Culture of Health: Water Borne Disease Outbreak Rainbow Valley Ranch

The department promotes a ‘Culture of Health’ in order to encourage water providers to provide the highest water quality practical and to avoid waterborne disease outbreaks. Generally the department relies on what we call “performance partners” which are operators and suppliers of water to ensure the drinking water is safe. There are times that property owners do not cooperate and it becomes all the more important for the partnership between professionally certified operators and the department to stand firm. In the situation below, which did result in human illness, the contract operator that visited the site was instrumental in helping us understand and discern the facts on the ground. While ultimately the owner chose to sell off a portion of the property to avoid being a regulated public water system, the important realtime information from performance partners in the field helped mitigate the effects of this outbreak. As it stands today, the community should be receiving hauled water from a nearby regulated public water system that is safe to drink, however there is not regulatory oversight of the situation. 

The department values the public health professionals and certified water operators that are the ‘boots on the ground’ helping to protect public health and the environment every day. “If you see something, say something.” It may make all the difference in helping prevent or stop a waterborne disease outbreak.

Outbreak Summary Report:

Rainbow Valley Ranch is a small community and fishing club located in Teller County, Colorado. Before this outbreak, Rainbow Valley Ranch was considered to be a nonpublic water system as they served fewer than 25 people for at least 60 days of the year. Nonpublic water systems are not required to comply with the Safe Drinking Water Act and CDPHE has no regulatory authority over their water system.

According to residents of Rainbow Valley Ranch, people reported illness in April 2022, and CDPHE epidemiologists and WQCD staff worked together to collect and analyze information. Ultimately, CDPHE confirmed this as a confirmed waterborne disease outbreak on July 25, 2022. Four people from multiple households met the case definition of an acute onset of gastrointestinal illness. All four cases were Colorado residents, no one was hospitalized, and all individuals survived the illness.

Epidemiology and Investigation Concluded: Illness was likely Non-Shiga Toxin-Producing Escherichia coli bacteria are found in surface water, like lakes and streams. These bacteria live in the intestines of mammals, and some can cause mild to severe gastrointestinal illnesses.

Summary of Sampling and Gastrointestinal illness:

• 4 sick individuals
• 5 total coliform positive results
• 2 E. coli positive results 

Gastrointestinal Illness: 

Non-Shiga Toxin-Producing Escherichia coli infections can cause gastrointestinal illness with diarrhea and abdominal cramps, among other symptoms. These bacteria occur naturally in the intestinal tract of most animals and people, and can enter surface waters like rivers and

lakes through animal waste. When the people at Rainbow Valley Ranch drank the untreated surface water, the bacteria made them sick. 

Incident Timeline: 

• April 1, 2022
• At least one resident experienced gastrointestinal illness symptoms.
• July 20, 2022
• CDPHE received notification from a tenant at Rainbow Valley Ranch about their drinking water. According to the complainant, the landlord was using untreated lake water for the community’s drinking water and the complainant had diarrhea and blood in their stool. The complainant took a drinking water sample and sent it to the lab, where it was later confirmed as containing E. coli bacteria.
• July 21, 2022
• WQCD performed a site visit, reviewed the source (2 lakes) and treatment processes and collected total coliform samples. WQCD identified a filtration and disinfection system, but the disinfection was not connected to the water and the filtration system was not certified to remove bacteria or viruses. Chlorine results were non-detect.
• In addition, WQCD completed a population count and determined that Rainbow Valley Ranch met the definition of a public water system and would need to comply with the requirements in the Safe Drinking Water Act.
• July 22, 2022
• WQCD received lab results from the total coliform samples showing the presence of total coliform and E. coli. The division issued a boil water advisory to the system, requiring the owner to inform all residents that they must boil their water before using it.
• July 23-24, 2022
• Teller County Public Health and Environment received several other complaints from Rainbow Valley Ranch residents who were experiencing similar gastrointestinal illness symptoms.
• July 25, 2022
• Teller County Public Health and Environment interviewed residents to gather information on symptoms, onset dates, and water quality issues. CDPHE evaluated information and sample results and determined this was a confirmed waterborne disease outbreak. CDPHE required that the owner continue to post the boil water advisory and maintain a 2 ppm chlorine residual until the issue was resolved.
• August 31, 2022
• The owner of Rainbow Valley Ranch reported that she has stopped using the lakes for water and is instead hauling water from a nearby public water system.
• September 7, 2022
• WQCD issued an enforcement order and required the owner to pay a penalty, correct sanitary defects, and hire a certified operator, among other things.
• Late Fall/Early Winter 2022
• The Owner subdivided the property and sold half in order to avoid being a regulated public water system. The fine is still in effect.

➽ Tyson Ingles, Lead Drinking Water Engineer

Program Manger's Message: Draft CCR Rule Considerations

We recently published an article about the draft PFAS rule published by EPA in March 2023. EPA also published a draft rule in March 2023 to revise the Consumer Confidence Report (CCR) Rule. EPA was required to undertake this action when Congress passed and the President signed America’s Water Infrastructure Act (AWIA) of 2018. AWIA amended the Safe Drinking Water Act and required EPA to revise the CCR rule to:

• Increase the accuracy and readability of CCRs;
• Provide more information about lead;
• Require systems serving more than 10,000 people to provide CCRs twice per year; and,
• Allow for electronic CCR delivery.

EPA also decided to include a provision in the rule requiring states to provide direct compliance monitoring data to EPA as opposed to the current practice of reporting summary information and violations only. We are concerned about this provision leading to EPA micromanaging states with primacy and frequently questioning us about specific water systems that may have issues particularly with per- and polyfluorinated alkyl substances (PFAS) or lead or whatever contaminant may be perceived as a hot topic at the moment.

In reviewing the draft rule we identified some items of concern that the Association of State Drinking Water Administrators (ASDWA) highlighted in its comments on the draft rule. While EPA was certainly required by AWIA to increase the CCR frequency for large systems, specific provisions in the draft rule appear to require water systems to duplicate efforts and communications already undertaken when water systems provide information to the public as part of the Public Notice Rules. We hope EPA elects to reduce those duplicative activities. 

The draft CCR rule also placed a heavy emphasis on translating CCRs into alternate languages and requires states to assist water systems in this process. We support helping people get information they need in a language they best understand. We are happy to assist water systems in achieving this goal. However, we are concerned that the draft rule could be construed as requiring states to undertake translation services in some instances. We believe that EPA must take the lead in helping states and water systems with translation. But states should not be directly required to take on this task by EPA; doing so can create an inherent conflict of interest with states' oversight role. 

Although EPA was tasked in AWIA with improving readability, ASDWA still believes that some of the revised language, such as the nitrate and arsenic education statements, are reading at a 12th -14th -grade level, which is too high for the general public. To improve readability, EPA should simplify much of its new language to a lower reading level. 

EPA also had some concerning language in the draft rule about “misleading statements.” We agree that it is unacceptable for water systems to put misleading statements in CCRs that underplay the health risks from violation or similar circumstances. In Colorado, we review CCRs and require that misleading statements be corrected. However, EPA used an example of a misleading statement as characterizing the drinking water as “safe.” We have serious concerns about this example. Considering that the Maximum Contaminant Level Goals (MCLGs) for many contaminants are zero, we understand that many contaminants can impart a very low health risk even if below the MCL. However, we do not believe that stating the water is safe to drink when a system is in compliance is a misleading statement that must be corrected. 

The timeline for this proposed rule is also concerning. EPA plans to finalize this rule in 2024, and then have it go into effect in 2025. This is not enough time and very challenging from a feasibility standpoint. For most drinking water rules, states have two years to adopt the rule and then the compliance date is one year out from that. Specifically, this is not enough time for states to adopt the rule and attain primacy. This is also not enough time for states to develop the needed policies, guidance, and business processes to support implementation. This is not enough time for states and water systems to develop translation assistance efforts and materials needed. We hope that EPA takes a more reasonable approach to the timing of the final rule.

Lastly, this rule will also require new resources for the division to implement. Colorado has been able to implement several new rules the last decade involving disinfection, water haulers, storage tanks, backflow prevention and cross connection control, and the revised total coliform rule without adding program resources for implementation. However, with this CCR rule coming essentially at the same time as the Lead and Copper Rule Revisions (LCRR) and the PFAS rule, the division must obtain additional resources to support maintaining primacy into the future.  

As always, we will engage with stakeholders in developing the CCR rule for Colorado. We already have a very strong program with respect to public notice, the current CCR rule and translation, especially into Spanish. We will do our best to help water systems comply with the CCR rule considering our funding and resource levels. I advise you to learn about the new draft CCR rule and take steps to prepare your water system for it. 

Thank you,

➽ Ron Falco, P.E. Safe Drinking Water Program Manager