Drinking Water Sector - Damage Assessment Report The Division s Drinking Water Sector Damage Assessment Report (available on-line at the Division s Website http://www.state.nj.us/dep/watersupply ) and included within this document should be used by water systems involved in a large scale emergency incident (i.e. Hurricane) to provide an initial report - general impact assessment and summary damage assessment, comprised of pages 1 and 2 of the form. The completed initial report should be prepared within 6 hours following the emergency incident. A second report should be prepared no later than 16 hours following the emergency incident and provide a detailed damage assessment and identify the resources required to mitigate water supply disruptions. The completed reports can be submitted to the Division s general email address at watersupply@dep.state.nj.us, unless otherwise specified.
DEPARTMENT OF ENVIRONMENTAL PROTECTION DRINKING WATER SECTOR DAMAGE ASSESSMENT REPORT te 1: An initial report which provides a general impact assessment and summary damage assessment, comprised of pages 1 and 2, should be prepared within 6 hours following the emergency incident. te 2: A second report, providing a detailed damage assessment and identifying the resources required to mitigate the emergency, should be prepared no later than 16 hours following the emergency incident. DATE OF ASSESSMENT: - - WATER SYSTEM NAME: : PWSID NUMBER: : NJ INCIDENT DATE, TIME, DESCRIPTION: (Flood, Power Outage, Explosion, Contamination, etc. ) General Impact Assessment 1) Does the damage or loss of facilities constitute a health and/or safety hazard to the general public: Yes If you answered Yes, indicate the services connections/ population served which is adversely affected by the loss or damages of the facilities: 2) County/Municipality impacted: 3) Has the incident caused the loss of water pressure and/or the quality of delivered water to be adversely affected: Yes If Yes, check accordingly: Water Pressure Water Quality 4) If water quality is adversely affected, has the appropriate Advisory Water Use Restriction [Boil Water, Do t Drink, Do t Use ] been implemented: Yes N/A 5) Does the damage or loss of facilities affect critical activities for other sectors (Agriculture/Food, Financial Services, Healthcare, Emergency Services, Federal/State governance, etc.): Yes If you answered Yes, identify the sector, activity, sector entity adversely affected:
PWSID NUMBER: NJ Summary Damage Assessment Has any resource need been sent through NJWARN at this time: Yes Infrastructure Component Name & Location of Infrastructure Damage Description Present Capacity % Needs: Manpower, Equipment, Supplies Estimated Repair Time (days) Condition of Access Routes O Open 0 Operational C Closed P Partial T Total Loss Urgent Projected < 1 week > 1 week (check column) S Specialized Vehicle SOURCE PUMP STATION RAW WATER TRANSMISSION TREATMENT FACILITY FINISHED WATER STORAGE DISTRIBUTION TRANSMISSION
SECTION I - DAMAGE ASSESSMENT OF SOURCE WATER* * If water is treated, complete form for Treatment Plant If water is pumped from source to distribution, complete form for Pumping Station PWSID NUMBER: : NJ Name of Surveyor: Function/Title: Telephone Contact Numbers: Date of Assessment: - - Name of Water Source Location of Water Source Type of water source: River Intake Other (describe): River Intake Reservoir Intake Well Other ACCESS METHOD: Truck 4WD Vehicle Car Foot Boat Air Access Describe any blockage of access roads: Describe needs to provide access: Is the source operating normally? (circle one) YES NO If, Describe damage to source water capability: Describe needs to repair damage and restore normal operation:
SECTION II - DAMAGE ASSESSMENT OF STORAGE TANKS PWSID NUMBER: : NJ Name of Surveyor Function/Title Telephone Contact Numbers: Date of Assessment - - Name of Storage Tank Location of Water Tank ACCESS METHOD: Truck 4WD Vehicle Car Foot Boat Air Access Describe any blockage of access roads: Describe needs to provide access: Type of tank: Elevated Above ground Underground Capacity of Storage tank (in MG); Presently the tank is: Full 3/4 Full 1/2 Full 1/4 Full Empty Provide date and time of determination: Is the tank operating normally? Yes Is the tank equipped with an isolation valve? Yes Provide status of isolation valve: Open Closed Is the tank secured against unauthorized access? (check one) Describe damage to storage tank, if any: YES NO Describe needs to repair damage and restore normal operation:
SECTION III - DAMAGE ASSESSMENT OF WATER TRANSMISSION MAINS PWSID NUMBER: : NJ Name of Surveyor Function/Title Telephone Contact Numbers: Date of Assessment - - What source of water does the transmission main convey? RAW FINISHED Is the transmission main operating normally? Yes Is the transmission main isolated from service? Yes Is the transmission main damaged? Yes If yes, complete detailed description below. Description of damaged transmission main: Location Reference: From: to : Municipality County Length (mi) Diameter (in) Construction Type: minal Pressure:. of stream crossings:. of crossings damaged: Access Method: Truck 4WD Vehicle Car Foot Boat Air Access Describe any blockage of access roads: Describe needs to provide access: Describe damage to transmission main capability: Describe needs to repair damage and restore normal operation:
SECTION IV - DAMAGE ASSESSMENT OF TREATMENT PLANT PWSID NUMBER: : NJ Name of Surveyor Function/Title Telephone Contact Numbers: Date of Assessment - - Name of Treatment Plant Location of Treatment Plant Name of Plant Supervisor Tel: Name of Plant Operator Tel: Access Method: Truck 4WD Vehicle Car Foot Boat Air Describe any blockage of access roads: Describe needs to provide access: Access Describe general condition of treatment plant: Describe any structural damage: Treatment plant capacity (MG/day): List treatment processes: Is the treatment plant operational? Yes Percent Operational: 100% 75% 50% 25% Is the treated water in compliance with SDWA standards/requirements? Yes If no, which treatment processes are impacted?
PWSID NUMBER: NJ Assessment of Power Supply Is the treatment plant operating under normal power supplies? Yes If no, describe damages to main power supply (mains, transformer, controls): Describe needs pertaining to damages to power supply: Is the treatment plant operating under auxiliary power supplies? Yes Auxiliary power is capable of sustaining what percentage of treatment/pumping operations? 100% 75% 50% 25% How long (in days) will fuel reserves sustain auxiliary power generators? Describe needs pertaining to sustaining auxiliary power supply:
PWSID NUMBER: NJ Assessment of Analytical Services Describe operational status of in-house laboratory analytical services: Describe status of contract laboratory services:
PWSID NUMBER: NJ Assessment of Equipment and Supplies Description of Damaged Equipment/Supply Needs to repair/replace Unit (valves, piping, pressure tanks, dosing equipment, flow and level recorders, pressure gauges, pumps, etc.) Identify treatment chemicals available and needed. Chemicals or Reagents Quantify Available Quantify Needed
Damage Assessment of Pumping and Booster Station(s) PWSID NUMBER: : NJ Name of Surveyor Function/Title Telephone Contact Numbers: Date of Assessment - - Name of Station Location of Station Access Method: Truck 4WD Vehicle Car Foot Boat Air Describe any blockage of access roads: Access Describe needs to provide access: Describe general condition of booster/pump station: Describe any structural damage: Describe needs to restore operation (complete pump specification section below when applicable): Booster/Pump Station capacity (MG/day): List treatment processes, if none then indicate N/A:
Is the Booster/Pump Station operational? Yes Percent Operational: 100% 75% 50% 25% Is the Booster/Pumping Station operating under normal power supplies? Yes If no, describe damages to main power supply (mains, transformer, controls): Describe needs pertaining to damages to power supply: Is the Booster/Pumping Station operating under auxiliary power supplies? Yes Auxiliary power is capable of sustaining what percentage of treatment/pumping operations? 100% 75% 50% 25% How long (in days) will fuel reserves sustain auxiliary power generators? Describe needs pertaining to sustaining auxiliary power supply: Pump Specifications Type of pump(s) Pump specifications Submersible Vertical Turbine Centrifugal Other Volts Amps Cycles (Hz) Speed (RPM) Brand Name