe (Inches)	Length of

Pipe

(Feet)	Cost Estimate

(if available)	Date of Cost Estimate

(Month/Year)	Documen-

tation

(List 4)

Ex. 1	Cleaning and Lining Old Cast Iron Mains	M1	A1	H	C	4A	12	18,000	-	-
11

Ex 2	Replace Deteriorated Transmission Main	X2	A1	R	C	4A	24	20,000
$4,200,000	06/05	1

2000











	2001











	2002











	2003











	2004











	2005











	2006











	2007











	

If you have more transmission or distribution projects check this box (
and continue on a supplemental sheet (included in this package or
downloadable at www.DWNeeds.com). Project numbers for transmission or
distribution projects are 2000-2999, and should be numbered in sequence.

EPA requires documentation of all projects provided.  Applicable types
of documentation are presented in List 4 of the Lists of Codes.

Use only existing documentation of cost.   We do not expect you to
develop new cost estimates.



Backflow Prevention Devices/Assemblies, Hydrants, Service Lines, Valves,
Water Meter, and Other Inventory

Although these needs may fit into the other categories of the
questionnaire, projects for backflow prevention devices and assemblies,
hydrants used to flush water mains, service line replacement, and other
items such as valves and meters are recorded in this section to
accommodate entries of multiple identical items on one line in the
project table. 

Record only projects that are not a part of another project (e.g., water
main replacement projects will already include valves, hydrants and
other appurtenances).



To ensure all potential projects are considered, it may be helpful to
complete some or all of this inventory table.  However, completion of
this table is not required.  

Inventory	Needing Replacement	Needing Rehabilitation	New Infrastructure
Needs

Total Number of Existing Valves (gate, butterfly, PRVs, altitude, etc.):

		Number of Valves:

		Number of Valves:

		Number of Valves:

	

Total Number of Existing Water Meters:  

		Number of Water Meters:

		Number of Water Meters:

		Number of Water Meters:

	

Total Number of Existing Hydrants for Flushing Water Mains: 

		Number of Hydrants for Flushing Water Mains:

		Number of Hydrants for Flushing Water Mains:

			Number of Hydrants for Flushing Water Mains:

		

Total Number of Lead Service Lines: 

		Number of Lead Service Lines:

		Number of Lead Service Lines:

			Number of Lead Service Lines:

		

Total Number of Backflow Prevention Devices/Assemblies:

		Number of Backflow Prevention Devices/Assemblies:

		Number of Backflow Prevention Devices/Assemblies: 

			Number of Backflow Prevention Devices/Assemblies: 

		

Total Number of Other Items (generators, security components, well
houses, computer hardware, etc.):

		Number of Other Items:

		Number of Other Items: 

			Number of Other Items: 

		

Backflow Prevention Devices/Assemblies, Hydrants, Service Lines, Valves,
Water Meter, and Other Projects

Please do not list any component that is included in a pipe replacement
or rehabilitation project listed on the Transmission and Distribution
Project Table.  If you listed any pipe replacement or rehabilitation
project without a cost, EPA will assign a cost using a model that
includes all these components. 

Project

Number	Project Name	Type of Need

(List 1)	Reason for Need

(List 2)	New,

Replace, or

Re-

Habilitate	Current

or

Future	Regulation

(List 3)

(if applicable)	Size (Diameter in Inches)	Number Needed	Cost Estimate

(if available)	Date of Cost Estimate

(Month/Year)	Documen-

tation

(List 4)

Ex. 1	New valves to isolate sections of distribution	M5	A11	N	C	4A	12	16
-	-	11

Ex. 2	Replace Lead Service Lines	M2	A7	R	C	1D	-	100	$100,000	5/04	9, 11

3000











	3001











	3002











	3003











	3004











	3005











	

If you have more of these types of projects check this box ( and
continue on a supplemental sheet (included in this package or
downloadable at www.DWNeeds.com). Project numbers for these types of
projects are 3000-3999, and should be numbered in sequence.

EPA requires documentation of all projects provided.  Applicable types
of documentation are presented in List 4 of the Lists of Codes.

Use only existing documentation of cost.  We do not expect you to
develop new cost estimates.



Respondent Information

Please provide the following information in case we need to contact you
for clarification or additional explanation of any of your responses. 

Contact Person (Person who completed this questionnaire):



Signature:  		

Name (please print):  		

Title:  		

Mailing Address:		

(Street Address) 

			

			

	

Telephone Number:  		

Fax Number:  		

E-mail Address:  		

Best Time to Reach You:  		

If you have any questions, contact {State Contact} at {State Contact
Phone Number} or e-mail to {State Contact E-Mail} or call the U.S. EPA
toll-free Needs Survey Helpline at 1-888-XXX-XXXX.



CLOSING: Thank you for your help. Did you remember to:

	Attach all additional project tables to the questionnaire? 

	Identify, by project number, available documentation for all needs and
costs reported above?

	Put the questionnaire and the documentation in the pre-paid,
pre-addressed Federal Express Pak provided and return this questionnaire
	and the documentation to the address below?  (See the pink enclosure
for further return instructions.)

Jane Q. Official

Division of Water

State Environmental Department

One Capital Street

Capital, XX 99999

2007 Drinking Water Infrastructure 

Needs Survey and Assessment 

Instructions

Please take a few minutes to read through these instructions, 

 the Lists of Codes (blue booklet), and the questionnaire before
beginning.

What is the Purpose of the Survey?

The 2007 Drinking Water Infrastructure Needs Survey and Assessment
(Assessment) captures the 20-year (January 1, 2007 to December 31, 2026)
infrastructure needs of public water systems eligible for Drinking Water
State Revolving Fund (DWSRF) monies and reports those needs to Congress.
The DWSRF provides low interest loans and other forms of financial
assistance to water systems.

The results of this survey document the total national and
state-specific infrastructure need for drinking water systems and are
used to allocate DWSRF monies to the states for fiscal years 2010
through 2013. Your participation is critical to the success of the
survey and to your state’s DWSRF allotment.

How Does the Survey Work?

	

Approximately 3,500 of the 55,000 community water systems across the
country have been selected to participate in the survey to report their
20-year need. 

The needs of each participating system are extrapolated to represent the
total need for each state.  State needs are summed to produce an
estimate of the national need. 

What is My Role? 

Your role is to assess your water system’s infrastructure and record
projects necessary to meet the needs of current water users over the
next 20 years 

Each project must be documented or described to show it would address a
current or future water quality and/or quantity deficiency.  Whenever
possible, please use existing documentation such as a capital
improvements plan (CIP) or master plan. 

If at all possible, please provide any existing project cost estimates. 
However, do not generate a cost estimate for this survey.  If a project
does not have a documented cost estimate, please provide design
parameters (e.g., length and diameter of pipe needed) so EPA can model
the costs. 

 How Do I Identify Projects to Be Included?

Begin by referring to any planning documents available for your system. 
Projects listed in your CIP or Master Plan are likely to be allowable
needs.  You may also refer to the 2003 Needs Survey if your system
participated.

Next, review your system inventory and consider projects that may not be
included in your planning documents but that you are aware you will need
to address within the next 20 years.  The inventory tables presented
with each project table in the questionnaire are provided to help you
identify your needs.

Use “List 1 - Type of Need” in the accompanying Lists of Codes (blue
booklet) to help prompt you to consider the types of projects to be
included.

Include projects for necessary new infrastructure, or to replace or
rehabilitate existing infrastructure, or in the case of a treatment
plant, to expand/upgrade the plant. 

Current and Future Needs – Include projects that are needed now as
well as projects that will be necessary over the next 20 years to
address the needs of your existing customer base.  However, do not
include projects to encourage future growth as discussed in the next
section.

Include only one project to address any given piece of infrastructure. 
For example, if you have a project for the construction of a tank, do
not include the subsequent rehabilitation of that tank in 15 years.

Include only projects that have not yet begun construction.  If a
project has begun construction as of January 1, 2007, do not include it.
 You may, however, include future phases of a project if it will be
built in phases. 

What Types of Projects Should Not Be Included?

Projects or costs that are not SRF-eligible:

Projects solely for fire flow, fire protection, or ISA ratings 

Projects solely to meet demand of expected future growth or to encourage
future expansion or development that are not also necessary to meet the
needs of existing customers

Projects for land acquisition not necessary for siting of an
infrastructure component (e.g., land purchase to locate a tank would be
eligible) 

Projects for dams or raw water reservoirs

Projects or costs that are not for capital improvements:

Projects for studies or watershed control programs

Operations and maintenance needs/costs, laboratory analytical  costs, or
sample collection

Costs associated with staff

Loan interest and fees

Projects that are not associated with public health protection:

Landscaping or other projects for appearance

If documentation implies a project is for one of the above reasons, but
you are aware of additional reasons the project is needed, you may
provide a signed statement clarifying why the project would address an
allowable need.

How is the Questionnaire Organized?

The questionnaire consists of three separate tables on which projects
are recorded. The tables address the categories of the type of projects
listed below:

Source, Treatment, Finished or Treated Water Storage, and Pumping,
Projects.

Transmission and Distribution Projects.

Backflow Prevention Devices/Assemblies, Hydrants, Service Lines, Valves,
Water Meters, and Other Projects.

The questionnaire also includes water system inventory tables
accompanying each project table.  While NOT REQUIRED, completing these
tables can help you to consider your system’s entire inventory and
assess what parts of your system’s infrastructure may need
improvement.  

How Do I Provide Project Documentation?

Every project recorded on the questionnaire must be accompanied by
documentation that discusses the reason the project is needed.  In
addition, in order to assign a cost to a project, you must provide
either an existing documented cost estimate or sufficient information
for the project to be assigned a cost based on cost models.  

Documentation Types - See List 4 in the List of Codes for specific types
of documentation.  The two types of documentation are:

Independent – generated through a process independent of this survey
(examples include a CIP, master plan, laboratory results, or bid
tabulation).  

Survey-generated – written by you or the state specifically for the
purposes of this survey.  It must include project details such as age,
condition, or associated problems.

Documentation of Need

Documentation must provide enough information to indicate that project
is for an allowable need.  If an independent document is not available
or does not specifically address why a project is needed, please provide
a signed statement indicating why the project is needed (see example
above).

Documentation of need must be less than 4 years old.  If you have
documentation dated prior to January 1, 2003, please supplement this
with a signed statement indicating whether the project is still needed,
whether it started construction by January 1, 2007, and if it is still
within its original scope.

Documentation of Cost

EPA needs either a cost estimate or enough information to model the cost
of each project.

Cost estimates must be from independent documentation such as a CIP,
master plan, or bid tabulation.  Please indicate the date the estimate
was generated, and EPA will adjust for inflation to current year
dollars.  Do not adjust costs yourself.

Cost estimates must be less than 10 years old (after January 1, 1997).

If there is no independent estimate of cost for a project, simply
include the modeling parameters (design capacity in MG or MGD, length
and diameter in feet and inches, and number needed) so EPA can estimate
the cost.

How Do I Represent a Project on the Questionnaire? 

 

Familiarize yourself with the Lists of Codes booklet and the
questionnaire.

Pages 1 and 2 of the Instructions and Lists of Codes booklet have
important information about the data collected on the questionnaire.

The questionnaire has examples of projects at the beginning of each
table.

Enter a project title and the appropriate codes across each row for each
project you have identified.  

Document the need for all projects and any cost estimates that are
recorded.  Identify each piece of documentation by the related project
number.

Enclose the necessary documentation for each project with the completed
questionnaire.

If you need additional pages for a table, they have been provided.  Make
copies of blank sheets before beginning.



Project Examples and Helpful Hints

Project

Number	Project Name	Type of Need

(List 1)	Reason for Need

(List 2)	New,

Replace, or

Re-

Habilitate	Current

or

Future	Regulation

(List 3)

Diameter of Pipe (Inches )	Length of

Pipe

(Feet)	Cost Estimate

(if available)	Date of Cost Estimate

(Month/Year)	Documen-

tation

--       	--	11

2001	Replace Deteriorated Transmission Main	X2	A1	R	C	4A	24	20,000  
$4,200,000 	06/05	1



Project

Number	Project Name	Type of Need

(List 1)	Reason for Need

(List 2)	New,

Replace,

Expand, Re-

Habilitate 	Current

or

Future 	Regulation

(List 3)

(if available )    	Design Capacity (MG, MGD, kW)	Number Needed

(if applicable)	Cost Estimate

(if available)	Date of Cost Estimate

(Month/

Year)	Documen-

tation

 PAGE   

 PAGE   2 

 PAGE   

 PAGE   8 

Source Projects are all projects related to collecting and pumping raw
water.  This includes wells, surface water intakes, springs, off-stream
raw water storage, pumps, and well houses.

Treatment Projects are all projects related to disinfection, filtration,
or other treatment processes for ground or surface water sources, or for
treatment applied in the distribution system.

Storage and Pumping Projects are related to finished or treated water
storage, and booster pump stations.

OMB No.: XXXX-XXXX

Approval Expires:  XX/XX/XX 

Federal PWSID No.: XX0000000

Current Need – projects that are needed now, even if you may not be
able to start immediately due to budget or other issues.

Future Need – projects that you know will be necessary over the next
20 years, but are not needed immediately (example: a currently
operational storage tank that will require rehabilitation in 15 years).

Future Growth – projects associated with encouraging growth or based
on speculative growth - these are not allowable.

	

DRAFT version 8/4/06

What is a “need?”

For the purposes of the Assessment, a “need” is a project related to
installation or major rehabilitation of capital infrastructure required
now or within the next 20 years to continue to provide safe drinking
water to your consumers.  Infrastructure needs are those that will
preserve the physical integrity of the water system and protect public
health.

What am I asked to do?

Read all materials

Identify 20-year project needs from January 1, 2007 through December 31,
2026

Record projects and identify documentation

Send completed survey and documentation to the state by March 2, 2007 or
call the state to make other arrangements.

Some project types require independent documentation of need (such as a
CIP, Master Plan, or laboratory results):

New Surface Water Sources

New Aquifer Storage and Recovery Wells

New Treatment Plants 

Replacement of an Existing Treatment Plant

Expansion/Upgrade of an Existing Treatment Plant

Example of Survey-generated Documentation:

“Project 1006 is for a new well to replace the existing well.  The
existing well was drilled in 1957.  It has never had any major work done
other than replacing the pump.  It has lost production capacity
substantially due to iron build up on the screen.  In addition,
subdivision development with on-site septic systems in the area of the
well has compromised the source’s water quality.  We need to replace
this well with a new source in the northeast section of town.”

How do I submit large pieces of documentation?

If you’re using a large document such as a CIP, you may submit the
entire document or make copies of the pertinent pages. 

If you choose to send only pertinent pages, be sure to include a copy of
the front page with the document title and date.

Please mark up the documentation indicating where each project is
discussed.  Use tabs, highlighters or simply write the project number in
the margin of each applicable page.

An electronic version of this questionnaire package and other materials
that may be useful for completing the questionnaire, such as a complete
dictionary of types of need, are available for downloading at  
HYPERLINK "http://www.2007needs.com"  www.DWNeeds.com .

Also, if you have questions, please call your state's Assessment contact
or the toll-free Assessment Helpline at 1-800-xxx-xxxx.  All contact
information is provided on the last page of the questionnaire.

Descriptive project name is used.

Modeling parameters provided when available, even if cost is also
provided.

Cost and date of cost provided.  Date allows cost to be updated to 1/07
dollars by EPA.

The appropriate codes or where to find them are identified in each
column.

Two wells at 0.5 MGD capacity each need to be rehabilitated and the cost
will be modeled.

All applicable types of documentation recorded.

The appropriate codes or where to find them are identified in each
column.

Two reasons for need are recorded; more than one code can be used.

More than one type of need may be appropriate, but only if cost is
provided.

Regulation code is recorded when applicable, or 4A is used if none
apply.

