1 DEPARTMENT OF ENVIRONMENTAL CONSERVATION WATER CONSERVATION PROGRAM FORM TO BE COMPLETED AND SUBMITTED AS PART OF A PERMIT APPLICATION NYSDEC WATER WITHDRAWAL *SEE PAGE 6 THIS FORM AND INSTRUCTION REGARDING FOR FURTHER INTRODUCTION submit it as a supplement to If your water facility already has its own written water conservation program, you may this taken when the system is completed will be If your system is new, indicate the water conservation measures that WCPF. (e.g. All withdrawal will be 1 00% metered ). sources of I. GENERAL SYSTEM INFORMATION Facility Name : Street Address: Box : Post Office State : ZIP: County: Name : Contact Street Address: County: State Post Office ZIP: Box : : Contact's Telephone: Applicant's Telephone: II. SOURCES OF WATER WITHDRAWAL capacity and withdrawal in gallons per minute ( [S tate ), gallons per day ( gpd ), or million gallons per day ( mgd ). ] gpm water Source Type S = Surface supply, G : supply, P = Pur chased supply = Ground Source Status : R = Regular use, S = Standby use, E = Emergency use, I = Inactive, D = Decommissioned Source Start -up Source Actual Current Tested Source Name Status Withdrawal Year Type Capacity
2 AND METERING III. WATER SOURCES , please provide your best estimates For unmetered systems for water production and/or consumption. Are all sources of supply (including major interconnections) equipped with master meters? How often are they read? How often are they calibrated? Are there secondary meters located within the facility or system? If yes, how many? Describe secondary metering system if applicable: Calendar Year Water Production for Total metered water production: gallons per year Average day production (total/days of use): gallons per day Maximum day production (largest single day ): day gallons per nd schedule for water metering? What are your future goals a Best Management Practices: * 100% metering of all sources of water withdrawal . * Source and secondary meters must be tested and calibrated annually.
3 IV. WATER AUDIT ING collect wat The process of ion of data on how much and where conducting an audit of a er system will enable the r enters, leaves and is used within a facility . wate Another goal of a water audit is to estimate or system unaccounted- -functioning or inoperative system for water use, which includes: Losses through leaks, improperly water audit provides a system controls and unmetered sources of water. The with a baseline against which -conservation measures can be evaluated. water Do you conduct a water audit at least once each year? If yes, please submit a copy of your latest audit in addition to completing the following section. ** Water Audit for Calendar Year Total metered water production (from previous section) Total Metered or % of Sources of Water Use Estimated? Total s ubtract Process Water subtract Cooling Water subtract Wash Water subtract Sanitary subtract Incorporation into Product subtract Irrigation subtract subtract Sub - FOR WATER TOTAL UNACCOUNTED- total Meter under -registration subtract -for Unaccounted Unrepaired leakage subtract water breakdown Other: subtract Water measurement and accounting techniques are available in NYSDEC = s ** http://www.dec.ny.gov/lands/39346.html Water Conservation Manual, 0 What are your future goals for water system auditing? Best Management Practices: * At least once each year, a system water audit must be conducted using metered water production and consumption data to determine unaccounted-for water. * Keep accurate estimates of unmetered water use. * Quantify all authorized water uses by consumption categories. 3
4 V. LEAK DETECTION AND REPAIR you regularly survey your facility fo r leakage ? Do Are leaks repaired in a timely manner? If applicable, do you regularly survey underground piping for water leakage? Percent of Length of pipe Number Total Number length of Year of last piping surveyed of leaks surveyed each of leaks underground Listening survey year found repaired each year piping equipment used What are your future goals for water system leak detection and repair? Best Management Practices: * Check any underground water distribution systems for leaks each year. * Fix every detectable leak as soon as possible. -going system rehabilitation program. * Have an on 4
5 VI. WATER REUSE, AND DROUGHT PLANNING RECYCLING If yes, describe process : Does your facility reuse or recycle primary use water? Does your facility use reclaimed rainwater, storm water runoff or wastewater? If yes, describe process: Describe any equipment or processes that promote the efficient use of water by your facility: Does your system include storage tanks or ponds to meet short term water demands? Describe any actions that can be taken to reduce water use during times of drought: recycling or reducing water usage? What are your future goals for Best Management Practices : * Reuse or recycle water whenever possible. * Employ efficient irrigation techniques * Develop a plan to reduce water use during times of drought. 5
6 VI. SIGNA TURE PAGE AND DISCUSSION Facili t Name: WWA No. y Signature : Signatory: Title: Date: : DISCUSSION § ECL 15 -1501 ) has required that Effective February 15, 2011, New York State Environmental Conservation Law ( all applications for a NYSDEC Water Withdrawal Permit include a water conservation program. This Water Conservation Program Form (WCPF) is a required submittal of all such applications. The WCPF has been set up to cover the following basic elements of a water conservation program: Source Water Inventory, Water Usage and Metering, Water Auditing, Leak Detection/Repair, and Water Use Reduction. The Best Management Practices listed at the bottom of each page represent DEC water conservation policy objectives and should be incorporated into your program development. Additional water conservation measures that are specific to your category of water usage should also be incorporated into your individual program. Water withdrawal permit applicants can consult the NYSDEC publication entitled “A Survey of Methods for Implementing and Documenting Water Conservation in New York”. The American Water Works As sociation (AWWA) is also an excellent source of information regarding water conservation practices and procedures. Information ranging from technical manuals to online resources and tools can . g be found at http://www.awwa.or 6