Application Form for DWSRF Eligible Projects
State of Maine
2023 Drinking Water State Revolving Fund

Applications for the 2023 General Construction Fund Have Closed.

**Lead Service Line Replacement Projects and Emerging Contaminant (PFAS) Projects will continue to be accepted on a rolling basis.**

A separate form must be completed for each project. Upon completing an application, you will be given the option to submit another response if you intend to submit multiple applications.

If you have any questions regarding this project submittal process, please contact Bill Dawson at 207-287-6196 or McKenzie Parker at 207-557-2255.

A copy of your completed application will be automatically emailed to the address provided below for your records. If you need to make changes to a submitted application there is a link to "Edit Response" in this email. Edits may be made until the submission deadline. 

Note: Creating a Google Account is not required to submit an application, however, creating an account will allow you to automatically save your progress, allowing you to close your application and revisit to finish at another time or protect your work in the event of a power/internet outage. Without a Google Account, you will need to complete the application and submit in one sitting.
Sign in to Google to save your progress. Learn more
Email *
Project Title *
Name of Public Water System (PWS) *
PWSID Number *
Contact Information
Name of Contact Person at PWS *
Who should we reach out to if there are questions about your application?
Title of Contact Person at PWS *
PWS Street (Mailing) Address *
PWS Town *
PWS Zip Code *
PWS Contact Telephone Number *
Include area code - enter in 123-456-7890 form
PWS Contact Email Address *
Name of Engineering Consultant *
Who should we reach out to if there are questions about your application?
Engineering Company *
Engineer Street (Mailing) Address *
Engineer Town *
Engineer State *
Engineer Zip Code *
Engineer Telephone Number *
Include area code - enter in 123-456-7890 form
Engineer Email Address *
Public Water System Information
Current annual residential water rate (Based upon 2000 ft3/quarter usage)
 *
Service Area Median Household Income (MHI)
 *
Number of service connections
 *
Type of Water System *
PWS Ownership *
Does this system have an Asset Management Plan? *
If yes, software name or type
Does this system have a GIS Mapping system? *
If yes, software name or type
Does this system have a Comprehensive Plan (Master Plan)? *
If yes, what year was the plan completed?
If yes, is an electronic copy of the plan available?
Clear selection
When was the system's last water rate increase? *
(Year)
What was the percentage of the last water rate increase? *
Project Information
Type of Project *
Project Description *
Purpose or Need for Project
 *
Indicate if this project is intended to address known compliance and/or public health issues. Include a discussion of the alternative analyses conducted if you are developing a new source or if the project will include substantial treatment modifications or adding new treatment. The alternatives analysis must include all feasible options including consolidation with other systems.
Which of the following best describes your project? *
If more than one options applies, choose the option that most strongly describes your reason for undertaking this project
Does the proposed project address a compliance/enforcement issue? *
If yes, what is the PWS compliance/enforcement status?
Is this project recommended in a Facility or Master Plan? *
Are plans and specifications in progress for this project? *
What percentage are plans and specifications complete? *
Is the Environmental Review complete for this project? *
Will other Federal or State sources be used to co-fund this project?  *
Co-funding Agency
If Applicable
Clear selection
Is co-funding grant or loan?
If Applicable
Clear selection
Co-funding Loan or Grant Amount
If Applicable
Has the Co-funder committed to funding?
If Applicable
Clear selection
Is Project in conjunction with a road reconstruction project? *
Local, town paving, MDOT project, etc. 
If a water main replacement project, what material pipe is primarily being replaced?
Clear selection
For infrastructure replacement projects, approximately how old is the infrastructure being replaced?
Enter number only - Ex: for a 80-year old water main enter "80" [not "eighty year old", "80 years"] 
Is this project related to Lead Service Line Removal? *
 If "yes" project must be a lead service line replacement (LSLR) project or associated activity directly connected to the identification, planning, design, and replacement of lead service lines. 
If yes, identify the lead components that will be removed and where they are in the water system.
Is this project to address Emerging Contaminants (i.e. PFAS) in Drinking Water? *
If yes, what is the confirmed PFAS level in supply to be treated?
Clear selection
Anticipated Project Timeline
Provided an estimated timeframe for when each of the below project milestones will be reached.
Start of Design *
MM
/
DD
/
YYYY
Design Complete *
MM
/
DD
/
YYYY
Bid Date *
MM
/
DD
/
YYYY
Start of Construction *
MM
/
DD
/
YYYY
Construction Complete *
MM
/
DD
/
YYYY
Estimated Project Costs
Provide estimated costs for each of the applicable categories that may be associated with your project.
1. Construction
Contract 1 - Estimated cost in USD
1. Description of Contract
2. Construction
Contract 2 (if applicable)   - Estimated cost in USD
2. Description of Contract
3. Construction
Contract 3 (if applicable) - Estimated cost in USD
3. Description of Contract
4. Preliminary Expenses
Studies  - Estimated cost in USD
5. Land & Rights
Estimated cost in USD
6. Legal and Administration 
Estimated cost in USD
7. Engineering Administration
 Estimated cost in USD
8. Engineering Design
Estimated cost in USD
9. Engineering Inspections
Estimated cost in USD
10. Engineering Other Services
Estimated cost in USD
11. Financing Expenses
Bond Counsel, Short Term Interest -  Estimated cost in USD
12. Equipment and Miscellaneous
Estimated cost in USD
13. Contingency 
Not to exceed 20% -  Estimated cost in USD
14. DWP Project Management Fee
Add items 1 - 13 above then multiply by 0.010101
Total Estimated Project Cost *
Add items 1-14 above
Who provided the values for this cost estimate? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms