ATTACHMENT “A”

Annual Regulatory Water Quality Report to

The Ministry of the Environment (MOE)

Covering the period from

January 1, 2004 to December 31, 2004

In compliance with

Ontario Drinking Water Systems Regulation 170/03

Annual Regulatory Report to MOE Submission

February 25, 2004

FAX COVER PAGE

FAX to: Laboratory Services Branch, Ministry of the Environment (416) 235-6312

Laboratory Services Notification

Schedule 6 ( Subsection 6-9 (4))

This package of forms has been developed for making the submissions to the Ministry of the

Environment specified by the provisions of Ontario Regulation 170/03.

The most current versions of these forms are posted on the Ministry of the Environment web

site www.ene.gov.on.ca. These forms are to be completed and submitted by following the

instructions posted with the forms. Each submission will consist of Part I (determination of the

category of the system) Part II (contact information) and Part III, Form 6 Laboratory Services

Notification Form.

This Drinking-Water System name (DWS) is:

The owner of this Drinking-Water System is:

The DWS owner’s telephone number is:

.. This submission is part of a New Registration of a Drinking Water System

.. This submission is part of an Update of Existing Registration Information

The Drinking-Water System number is:

Part III Form 6

Schedule 6 ( Subsection 6-9 (4))

IDENTIFYING THE LABORATORY THAT WILL CARRY OUT LABORATORY TESTING

As specified in Ontario’s Drinking-water Systems Regulation O. Reg. 170/03, this form must be completed and delivered to the

Ministry of the Environment prior to the laboratory analyzing your water samples for required parameters for the first time. Once you

have completed this form, you do not need to re-submit it unless there are any changes in a laboratory being contracted to analyze any

required parameter (i.e. Section 2 of this form). Please note that this form is to be used for the identification of Regulation testing and

not for the purpose of the Engineer’s Report testing. Failure to notify the parties in accordance with the Regulation and/or

submission of false information constitutes an offence. All testing for Ontario Drinking-Water Quality Standards and health-

related parameters required in a MOE Certificate of Approval, Order or Direction must be performed by a licensed

laboratory.

SECTION 1 – SUBMISSION INFORMATION

Date of Submission: (yyyy/mm/dd)

For Ministry Use Only

Date Received: (yyyy/mm/dd)

. New Submission

. Updated Submission

SECTION 2 – CONTRACTED LABORATORY(S) HIRED TO ANALYZE DRINKING -WATER

SAMPLES AND THE SPECIFIC PARAMETERS TESTED

Contracted Laboratory

Name of Contracted Laboratory:

Laboratory Address:

Street No. and Name

Town/City

Postal Code

Phone:

Fax:

Email:

Check all tests that Contracted Laboratory has been contracted to perform:

MICROBIOLOGICAL:

Membrane Filtration

Presence/Absence

HPC

MPN

.. E. coli

.. Fecal coliforms

.. Total coliforms

.. Total coliform (Background)

.. E. coli

.. Fecal coliforms

.. Total coliforms

.. HPC – Membrane

Filtration

.. HPC – Spread Plate

.. HPC – Pour Plate

.. E. coli

.. Total coliforms

CHEMICAL PARAMETERS:

Volatile Organic Parameters:

Inorganic Parameters:

.. 1,2-dichlorobenzene

.. 1,4-dichlorobenzene

.. 1,2-dichloroethane

.. 1,1-dichloroethylene

.. Benzene

.. Carbon tetrachloride

.. Dichloromethane

.. Monochlorobenzene

.. Tetrachloroethylene

.. Trichloroethylene

.. Trihalomethanes (Total)

.. Vinyl chloride

.. Antimony

.. Arsenic

.. Barium

.. Boron

.. Cadmium

.. Chromium

.. Fluoride

.. Lead

.. Mercury

.. Nitrate + Nitrite (as

nitrogen)

.. Selenium

.. Sodium

.. Uranium

.. All of the Above Volatile Organic Parameters

.. All of the Above Inorganic Parameters

Pesticide and General Organic Parameters:

.. 2,3,4,6-tetrachlorophenol

.. 2,4-dichlorophenol

.. 2,4,6-trichlorophenol

.. 2,4-D

.. 2,4,5-T

.. Alachlor

.. Aldicarb

.. Aldrin + Dieldrin

.. Atrazine +

Metabolites

.. Azinphos-methyl

.. Bendiocarb

.. Benzo(a)pyrene

.. Bromoxynil

.. Carbaryl

.. Carbofuran

.. Chlordane (Total)

.. Chlorpyrifos

.. Cyanazine

.. DDT + Metabolites

.. Diazinon

.. Dicamba

.. Diclofop-methyl

.. Dimethoate

.. Dinoseb

.. Diquat

.. Diuron

.. Glyphosate

.. Heptachlor

+Heptachlor Epoxide

.. Lindane (Total)

.. Malathion

.. Methoxychlor

.. Metolachlor

.. Metribuzin

.. Paraquat

.. Parathion

.. PCBs (Total)

.. Pentachlorophenol

.. Phorate

.. Picloram

.. Prometryne

.. Simazine

.. Temephos

.. Terbufos

.. Triallate

.. Trifluralin

ADDITIONAL

Other Parameter(s) identified in a MOE certificate of approval, order or direction.

Specify: ________________________________________________________________________________________________

________________________________________________________________________________

COMMENTS:

Prepared by:

Name (Please Print) _______________________________ Telephone No. ________________________

Title ___________________________________________ Date (yyyy/mm/dd) _____________

Text Box: Page 3 of 3Text Box: ? UAll of the AboveU Pesticide and General Organic Parameters

This package of forms has been developed for making the submissions to the Ministry of the Environment

(MOE) specified by the provisions of Ontario Regulation 170/03. Under the provisions of Section 14 the MOE

Director provides these forms for the submissions by Drinking-Water System owners. The Director has required

that these forms be given in the specified electronic format.

The most current versions of these forms are posted on the Ministry of the Environment web site

www.ene.gov.on.ca.

For your initial submission you are required to supply extensive detail about your system so you may find it

useful to print the form and use it to gather the required information before you begin.

New Registration

If you made a submission previously and received a DWS number for your system, enter the DWS number

below along with the DWS name and the owner’s name. Then you need only update the DWS category and

DWS details that have altered since the earlier submission, and complete the submission portions.

Update Existing Registration Information Date of Submission (yyyy/mm/dd):

The number assigned to this Drinking-Water System is:

This Drinking-Water System name is:

The owner of this Drinking-Water System is:

Text Box: Step 1: Save the Part I and II and your Part III submission form(s) (pdf file / MS Word document) locally on your computer.

Step 2: Fill out Part I and II.

Step 3: Fill out the relevant form(s) from Part III,

Step 4: Save the information you entered made by saving the document using Adobe Acrobat/MS Word.

Step 5: Create an e-mail message with the following subject line

For systems without DWS # New <DWS name>, <owner name>, form #

For systems with DWS # Update <DWS name>, <DWS #>, form #

where <DWS name> is the name of your Drinking-Water System,

<owner name> is the name of the owner of your Drinking-Water System,

< DWS #> is the Drinking-Water System number, and

Form # is the number(s) of the Part III form(s) you are submitting.

Step 6: Attach your Parts I, II and III(s) to your e-mail message.

Step 7: Send your e-mail to HTUReg170_FormSubmission@ene.gov.on.caUTH

Please contact the Ministry’s Help Desk by calling 1-866-793-2588 during normal business hours if you require assistance in filling out or in submitting the forms.

PART I

O. Reg. 170/03 defines 8 categories of Drinking-Water Systems and specifies the requirements to be met by

each. The following tool enables you to determine the category of any water system.

Please answer the following questions by placing an X in the appropriate box and follow the

instruction beside it. Once you are finished you will know the category of your system.

Item

Question

Does this Drinking-Water

System (DWS) use electricity

or serve any building or other

structure that uses electricity?

YES If YES, Go to B

NO If NO, Once notices are posted, water fountains

rendered inoperative and Form #1 is submitted

to the director then Go to X

Is this DWS municipal or will

be owned by a municipality

based on O. Reg 170/03?

YES If YES, Go to C

NO If NO, Go to E

Does this DWS serve more

than 100 private residences?

(Definition 1)

YES If YES, This System is Large Municipal

Residential. (Do not answer any further

questions. Please go to PART II)

NO If NO, Go to D

Does this DWS serve more

than 5 but less than 101 private

residences?

YES If YES, This system is Small Municipal

Residential (Do not answer any further

questions. Please go to PART II)

NO If NO, Go to I

Does this DWS serve more

than 5 private residences or a

trailer park or campground

with more than 5 service

connections?

YES If YES, Go to F

NO If NO, Go to G

Does this DWS operate

seasonally (Definition 2)?

YES If YES, This system is Non-Municipal

Seasonal Residential (Do not answer any

further questions. Please go to PART II)

NO If NO, This system is Non-Municipal Year -

Round Residential (Do not answer any further

questions. Please go to PART II)

Does this DWS have a

capacity more than 2.9

litres/sec?

YES IF YES, Go to the Calculation for Non-Municipal

Systems On Page # 5

NO If NO, Go to H

Does this DWS serve a

Designated Facility?

(Definition 3) or a Public

Facility? (Definition 4)

YES If YES, This system is Small Non- Municipal

Non-Residential (Do not answer any further

questions. Please go to PART II)

NO If NO, Go to X

Does this DWS have a

capacity more than 2.9

litres/sec?

YES If YES, Go to calculation for Municipal Systems

on page # 4

NO If NO, Go to J

Does this DWS serve a

Designated Facility or a

Public?

YES If YES, This system is Small Municipal Non-

Residential ( Do Not answer any further

Questions.Please go to PART II)

NO If NO, Go to X

Based on the answers you have given this Drinking-Water System is currently exempt from the

provisions of O. Reg. 170/03. To enable the Ministry to supply you with information that will

assist you to keep up to date with situations which might impact the quality of water you provide

please complete and submit only the information set out in Part II: Drinking-Water System

owner information, operator’s information and Drinking-Water System’s operational

information.

Text Box: Page 3 of 5

CALCULATION FOR MUNICIPAL SYSTEMS

If this Drinking-Water System has one or more distribution lines that supply water exclusively for the listed

operations then this calculation may be undertaken to determine if the impact of these operations should alter

the category of the Drinking-Water System.

QUESTION

YES

If YES

If NO

I) Does your Drinking-Water

System have one or more

distribution lines that supply

water exclusively for either of

the following operations

.. Agricultural

.. Landscaping

.. Industrial or Manufacturing

(including food

manufacturing and

processing)

.. Swimming pool

.. Skating rink construction

.. Maintenance?

Complete the

calculation (A-B)

This system remains a

Large

Municipal

Non-Residential

(Do not answer any further

questions. Please go to

PART II)

CALCULATION

A = Maximum Rate the systems can supply water in litres/sec

B = The Sum of Average rates in litres/sec at which the Drinking-Water System supplied water in the

preceding calendar year to the distribution lines

An estimated sum of the average rates (for the period Jan- Dec) in litres per sec

Calculate A-B

If A-B is equal to or

less than 2.9 litres/sec

Go to J for

municipal systems

If A-B is more than 2.9

litres/sec

This system is

Large

Municipal

Non-Residential

(Do not answer any further

questions. Please go to

PART II)

Text Box: Page 4 of 5

CALCULATION FOR NON-MUNICIPAL SYSTEMS

If this Drinking-Water System has one or more distribution lines that supply water exclusively for the listed

operations then this calculation may be undertaken to determine if the impact of these operations should alter

the category of the Drinking-Water System.

QUESTION

YES

If YES

If NO

I) Does your Drinking-Water

System have one or more

distribution lines that supply

water exclusively for either of

the following operations

.. Agricultural

.. Landscaping

.. Industrial or Manufacturing

(including food

manufacturing and

processing)

.. Swimming pool

.. Skating rink construction

.. Maintenance?

Complete the

calculation (A-B)

This system remains a

Large Non-

Municipal

Non-Residential

(Do not answer any further

questions. Please go to

PART II)

CALCULATION

A = Maximum Rate the systems can supply water in litres/sec

B = The Sum of Average rates in litres/sec at which the Drinking-Water System supplied water in the

preceding calendar year to the distribution lines

An estimated sum of average rates (for the period Jan- Dec) in litres per sec

Calculate A-B

If A-B is equal to or

less than 2.9 litres/sec

Go to H for non-

municipal systems

If A-B is more than 2.9

litres/sec

This system is

Large Non-

Municipal

Non-Residential

(Do not answer any further

questions. Please go to

PART II)

Text Box: Page 5 of 5

PART II COMPLETE FOR YOUR DRINKING-WATER SYSTEM (DWS)

The blank areas within the form will expand to allow you to enter your information.

The number assigned to this Drinking-Water System is

[A] DRINKING WATER-SYSTEM OWNER INFORMATION

Data Element

Please Enter Your Information

Explanation

Name of the Business

that owns the Drinking-

Water System

Full name required

Drinking-Water System

Ownership Type

Please select one of the following which

most closely matches your type:

Commercial/ Conservation Authority/

Corporation/ Crown Corporation/ Federal/

First Nation/ Industrial/ Municipal/

Partnership/ Provincial/ Sole

Proprietorship/School Board

Legal name of Business

Full, legal company name

If your Drinking-Water

System began operation

after June 1, 2003

please enter date

YYYY/MM/DD

Owner’s Mailing Address Information

Street Number

Street Name

Street Type

Street, Road, etc.

Street Direction

N, S, E, W, NE, SW, etc.

Unit / Apt Number

/Suite

Delivery Mode

P.O. Box, R.R., etc.

PO Box/Rural Route #

Delivery Installation

Type

STN, RPO

Delivery Installation

Qualifier

MAIN, A

City/Town

Province/State

Postal Code/Zip

Owner’s Contact Person Details

Courtesy Title

Dr., Miss, Mr., Mrs., Ms.

Contact Name

Contact Name Title

Primary Phone Number

Extension

Fax Number

Mobile Number

Pager Number

E-mail Address

Full E-mail address required.

e.g.: name@company.com

Alternate Contact (if any)

Courtesy Title

Dr., Miss, Mr., Mrs., Ms.

Contact Name

Contact Name Title

Primary Phone Number

Extension

Fax Number

Mobile Number

Pager Number

E-mail Address

Full E-mail address required.

e.g.: name@company.com

[B] DRINKING-WATER SYSTEM – OPERATOR INFORMATION

Data Element

Please Enter Your Information

Explanation

Name of Drinking-

Water System’s

Operator

Full name of operator required

Drinking-Water

System Operator Type

Please select one of the following

which most closely matches your type:

Commercial/ Conservation Authority/

Corporation/ Crown Corporation/

Federal/ First Nation/ Industrial/

Municipal/ Partnership/ Provincial/

Sole Proprietorship/ School Board

Legal Name of

Business

Full, legal company name of operator

Operator’s Mailing Address Information

Street Number

Street Name

Street Type

Street, Road, etc.

Street Direction

N, S, E, W, NE, SW, etc.

Unit/Apt Number

/Suite

Delivery Mode

P.O. Box, R.R., etc.

PO Box/Rural Route #

Delivery Installation

Type

STN, RPO

Delivery Installation

Qualifier

MAIN, A

City/Town

Province/State

Postal Code/Zip

Operator’s Contact Person Details

Courtesy Title

Dr., Miss, Mr., Mrs., Ms.

Contact Name

Contact Name Title

Primary Phone

Number

Primary Phone

Number Extension

Fax Number

Mobile Number

Pager Number

E-mail Address

Full E-mail address required.

e.g.: name@company.com

Alternate Contact (if any)

Courtesy Title

Contact Name

Contact Name Title

Primary Phone

Number

Primary Phone

Number Extension

Fax Number

Mobile Number

Pager Number

E-mail Address

[C] DRINKING WATER-SYSTEM’S OPERATIONAL INFORMATION

Data Element

Please Enter Your Information

Explanation

Drinking-Water System Name

In what Municipality is this

Drinking -Water System

located?

Use Ministry of Municipal Affairs and

Housing’s municipal name

Drinking-Water System

Civic Location Address

Street Number

Street Name

Street Type

Street, Road, etc.

Street Direction

N, S, E, W, NE, SW, etc.

Unit/Apt. Number/Suite

City/Town

Postal Code

If system has no street address:

Geographical Township

Lot

Concession

If located in unorganized area

In what Community is this

Drinking-Water System

located?

Operational Parameters

Map Datum

Enter the Geographical Reference

Information for this Drinking Water

System

Geo-Referencing Method

Accuracy Estimate

Location Reference

Latitude

Longitude

Zone

Easting

Northing

Population served

Number of private residences

served

Number of service

connections

Design/ Rated Capacity

Estimate acceptable (in litres/sec)

Is your Drinking-Water

System seasonally operated?

Indicate Yes or No

Seasonal System means a Drinking-

Water System that

a) does not operate for at least 60

consecutive days in every

calendar year or

b) does not operate for at least 60

consecutive days in every

period that begins on April 1

in one year and ends on March

31 in the following year or

c) does not operate for at least 60

consecutive days in a 365 day

period that begins on the day

the Drinking-Water System

begins operation

If yes to above, please specify

operational periods.

Use format: YYYY/MM/DD to

YYYY/MM/DD

Does your Drinking -Water

System shut down for 7 or

more consecutive days during

the operational period?

Indicate with Yes or No

For definition of Seven-day Shutdown

please see last page.

If yes to the above, how many

such shut downs are there in a

year?

Please provide the number of

shutdowns.

For seasonal systems, this refers to

shutdowns during operational periods.

Please specify the period the

system is not in operation for

each shut down

Start date to end date that the DWS is

not in operation

YYYY/MM/DD to

YYYY/MM/DD

[D] DRINKING-WATER SYSTEM CONTACT AT THE LOCATION OF THE DRINKING-WATER SYSTEM OR

THE 24 HOUR 7 DAYS A WEEK CONTACT NUMBER

Courtesy Title

Dr., Miss, Mr., Mrs., Ms.

Contact Name

Contact Name Title

Primary Phone Number

10 Digits + extension if applicable

Fax Number

Mobile Number

Pager Number

E-mail Address

Full E-mail address required.

e.g.: name@company.com

[E] Complete the information for each DESIGNATED FACILITY/ PUBLIC FACILITY served by your Drinking-Water

System if your Drinking-Water System is categorized as:

Small Municipal Non Residential / Large Municipal Non Residential / Large Non Municipal Non Residential / Small Non

Municipal Non Residential / Non Municipal Year-Round Residential / Non Municipal Seasonal Residential

How many designated facilities does your Drinking-water system serve?

Please complete a table for each designated facility.

Data Element

Please Enter Your Information

Explanation

Designated Facility Name

Designated Facility Type

Social care/Children’s Camp/Health Care

Seniors/Health Care/Degree Granting

Institution/ Delivery Agent Care Facility/

School

Are there weeks in the year

when this facility is not in

operation?

Indicate with Yes or No

Please specify the time frame

for each period that the facility

is not in operation

Use format: YYYY/MM/DD to

YYYY/MM/DD

Designated Facility Contact Person Details

Courtesy Title

Dr., Miss, Mr., Mrs., Ms.

Contact Name

Primary Phone Number

Extension

Fax Number

Mobile number

Pager number

E-mail Address

Full E-mail address required.

e.g.: name@company.com

Designated Facility’s Physical Address

Street #

Street Name

Street Type

Street, Road etc.

Street Direction

N, S, E, W, NE, SW, etc.

Unit/Apt. #

Delivery Mode

P.O. Box, R.R., etc.

PO Box/Rural Route #

Delivery Installation Type

STN, RPO

Delivery Installation Qualifier

MAIN, A

City /Town

Postal Code

Interested Authority Information

Name of Interested Authority

e.g.: Ministry of Health and Long-Term Care/

Ministry of Community, Family and

Children’s Services/ Ministry of Education/

Ministry of Training, Colleges and

Universities / Private/ Delivery Agent

PUBLIC FACILITIES

Data Element

Please Enter Your Information

Please provide the names of all

the public facilities served by your

Drinking-Water system

[F] CERTIFICATE OF APPROVAL INFORMATION

The existing Certificate(s)

of Approval Number

Please list the C of A number(s)

Does your drinking-water

system have an order(s) that

require extra sampling and

analysis?

Yes/No

Order number

Order date

YYYY/MM/DD

[G] PROFILE QUESTIONS: IMPORTANT QUESTIONS REGARDING YOUR DRINKING-WATER SYSTEM

Data Element

Please Enter Your Information

Explanation

1) Does your Drinking-Water

System receive water from any

other Drinking- Water System?

Indicate with Yes or No.

2b) If you answered “Yes” to 2(a),

specify the way you receive water

- Transported Water, or

- Through a connection

Indicate either-Transported water,

or -Through a connection.

[2b is for non residential systems only:

1) A large municipal non residential system

2) A small municipal non-residential system

3) A large non-municipal non-residential system

4) A small non-municipal non residential system]

2) Does your Drinking-Water

System supply water to any other

Drinking-Water Systems?

Indicate with Yes or No.

3a) Does your Drinking-Water

System own any of the raw water

sources?

Indicate with Yes (if you own well(s) or intake pipe

in river/lake)

or No

3b) If you answered “yes” to

Q3(a), then indicate the raw water

sources

-well(s)

-Intake pipe in river, lake

Indicate Source Type - Wells, Intake pipe in river/

[H] DRINKING WATER SYSTEM(S) THAT SUPPLY WATER TO YOUR DRINKING WATER SYSTEM

Supplying Drinking-Water

System’s Number

Please provide if available

When do you receive water

from this drinking-water

system?

Intermittently/continuously

Specify the way you receive

the water

Transported Water/Through a connection

Does this Drinking-Water

System provide secondary

disinfection?

Indicate with Yes or No

Secondary disinfection

method

e.g. Chlorination, Chloramination, Ozonation,

Chlorination with Chlorine Dioxide, Ultraviolet

Irradiation, or list any other type

If the Secondary disinfection

method is other than

chlorination or

chloramination, is it approved

by the Director? ( for Large

and Small Municipal

Drinking-Water Systems) Or

is it approved by a

Professional Engineer? (for

other categories of Drinking-

Water Systems)

Indicate with Yes or No

[I]DRINKING-WATER SYSTEM(S) THAT RECEIVE WATER FROM YOUR DRINKING WATER SYSTEM

Receiving Drinking-Water

System’s number

Please provide if available

When do you supply water to

this Drinking-water system

Intermittently/Continuously

[J] DRINKING-WATER SYSTEM USING GROUND WATER SOURCE(S)

Number of wells: ______

Please complete a table for each ground water source.

Data Element

Please Enter Your Information

Explanation

Well Name

Point of Entry Name

A Point of Entry is the point in the system

at which treated water from this source

enters the distribution system or the

treatment location.

Is the ground water under the direct influence of

surface water?

For GUDI definition please refer

definition # 5 on the definition page

Indicate with Yes or No

Is there a written report prepared after August 1,

2000 by a professional engineer or professional

hydrogeologist that concludes the raw water

supply is not ground water under direct influence

of surface water, or

Is there an approval from the Director agreeing

that the raw water supply is not GUDI?

Indicate with Yes or No

If you have answered ‘YES’ to the above

question please specify the date of the

report/approval

Use format: YYYY/MM/DD

Treatment Process Information

Do you have Disinfection?

Indicate with Yes or No

Disinfection Method(s)

E.g. Chlorination, Chloramination,

Ozonation, Chlorination with Chlorine

Dioxide, Ozonation, Ultraviolet

Irradiation, or list any other type

Do you have Coagulation?

Indicate with Yes or No

Do you have Flocculation?

Indicate with Yes or No

Do you have Sedimentation?

Indicate with Yes or No

Do you have Filtration?

Indicate with Yes or No

Filter Medium

Sand/Manganese Greensand/ Anthracite

Coal/ Granular Activated Carbon/ Others.

If Others please specify

Do you have Membrane Filtration?

Indicate with Yes or No

Membrane Filtration Type

Microfiltration/ Ultrafiltration/

Nanofiltration/ Reverse Osmosis/list any

other type

Do you have Alkalinity Adjustment?

Indicate with Yes or No

Do you have pH Adjustment?

Indicate with Yes or No

Do you have a Sludge Blanket Clarifier?

Indicate with Yes or No

Do you have an Upflow Clarifier?

Indicate with Yes or No

Do you have Dissolved Air Flotation?

Indicate with Yes or No

Do you have Fluoridation?

Indicate with Yes or No

Do you have Iron Sequestering?

Indicate with Yes or No

Do you have Softening?

Indicate with Yes or No

Do you have Stripping?

Indicate with Yes or No

Do you have Taste and Odour Control?

Indicate with Yes or No

Do you have Zebra Mussel Control?

Indicate with Yes or No

[K] DRINKING-WATER SYSTEM USING SURFACE WATER SOURCE(S)

Number of surface water sources: ______

Please complete a table for each surface water source.

Data Element

Please Enter Your Information

Explanation

Water Body Name

Point of Entry Information

Point of Entry Name

A Point of Entry is the point in the system

at which treated water from this source

enters the distribution system or the

treatment location

Treatment Process Information

Do you have Disinfection?

Indicate with Yes or No

Disinfection Method(s)

e.g. Chlorination, Chloramination,

Ozonation, Chlorination with Chlorine

Dioxide, Ozonation, Ultraviolet

Irradiation, or list any other type

Do you have Coagulation?

Indicate with Yes or No

Do you have Flocculation?

Indicate with Yes or No

Do you have Sedimentation?

Indicate with Yes or No

Do you have Filtration?

Indicate with Yes or No

Filter Medium

Choose: Sand/Manganese Greensand/

Anthracite Coal/ Granular Activated

Carbon/ Others. If Others please specify

Do you have Membrane Filtration?

Indicate with Yes or No

Membrane Filtration Type

Choose: Microfiltration/ Ultrafiltration/

Nanofiltration/ Reverse Osmosis/list any

other type

Do you have Alkalinity Adjustment?

Indicate with Yes or No

Do you have pH Adjustment?

Indicate with Yes or No

Do you have a Sludge Blanket Clarifier?

Indicate with Yes or No

Do you have an Upflow Clarifier?

Indicate with Yes or No

Do you have Dissolved Air Flotation?

Indicate with Yes or No

Do you have Fluoridation?

Indicate with Yes or No

Do you have Iron Sequestering?

Indicate with Yes or No

Do you have Softening?

Indicate with Yes or No

Do you have Stripping?

Indicate with Yes or No

Do you have Taste and Odour Control?

Indicate with Yes or No

Do you have Zebra Mussel Control?

Indicate with Yes or No

OTHERS: DISTRIBUTION SYSTEM (If you own the Distribution system /Plumbing )

These are treatment processes that occur in the Distribution System/Plumbing only.

Do you have disinfection in the distribution

system after treatment?

Indicate with Yes or No

Disinfection Method(s)

e.g. Chlorination, Chloramination,

Ozonation, Chlorination with Chlorine

Dioxide, Ultraviolet Irradiation, or list any

other type

DEFINITIONS

1) Private Residence is a dwelling place occupied for an extended period of time by the same person if

a) The residents have a reasonable expectation of privacy

b) Food preparation, personal hygiene and sleeping accommodations are not communal in nature and

c) Any use of the dwelling place by a resident for a home occupation, trade, business, profession or craft is secondary to the use

of the dwelling place as a residence and does not use more than 25 per cent of the indoor floor area.

2) Seasonal System means a Drinking-Water System that does not operate for 60 or more consecutive days in a fiscal (April 1st to

March 31st)/ Calendar (Jan 1st to Dec 31st) year/ 365 day period that begins on the day the drinking-water system begins operation

3) Designated Facility means

a) A children's camp – a camp that is intended primarily for campers under 18 years of age and that is a class A camp or a class

B camp within the meaning of Reg. 568 of the Revised Regulations of Ontario, 1990 (Recreational Camps) under the Health

Protection and Promotion Act; (“camp de vacances pour enfants”)

b) A delivery agent care facility

c) A health care facility

d) A school or private school

e) A social care facility

f) A university, a college of applied arts and technology or an institution with authority to grant degrees

4) Public Facility means

a) Food Premises, as defined in the Health Protection and Promotion Act

b) A place that provides overnight accommodation to the traveling public, including trailer park or campground

c) A marina

d) A church, mosque, synagogue, temple or other places of worship

e) A recreational camp

f) A recreational or athletic facility

g) A place, other than a private residence, where a service club or fraternal organization meets on a regular basis

h) Any place where general public has access to a washroom, drinking water fountain or shower and does not include a

designated facility

5) GUDI (ground water under direct influence of surface water).

The following are deemed GUDI:

A DWS that obtains water from a well that is not a drilled well or obtains water from a well that does not have a watertight casing

that extends to a depth of at least 6 metres

A DWS that obtains water from an infiltration gallery

A DWS that supplies water at the rate of 0.58 L/s or less and that obtains water from a well, any part of which is within 15 metres

of surface water

A DWS that supplies water at the rate greater than 0.58 L/s and that obtains water from a overburden well, any part of which is

within 100 metres of surface water

A DWS that supplies water at the rate greater than 0.58 L/s and that obtains water from a bedrock well, any part of which is

within 500 metres of surface water

A DWS that exhibits evidence of contamination by surface water or

A DWS for which a report has been prepared by a professional engineer or professional hydrogeologist that concludes that the

system’s raw water supply is ground water under the direct influence of surface water.

6) Seven-days shutdown. Sampling and testing is not required during a period of seven or more consecutive days when: the

drinking-water system is not in operation, the drinking-water system supplies water only to private residences that are

occupied by the owner of the system, members of the family of the owner of the system, employees or agents of the owner of

the system, or members of the families of employees or agents of the owner of the system. The owner shall ensure that no

drinking-water is supplied to a user of water until samples have been taken and tested and the results of the tests have been

received by the owner and the operating authority.

Applies to: Small municipal residential systems, large municipal non-residential systems, non-municipal year-round

residential systems, large non-municipal non-residential systems. Also to: small municipal non-residential systems, non-

municipal seasonal residential systems and small non-municipal non-residential systems. As per Schedule 11 and 12 of the

Ontario Safe Drinking Water Regulation 170/03.

Part III Form 2

Section 11. ANNUAL REPORT.

Drinking-Water System Number:

220004162

Drinking-Water System Name:

Markham Distribution

Drinking-Water System Owner:

The Corporation of the Town of Markham

Drinking-Water System Category:

Large Municipal Residential System

Period being reported:

January 1, 2004 to December 31, 2004

Complete if your Category is Large Municipal

Residential or Small Municipal Residential

Does your Drinking-Water System serve

more than 10,000 people? Yes [x ] No [ ]

Is your annual report available to the public

at no charge on a web site on the Internet?

Yes [x ] No [ ]

Location where Summary Report required

under O. Reg. 170/03 Schedule 22 will be

available for inspection.

Complete for all other Categories.

Number of Designated Facilities served:

Did you provide a copy of your annual

report to all Designated Facilities you

serve?

Yes [ ] No [ ]

Number of Interested Authorities you

report to:

Did you provide a copy of your annual

report to all Interested Authorities you

report to for each Designated Facility?

Yes [ ] No [ ]

Note: For the following tables below, additional rows or columns may be added or an

appendix may be attached to the report

List all Drinking-Water Systems (if any), which receive all of their drinking water from

your system:

Drinking Water System Name

Drinking Water System Number

Not applicable

Did you provide a copy of your annual report to all Drinking-Water System owners

that are connected to you and to whom you provide all of its drinking water?

Yes [ ] No [x ]

Text Box: Markham Civic Centre –

Waterworks Department

Indicate how you notified system users that your annual report is available, and is free

of charge.

[x] Public access/notice via the web

[x] Public access/notice via Government Office

[ ] Public access/notice via a newspaper

[ ] Public access/notice via Public Request

[ ] Public access/notice via a Public Library

[ ] Public access/notice via other method _______________________________________

Describe your Drinking-Water System

Markham distribution system is an extension of Toronto and York Region distribution

systems. Raw surface water from Lake Ontario is disinfected, treated and tested by

Toronto system for microbiological, organic and inorganic parameters prior to

reaching York Region distribution system. York Region distribution system acts as a

wholesale distribution system to Markham, and provides standard distribution testing

in their south distribution system only (refer to York Region Annual Report for

details). York Region distribution system also provides storage and pressure boosting

for Markham system.

Markham is a distribution system only without pumping and storage facilities.

Markham’s drinking water within the distribution system is tested for standard

parameters.

List all water treatment chemicals used over this reporting period

Not applicable

Were any significant expenses incurred to?

[ x ] Install required equipment

[ x ] Repair required equipment

[ x ] Replace required equipment

Please provide a brief description and a breakdown of monetary expenses incurred

Watermain Cement Relining (water main rehabilitation) = $982,000

Cathodic Protection of Iron Watermains = $359,000

Watermain Replacement Program = $1,928,600

Provide details on the notices submitted in accordance with subsection 18(1) of the Safe

Drinking-Water Act or section 16-4 of Schedule 16 of O.Reg.170/03 and reported to

Spills Action Centre

Incident

Date

Parameter

Result

Unit of

Measure

Corrective Action

Corrective

Action Date

Mar 1, 04

Mar 8, 04

Total Coliform

(TC)

Heterotrophic Plate

Count (HPC)

530

P/A

CFU

/mL

Flushing mains

& resample

Ditto

Mar 2 & 3,

04 (2 sets of

resamples

taken 1 day

apart)

Mar 10 &

11, 04 (2

sets of

resamples

taken 1 day

apart)

Jun 28, 04

Jul 12, 04

Sep 20, 04

Sep 22, 04

HPC

Background

680

860

680

600

580

CFU

/mL

CFU

/mL

CFU

/mL

CFU

/mL

CFU/

Ditto

Jun 30 &

Jul 1, 04

(2 sets of

resamples

taken 1 day

apart)

Jul 14 &

15, 04 (2

sets of

resamples

taken 1 day

apart)

Jul 14 &

15, 04 (2

sets of

resample

taken 1 day

apart)

Sep 22, 04

(1 set of

resample

taken)

Sep 23 &

Oct 18, 04

Dec 21, 04

Bacteria

HPC

900

1400

100mL

CFU

/mL

CFU

/mL

Ditto

24, 04 (2

sets of

resample

taken 1 day

apart)

Oct 20 &

21, 04 (2

sets of

resample

taken

apart)

Dec 23 &

24, 04 (2

sets of

resample

taken 1 day

apart)

Microbiological testing done under the Schedule 10, 11 or 12 of Regulation 170/03,

during this reporting period.

Number

Samples

Range of E.Coli

Or Fecal

Results

(min #)-(max #)

Range of Total

Coliform

Results

(min #)-(max #)

Number

of HPC

Samples

Range of HPC

Results

(min #)-(max #)

Raw

Treated

Distribution

2256

<1 -- >1

1138

<1 -- 1400

Operational testing done under Schedule 7, 8 or 9 of Regulation 170/03 during the

period covered by this Annual Report.

Number of

Grab

Samples

Range of Results

(min #)-(max #)

Turbidity

Chlorine

(Combined)

5811

(min 0.02mg/l)—

(max 1.24 mg/l)

Fluoride (If the

DWS provides

fluoridation)

NOTE: Record the unit of measure if it is not milligrams per litre.

Text Box: NOTE: For continuous monitors use 8760 as the number of samples.

Summary of additional testing and sampling carried out in accordance with the

requirement of an approval, order or other legal instrument.

Date of legal instrument

issued

Parameter

Date Sampled

Result

Unit of Measure

Summary of Inorganic parameters tested during this reporting period or the most

recent sample results

Parameter

Sample Date

Result Value

Unit of Measure

Exceedance

Antimony

Arsenic

Barium

Boron

Cadmium

Chromium

Lead

Jun 9, 04

<0.0007

mg/L

Mercury

Selenium

Sodium

Uranium

Fluoride

Nitrite

Nitrate

Summary of Organic parameters sampled during this reporting period or the most

recent sample results

Parameter

Sample

Date

Result

Value

Unit of

Measure

Exceedance

Alachlor

Aldicarb

Aldrin + Dieldrin

Atrazine + N-dealkylated metobolites

Azinphos-methyl

Bendiocarb

Benzene

Benzo(a)pyrene

Bromoxynil

Carbaryl

Carbofuran

Carbon Tetrachloride

Chlordane (Total)

Chlorpyrifos

Cyanazine

Diazinon

Dicamba

1,2-Dichlorobenzene

1,4-Dichlorobenzene

Dichlorodiphenyltrichloroethane (DDT) +

metabolites

1,2-Dichloroethane

1,1-Dichloroethylene

(vinylidene chloride)

Dichloromethane

2-4 Dichlorophenol

2,4-Dichlorophenoxy acetic acid (2,4-D)

Diclofop-methyl

Dimethoate

Dinoseb

Diquat

Diuron

Glyphosate

Heptachlor + Heptachlor Epoxide

Lindane (Total)

Malathion

Methoxychlor

Metolachlor

Metribuzin

Monochlorobenzene

Paraquat

Parathion

Pentachlorophenol

Phorate

Picloram

Polychlorinated Biphenyls(PCB)

Prometryne

Simazine

THM

(NOTE: show latest annual average)

Dec 7,

0.0124

mg/L

Temephos

Terbufos

Tetrachloroethylene

2,3,4,6-Tetrachlorophenol

Triallate

Trichloroethylene

2,4,6-Trichlorophenol

2,4,5-Trichlorophenoxy acetic acid (2,4,5-T)

Trifluralin

Vinyl Chloride

List any Inorganic or Organic parameter(s) that exceeded half the standard prescribed in

Schedule 2 of Ontario Drinking Water Quality Standards.

Parameter

Result Value

Unit of Measure

Date of Sample

(Only if DWS category is large municipal residential, small municipal residential, large

municipal non residential, non municipal year round residential, large non municipal non

residential)