ODW Forms - Drinking Water

Form Name	Main Page	Link
Request for Resources	Capacity Development	https://www.vdh.virginia.gov/content/uploads/sites/14/2019/01/D-Resources-Available.docx
Community Business Operations Plan	Waterworks Business Operations Plan	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/Community-Business-Operations-Plan.zip
NTNC Business Operations Plan	Waterworks Business Operations Plan	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/NTNC-Business-Operations-Plan.zip
NTNC EZ Plan	Waterworks Business Operations Plan	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/NTNC-EZ-Plan.zip
TNC Business Operations Plan	Waterworks Business Operations Plan	https://www.vdh.virginia.gov/content/uploads/sites/14/2020/09/TNC-Business-Operations-Plan.zip
Asset Management Plan Checklist	Asset Management	https://www.vdh.virginia.gov/content/uploads/sites/14/2019/09/2018-08-23-AMP-checklist_final_formatted_bem_2.docx
VDH Asset Inventory	Asset Management	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/10/VDH-Asset-Inventory-Template.xlsx
Planning & Design Fund Instructions	Planning & Design Fund Application and Information	https://www.vdh.virginia.gov/content/uploads/sites/14/2020/01/2020-Instructions_Plan-Design-Fund_Draft_FINAL.pdf
Planning & Design Fund Application: (PDF)	Planning & Design Fund Application and Information	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/03/2021-Application_Plan-Design-Fund_Draft.pdf
Planning & Design Fund Application: (Word)	Planning & Design Fund Application and Information	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/03/2021-Application_Plan-Design-Fund_Draft.docx
Public Comments & Set-Aside Form: (PDF)	Drinking Water Funding Program Details & Application	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/03/A.1-Program-Comment-and-Set-Aside-Suggestion-1.pdf
Public Comments & Set-Aside Form: (Word)	Drinking Water Funding Program Details & Application	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/03/A.1-Program-Comment-and-Set-Aside-Suggestion-1.docx
Refinance Loan Application (PDF)	Drinking Water Funding Program Details & Application	https://www.vdh.virginia.gov/content/uploads/sites/14/2019/01/05a-Refinance-Purchase-Loan-Application.pdf
Refinance Loan Application (Word)	Drinking Water Funding Program Details & Application	https://www.vdh.virginia.gov/content/uploads/sites/14/2019/01/05a-Refinance-Purchase-Loan-Application.docx
1452K Source Water Protection Initiative Application (PDF)	Drinking Water Funding Program Details & Application	https://www.vdh.virginia.gov/content/uploads/sites/14/2019/01/08a-Source-Water-Applications.pdf
1452K Source Water Protection Initiative Application (Word)	Drinking Water Funding Program Details & Application	https://www.vdh.virginia.gov/content/uploads/sites/14/2019/01/08a-Source-Water-Applications.docx
Lead Elimination Assistance Program (LEAP) Application (PDF)	Lead Elimination Assistance Program (LEAP)	TBD
Lead Elimination Assistance Program (LEAP) Application (Word)	Lead Elimination Assistance Program (LEAP)	TBD
Lead Elimination Assistance Program (LEAP) Application Instructions	Lead Elimination Assistance Program (LEAP)	TBD
D.1a. Simplified Consumer Notification	Additional Lead and Copper Resources	https://www.vdh.virginia.gov/content/uploads/sites/14/2022/04/D.1a.-Simplified-Consumer-Notification.docx
Construction Funds Application (PDF)	Drinking Water Funding Program Details & Application	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/04/06a-Construction-Funds-Application-2021-fillable-chkboxes-pdf.pdf
Construction Funds Application (Word)	Drinking Water Funding Program Details & Application	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/02/06a-Construction-Funds-Application-2021.docx
Construction Funds Application Instructions	Drinking Water Funding Program Details & Application	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/02/07-Construction-Funds-App_Instructions-2021.docx
VDH Water System Questionnaire	Information for Waterworks Owners	https://www.vdh.virginia.gov/content/uploads/sites/14/2018/11/Questionnaire_6-8-15.pdf
GW-2 Uniform Water Well Completion Report	Well Development Procedures	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/07/GW-2-form-fillable-08-19-2016.pdf
GW-5 Well Abandonment Form	Well Development Procedures	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/07/GW-5-Well-Abandonment-Form-fillable_080416.pdf
Well Lot Dedication Document Template	Well Development Procedures	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/WellLotDedication.docx
Hydraulic Modeling Analysis Certification	Design Guidance and Review	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/Hydraulic-Modeling-Analysis-Certification-fillable.pdf
Hydraulic Model Data Summary	Design Guidance and Review	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/Hydraulic-Model-Data-Summary-fillable-_-1.pdf
Waterline Review Sheet	Design Guidance and Review	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/11/Waterline-Review-Checklist.docx
Atmospheric Storage Tank Mixer and Aeration Review Sheet	Design Guidance and Review	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/07/Tank-Mixing-Aeration-Review-Sheet-fillable-forms.doc
VDH-ODW Construction Permit Application	Permit Program & Waterworks Design	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/02/PM-C5-Attachment-7-Construction-Permit-Application-1.docx
General Permit for Construction of Water Distribution Mains	Permit Program and Waterworks Design	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/General-Permit-Approval-Process-and-Implementation.pdf
VDH-ODW Operation Permit Application	Permit Program and Waterworks Design	https://www.vdh.virginia.gov/content/uploads/sites/14/2021/03/PM-C8-Attachment-15-Operation-Permit-Application-3.docx
Well Yield and Recovery Report	Well Development Procedures	https://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/HTO-007-2015-VDH-Well-Yield-and-Drawdown-Test-Procedures.pdf
Consumer Notification Template for Community Waterworks	Information for Waterworks Owners	https://www.vdh.virginia.gov/content/uploads/sites/14/2022/01/D.1.-Consumer-Notification-CWS.rev-1-2022.doc
Consumer Notification Template for NTNC Waterworks	Information for Waterworks Owners	https://www.vdh.virginia.gov/content/uploads/sites/14/2020/05/D.2.-Consumer-Notification-NTNC.rev-5-2020.doc
Public Education Delivery Certification - Community >3300		https://www.vdh.virginia.gov/content/uploads/sites/14/2022/01/E.1.-Public-Edu-CWS3300-pop-rev-1-2022.doc
Public Education Delivery Certification - Community ≤3300		https://www.vdh.virginia.gov/content/uploads/sites/14/2022/01/E.2.-Public-Edu-CWS-3300-pop.doc
Public Education Delivery Certification - NTNC Waterworks		https://www.vdh.virginia.gov/content/uploads/sites/14/2022/01/E.3.-Public-Edu-NTNC.doc
Well Yield and Recovery template	Well Development Procedures	https://www.vdh.virginia.gov/content/uploads/sites/14/2022/04/well_yield_and_recovery_report_form-fillable.pdf