Drinking Water Storage Tank Inspection Reporting Form PDF Details

Regularly scheduled water tank inspection is an important part of managing a property. A key indicator of the well-being of your water system and associated plumbing is regular maintenance and preventative upkeep, which includes inspections. To ensure that all components in a water tank are properly inspected, we’ve created this customizable form to help streamline the process for you. This checklist will provide step-by-step instructions on how to inspect various parts of your water tank, highlighting any necessary safety measures or maintenance tasks needed along the way – saving you valuable time!

Question	Answer
Form Name	Drinking Water Storage Tank Inspection Reporting Form
Form Length	4 pages
Fillable?	Yes
Fillable fields	110
Avg. time to fill out	23 min 4 sec
Other names	Water Tank Maintenance Checklist Form, Water Tank Inspection Checklist Form, Water Tank Cleaning Checklist Form

Form Preview Example

EPA Region 8 Drinking Water Unit

Finished Water Storage Tank Inspection/ Cleaning Checklist

Fill out one checklist per storage tank & submit labeled photos of each tank component with this form

PWS Name:

PWS ID:

Tank Name:

Tank ID:

Proposed Inspection Date:

Actual Inspection Date:

Name of Person Filling Out Form:

Title of Person Filling Out Form:

I certify that this information is complete and accurate:

Date:

Inspector Qualifications (answer to all questions must be “yes”)

Name and contact information of inspector (if water system personnel) or inspection company:

Yes

Has the inspector completed confined space training?

Yes

Did the inspector have a confined space entry permit?

Overall Tank Condition

Proposed

Actual

Significant Deficiency

Required Correction

Completion

Date

Does the tank appear to be

If no, what repairs are

Yes

suggested by the tank

structurally sound?

inspector?

Are there any unprotected openings

If yes, indicate type of

Yes

in the tank (breaches, leaks, daylight

breach and how it should

coming through tank in spots, etc)

be repaired.

Air Vent

Proposed

Actual

Significant Deficiency

Required Correction

Completion

Date

Yes

Does the tank have a vent

If no, indicate proposed

separate from the overflow?

correction:

Above Ground Tanks (Ground Level or Elevated)

Check if NA

Downturned vent: Is the vent

If no reconfigure vent to

Yes

at least 24” or 3 pipe

provide proper air gap.

diameters above the roof?

Non‐downturned vent: Is

If no, indicate deficiency

there a solid cover down to

Yes

and proposed correction:

the bottom of the vent

screen?

Non‐downturned vent: Is the

screen at least 8” above the

If no, indicate deficiency

roof surface? What is the

Yes

and proposed correction:

height of the start of the

screening above the tank?

Is the vent covered with #24

If no, indicate deficiency

mesh corrosion resistant

Yes

and proposed correction:

screening (some exceptions

apply)? Mesh Size:

Buried or Partially Buried Tanks

Check if NA

Is the vent covered with #24

If no, install proper #24

Yes

mesh corrosion resistant

screening?

screening.

Does the air vent terminate

If no, re‐configure the

Yes

vent so that it terminates

downward?

downward.

Is the air vent at least 24”

above the tank roof or ground

If no, raise air vent to

surface (whichever is higher)?

Yes

provide for an appropriate

What is the height of the vent

air gap.

above the roof or ground

surface?

Access Hatch

Proposed

Actual

Significant Deficiency

Required Correction

Completion

Date

Is the hatch raised at least 4” above

the roof (for ground level or elevated

If no, the hatch should be

tanks) or at least 24 inches above the

Yes

roof or ground, whichever is higher

raised to the appropriate

(for buried or partially buried tanks)?

height above the tank roof

What is the height of the access

or ground.

hatch above the roof or ground

surface?

If no, a properly designed

Yes

Does the hatch have a shoe box lid?

shoe box type lid should

be installed.

Is the lid water tight and sealed with

If no, the reason for the

Yes

lack of a seal should be

a rubber gasket?

investigated and repaired.

Yes

Is the hatch locked?

If no, the hatch should be

equipped with a lock.

Overflow

Proposed

Actual

Significant Deficiency

Required Correction

Completion

Date

Yes

Does the tank have an overflow

If no, indicate proposed

separate from the vent?

correction:

Discharge has #24 mesh corrosion

resistant screen OR a duckbill valve

If no, indicate proposed

Yes

OR a properly sealed flapper valve

correction:

with a screen inside (EPA

recommends #24 mesh screen)?

Overflow terminates between 12 and

If no, modify overflow to

24 inches above the ground surface?

Yes

provide for an appropriate

At what height does the overflow

air gap.

discharge?

Overflow discharges over an inlet

If no, indicate proposed

Yes

structure, splash plate, or engineered

correction:

rip‐rap?

Yes

Does the overflow have an air gap of

3 or more pipe diameters above the

If yes, indicate proposed

entrance to any storm or sanitary

correction:

sewers?

Is there blockage in the overflow, an

inadequately sized overflow, a

If yes, indicate what is

Yes

malfunction of the level control

causing the problem and

system, or other issue that is causing

how it should be repaired:

the tank to overflow through the

hatch or vent?

Yes

Is the overflow discharge point visible?

If no, it is recommended

Not Required

that the discharge point be moved to a location that is visible.

Drain

Proposed

Actual

Significant Deficiency

Required Correction

Completion

Date

Does the drain pipe have an air gap

Yes

of 3 or more pipe diameters above

If no, indicate proposed

the entrance to any storm or sanitary

correction:

sewers?

Does the discharge have a #24 mesh

corrosion resistant screen OR

Yes

a duckbill valve OR a properly sealed flapper valve with a screen

Not Required

inside? If no, EPA recommends that a #24 mesh screen be

installed.

Does the drain terminate between 12 and 24 inches above the

Yes

ground surface and discharges over an inlet structure or splash

Not Required

plate? If no, it is recommended that the discharge point be

modified to provide for the appropriate air gap.

Cleaning and Other Items

		Proposed		Actual
Significant Deficiency	Required Correction	Completion		Completion
			Date		Date
Describe any other items noted by the inspector that	What repairs are
Describe any other items noted by the inspector that	suggested to prevent or
have the potential to cause contamination of the	suggested to prevent or
have the potential to cause contamination of the	eliminate the source of
finished drinking water:	eliminate the source of
finished drinking water:	contamination?
	contamination?

Depth of sediment found in the tank before cleaning (inches):

How was the storage tank cleaned?

How was the storage tank disinfected after cleaning?

List any objects found inside the tank during cleaning that may have introduced contamination into the water system (examples: debris, animals, etc):

Yes No NA

If animal carcasses or other animal debris were found, was EPA notified immediately?

Was the entry point for the carcass or debris eliminated? Describe:

Please attach tank as‐built drawings (if available) or a sketch of the tank’s configuration and dimensions including the location, layout and dimensions of all major components (i.e. access hatch, vent, overflow, drain)

How to Edit Drinking Water Storage Tank Inspection Reporting Form Online for Free

This PDF editor was built with the purpose of allowing it to be as effortless and easy-to-use as possible. These actions will help make managing the Water Tank Inspection Checklist Form easy and quick.

Step 1: The very first step will be to choose the orange "Get Form Now" button.

Step 2: You're now allowed to update Water Tank Inspection Checklist Form. You possess a variety of options with our multifunctional toolbar - you'll be able to add, eliminate, or change the content material, highlight the specific sections, and carry out several other commands.

These areas are contained in the PDF template you'll be completing.

filling out Water Tank Cleaning Checklist Form step 1

Complete the Yes, Are there any unprotected openings, If no what repairs are suggested, Air Vent, Significant Deficiency, Required Correction, Proposed Completion Date, Actual Completion Date, Yes, Does the tank have a vent separate, If no indicate proposed correction, Above Ground Tanks Ground Level or, Check if NA, Yes, and Yes areas with any content which may be required by the software.

Finishing Water Tank Cleaning Checklist Form stage 2

The software will ask you for information to instantly prepare the part Downturned vent Is the vent at.

part 3 to finishing Water Tank Cleaning Checklist Form

The field Yes, Yes, Yes, Yes, Is the vent covered with mesh, If no indicate deficiency and, Buried or Partially Buried Tanks, Is the vent covered with mesh, Does the air vent terminate, Is the air vent at least above, Check if NA If no install proper, If no raise air vent to provide, Proposed Completion Date, Actual Completion Date, and Access Hatch will be where one can place both sides' rights and responsibilities.

Filling in Water Tank Cleaning Checklist Form part 4

Finalize by reading these fields and filling out the relevant data: Yes, Is the hatch raised at least, Yes, No Does the hatch have a shoe box, Yes, Is the lid water tight and sealed, Yes, Is the hatch locked, If no the hatch should be raised, and If no a properly designed shoe box.

Water Tank Cleaning Checklist Form Yes, Is the hatch raised at least, Yes, No Does the hatch have a shoe box, Yes, Is the lid water tight and sealed, Yes, Is the hatch locked, If no the hatch should be raised, and If no a properly designed shoe box fields to insert

Step 3: Hit the Done button to save the file. Then it is available for transfer to your gadget.

Step 4: Have at least a couple of copies of the form to prevent any specific potential difficulties.

Drinking Water Storage Tank Inspection Reporting Form – Fill Out and Use This PDF

Drinking Water Storage Tank Inspection Reporting Form PDF Details

Form Preview Example

How to Edit Drinking Water Storage Tank Inspection Reporting Form Online for Free

Drinking Water Storage Tank Inspection Reporting Form isn’t the one you’re looking for?

Drinking Water Storage Tank Inspection Reporting Form – Fill Out and Use This PDF

Drinking Water Storage Tank Inspection Reporting Form PDF Details

Form Preview Example

How to Edit Drinking Water Storage Tank Inspection Reporting Form Online for Free

Drinking Water Storage Tank Inspection Reporting Form isn’t the one you’re looking for?

Related Documents