Currently trying to calculate the alert and action levels for a purified water system after completing phase 1 of PQ

Using the following equations:

Alert Level = Average + 2 x Standard Deviation

Action Level = Average + 3 x Standard Deviation

when i use these equations, my action level for microbial count is well over the specifications (no more than 100 cfu/ml)

Is this normal? Does this mean my TVC counts are too high to progress to Phase 2 of the PQ?

Any suggestions on what to do with this information would be helpful.

Thank you