Does the WHP Plan Contain or Address the Following?

1. Institutional Roles: (see Section I of Wyoming’s Wellhead Protection Guidance Document)

   1.1 Has a listing of members of the Wellhead Protection Management Committee, including resolutions, if any, and descriptions of public participation efforts been included in the WHP Plan?

2. Delineation of the Wellhead Protection Areas: (see Section II of Wyoming’s Wellhead Protection Guidance Document)

   Have you followed the Flow Chart in Table II-1 to appropriately determine the type of flow (i.e. porous, diffuse or conduit)

   As identified in Table II-2 of Wyoming’s Wellhead Protection Guidance Document, a Wellhead Protection Area (WHPA) shall be delineated for each PWS well:

   2.1 Zone 1 - Does the radius (i.e. 50' or 100') of Zone 1 for each well meet the requirements specified?

   2.2 Zone 2 - Has the appropriate delineation method been applied, given the aquifer media type and flow type of the aquifer supplying your well(s)? See Table II-1, II-2, Appendix D and Part IV of Appendix G.

   2.3 Zone 3 - Has the appropriate delineation method been applied, given the aquifer media type and flow type of the aquifer supplying your well(s)? See Table II-1, II-2, Appendix D and Part IV of Appendix G.

   2.3.1 Are alternative criteria or methods required due to the presence of one or more of the conditions identified in Section II - ‘Special Considerations’, or in Part IV of Appendix G?

   2.4 Have aquifer/pump tests been performed?

   2.4.1 Have any of the delineated wells been constructed with state agency funding?

   2.4.2 Has rehabilitation of existing wells or the water distribution system been performed with state agency funding?

   2.5 (Community PWSs Only) Have the WHPAs been delineated and has the 'Susceptibility Assessment Form' (Appendix F) been completed for each well?

   2.6 Do the WHPAs of the wells overlap?

   2.6.1 If 'Yes': Have the overlapping WHPAs been properly ‘nested’ or ‘clustered’ into one WHPA for the wellfield WHPAs (see Figure II-4);

   If modeled, does computer modeling of the WHPA incorporate well interference?

   2.7 WHPA ‘Delineation Report' (see Section II):

   2.7.1 Does the report contain the required information on the following:

   • Geologic Data?
   • Aquifer Data?
   • Well Data?
   • Pump Data?
   • WHPA Delineation Information?
   • Map Showing Boundaries of the WHP Areas or Zones?
   • City/County Zoning and Land Use Map?
   • Confined Aquifer Conditions?
   • 'Susceptibility Assessment Form' (Appendix F) for each PWS in the WHP Plan?

3. Inventory of Potential Contamination Sources: (see Section III of Wyoming’s Wellhead Protection Guidance Document)

   Have the following steps been completed in developing an inventory of ‘existing’ and ‘potential’ contaminant sources within each WHPA?

   3.1 Indicate which of the following steps have been taken and completed for completing the contaminant source inventory:

   3.1.1 Local, state and/or federal databases have been accessed and source information for known (i.e. ‘existing’) sources has been included in the contaminant source inventory; ‘existing’ sources have been located and identified on the base map.

   3.1.2 Information has been collected on unknown (i.e. ‘potential’) sources and included in the contaminant source inventory; ‘potential’ sources have been located and identified on the base map.

   Indicate which method (or methods) was followed to collect information on ‘potential’ sources:

   • Mail Survey
   • Telephone Survey
   • Door-to-door Survey
   • Field Survey
   • Windshield Survey
   • Personal Interviews

   3.1.3 Has the accuracy and reliability of sources of information been verified?

   3.1.3.1 Indicate which method (or methods) was followed to verify information on ‘existing’ sources:

   • Mail Survey
   • Telephone Survey
   • Door-to-door Survey
   • Field Survey
   • Windshield Survey
   • Personal Interviews

   3.1.3.2 Indicate which method (or methods) was followed to verify information on ‘potential’ sources:

   • Mail Survey
   • Telephone Survey
   • Door-to-door Survey
   • Field Survey
   • Windshield Survey
   • Personal Interviews

   3.2 Have the 'existing' and 'potential' sources within the WHP area been described by:

   3.2.1 Completing Source Identification forms (Form III-1)?

   -or-

   Other forms that contain:

   • Source owner/operator name and location?
   • Source type and WHPA ‘Zone’ in which it is located?
   • Source Priority Method and Rank?

   3.3 Has the Source Inventory list been completed from the Source Identification forms?

   3.3.1 Does the Source Inventory list contain the following?

   • Minimum information that is on the Source Identification forms which is grouped by WHPA Zones?
   • Description of WHPAs to which the inventory applies?
   • Date of Completion of Source Identification data collection and survey(s)?
   • Statement describing the timing of completion of the Source Identification forms with respect to WHPA delineations and identifying the status of the Source Inventory ( i.e., 'Preliminary' or 'Final')?
   • Upon completion of the above, have Parts V and VI of the ‘Susceptibility Assessment Form’ (Appendix F) been completed?

   3.4 Have the ‘existing’ and ‘potential’ sources been ranked (prioritized) according to one (or more) of the following:

   • Distance or TOT to nearest public drinking water well?
   • 'Sensitivity' of the uppermost aquifer underlying the source?
   • Number of residents served by public drinking water well?
   • Ranking from EPA's "Managing Ground Water Contamination Sources in Wellhead Protection Areas: A Priority Setting Approach"?

   3.5 Have ‘existing’ and ‘potential’ contaminant source locations and information been plotted on a base map for use as an overlay on WHPA delineation maps?

   • Are 'existing' and 'potential' sources distinguished?
   • Are the souces on the map linked to the Source Inventory list by a source identification number?
   • Do different symbols or numbers differentiate between types of sources?
   • Is the Source Overlay identified as 'Preliminary' or 'Final'?

   3.6 Does the WHP Plan contain provisions for updating, refining, and expanding the source inventory information?

   3.7 Does the WHP Plan include provisions to update the Source Inventory at least every two years using the methods described in Section III?

4. Potential Contaminant Sources - Management Strategies: (see Section IV of Wyoming’s Wellhead Protection Guidance Document)

   4.1 Does the WHP plan describe the techniques that will be employed to manage and minimize the threats posed by the ‘existing’ and ‘potential’ contaminant sources identified in the Source Inventory?

   4.2 Has the contaminant source priority ranking information been used to develop management strategies that are appropriate for the priority rank of the ‘existing’ and ‘potential’ contaminant sources identified within the WHPA?

   4.3 Has a 'Potential Source, Hazards, Controls, Assessment, and Management Form' (Form IV-1; Appendix J) been completed for each potential contaminant source in the 'Source Inventory List'?

   4.4 Have ordinances, Memorandum of Understanding or Agreement, land use agreements, and other source management instruments been appended to the WHP plan?

5. Planning for the Future - Contingency Plans and Plans for Siting New Wells: (see Section V of Wyoming’s Wellhead Protection Guidance Document)

   5.1 Has the WHP Management Committee, or its designate, addressed and included the following requirements in the Contingency Plan?

   5.1.1 Existing system conditions (Form V-1; Appendix N) and copies of maps and/or construction plans, specifications, and drawings of water distribution and storage system?

   5.1.2 Chain of command and description of individual roles and responsibilities during an emergency (Form V-2; Appendix O)?

   5.2 Emergency responses planned for 'high' probability and 'high' severity events (Form V-3; Appendix P), which includes:

   • procedures to shut down or isolate a contaminated well?
   • source of emergency water for drinking and other household uses as well as sources of equipment to treat, transport, and distribute water?
   • procedures to decontaminate the distribution system and well(s)?
   • procedures to coordinate with county and state emergency response agencies?
   • procedures to effectively communicate with the water users?
   • a plan of action for siting a new permanent water supply to replace contaminated supply?
   • sources of emergency funds and equipment, and procedures for requesting and dispersing funds and equipment?

   5.2.1 Provisions for obtaining, distributing, and funding temporary alternate drinking water supplies?

   5.2.2 Provisions for developing and financing new drinking water sources in case of long-term shortages due to contaminated supplies?

   • An inventory of alternative water supply sources (quantity, quality, and ownership)?

   5.2.3 A plan and schedule for updating the Contingency Plan?

6. Plans for Updating and Revising the WHP Plan (see Section VIII of Wyoming’s Wellhead Protection Guidance Document):

   6.1 Are there provisions to update and revise the WHP plan at least every two years?

   6.1.1 Do the provisions describe how the following will be updated and revised?

   6.1.2 Hydrologic characteristics of producing aquifer.

   6.1.3 Changes in the water supply, or pumping volumes.

   6.1.4 New potential sources of contamination.

   6.1.5 New management strategy development or implementation.

   6.1.6 Contingency planning and emergency response.

   6.1.7 Planning or developing new water supplies.

   6.2 Does the WHP Plan include provisions for submitting revisions (i.e., delineations, Source Inventory lists and Identification forms, 'Source Overlays', source management strategies, Contingency Plans, and plans for siting new well(s)) to WDEQ/WQD at least every two years?

   6.3 If there are no changes (as described above) in two years, are there provisions for having a representative of the local government or the manager of the PWS send a letter to WDEQ/WQD documenting that the WHP Plan was reviewed and that no changes have occurred?

   6.4 Are there provisions to have any revisions or updates amended to, or incorporated into the WHP Plan?