Resources

DWP Forms for Download

Capacity Development

• Capacity Development Review Checklist (PDF)
• Very Small Water System Capacity Development Review Checklist (PDF)

Drinking Water Orders

• Boil Water Order Posting Template (English) (PDF)
• Boil Water Order Posting Template (Arabic) (PDF)
• Boil Water Order Posting Template (French) (PDF)
• Boil Water Order Posting Template (Somali) (PDF)
• Boil Water Order Posting Template (Spanish) (PDF)
• Do Not Drink Order Posting Template (English) (PDF)
• Do Not Drink Order Posting Template (Arabic) (PDF)
• Do Not Drink Order Posting Template (French) (PDF)
• Do Not Drink Order Posting Template (Somali) (PDF)
• Do Not Drink Order Posting Template (Spanish) (PDF)
• Do Not Use Order Posting Template (English) (PDF)
• Do Not Use Order Posting Template (Arabic) (PDF)
• Do Not Use Order Posting Template (French) (PDF)
• Do Not Use Order Posting Template (Somali) (PDF)
• Do Not Use Order Posting Template (Spanish) (PDF)

Emergency Response

• Emergency Response Plan Template - Pop <3000 (PDF)
• Emergency Response Plan Template - Pop >500 (PDF)
• Incident Action Checklist - Flooding (PDF)

Funding

Asset Security

• Water System Asset Security Grant Application (PDF) -- View or Download
• Water System Asset Security Grant Reimbursement Form 2024 (PDF)
• Water System Asset Security Grant Reimbursement Form 2023 (PDF)
• Water System Asset Security Grant Reimbursement Form 2022 (PDF)

Capacity Development

• Capacity Development Grant Application (PDF)
• Capacity Development Grant Reimbursement Form (PDF)
• Capacity Development TRF Application (PDF)
• Very Small System Capacity Development Grant Application (PDF)
• Very Small System Capacity Development Grant Reimbursement Request (PDF)

Compliance

• Very Small System Compliance Loan Fund Application (PDF)

Drinking Water State Revolving Fund (DWSRF)

• Resources: Drinking Water State Revolving Fund
• Application Form for DWSRF-Eligible Projects (Web Form)
• DBE Program Subcontractor Participation Form (DWP Form 6100-2) (PDF)
• DBE Program Subcontractor Performance Form (DWP Form 6100-3) (PDF)
• DBE Program Subcontractor Utilization Form (DWP Form 6100-4) (PDF)

DWSRF Supplemental General Conditions:

• Equivalency Projects (PDF)
• Non-Equivalency Projects (PDF)

DWSRF Project Specifications Checklists:

• Equivalency Projects (PDF)
• Non-Equivalency Projects (PDF)
• DWSRF Request for Reimbursement Form (XLS)
• Program Report of DBE Subcontractor Utilization Form (PDF)
• Use of American Iron and Steel (AIS) DeMinimis Spending Record (XLSX)
• Weekly Payroll Labor Standards Compliance Review Form (PDF)

Land Acquisition

• Land Acquisition Loan Application (PDF)

Lead Service Line Inventory

• Lead Service Line Inventory Assistance Grant Application (PDF)

PFAS (Emerging Contaminants)

• Small Public Water System Emerging Contaminant Grant Application (PDF)
• Small Public Water System Emerging Contaminant Grant Requirements (PDF)
• Very Small System Emerging Contaminant Planning Grant Application (PDF)
• Very Small System Emerging Contaminant Planning Grant Reimbursement (PDF)

Source Protection

• Source Protection Grant Application (PDF)
• Source Protection Grant Reimbursement Form (PDF)
• Wellhead Protection Grant Reimbursement Form (PDF)

System Consolidation

• System Consolidation Grant Application (PDF)

Total Coliform

• Very Small System Total Coliform Grant Application (PDF)
• Very Small System Total Coliform Grant Reimbursement Form (PDF)

Laboratory Accreditation

• Application for Initial Laboratory Accreditation (DOCX)
• Application for Renewal Laboratory Accreditation (DOCX)
• Application for Revision Laboratory Accreditation (DOCX)
• Method Analyte Table for Application (XLSX)

Lead & Copper

• Lead & Copper Rule Revision/Lead Service Line Inventory
• Form 141-A (RTF)
• Form 141-A (PDF)
• Lead Customer Notification Template for Community Systems (PDF)
• Lead Customer Notification Template for NTNC Systems with Five Sites (PDF)
• Lead Customer Notification Template for NTNC Systems with Ten Sites (PDF)
• Service Line Inventory Form (Small Systems) (PDF)
• Service Line Inventory Template (Large Systems) (XLSX)

Service Line Inventory Public Notices

• Notice of Service Line Inventory Completion: No Lead, Galvanized Requiring Replacement (GRR), or Unknown service lines were found (DOCX)
• Direct Notice to Customer Served: Individual home where Lead, Galvanized (GRR), and/or Unknown service lines were identified (DOCX)
• Optional Notice of Service Line Inventory Completion: System where Lead, Galvanized (GRR), and/or Unknown service lines were identified (DOCX)
• 24-Hour Tier 1 Lead ALE Public Notice: Lead Action Level Exceedance: PN Instructions, Template, and Certification for systems that exceed the lead action level under the LCRR (DOCX)

Level Assessments

• Level 1 Assessment Form (PDF)
• Level 2 Assessment Form (PDF)

Monthly Operating Reports

• MOR 001 -- Chemical usage and daily production: All Surface Water (SW) and Groundwater Under the Influence (GUI) systems (PDF) -- MS Excel
• MOR 002 -- Chemical usage and daily production: All Groundwater (GW) systems (PDF) -- MS Excel
• MOR 003 -- SWTR Report -- All SW and GUI systems using conventional and direct filtration (PDF) -- MS Excel
• MOR 004 -- SWTR Report: All SW and GUI unfiltered systems that use Chlorine only (PDF) -- MS Excel
• MOR 005 -- DBP Report: All SW and GUI systems serving >10,000 people (PDF) -- MS Excel
• MOR 006 -- DBP Report: All SW and GUI systems serving <10,000 people (PDF) -- MS Excel
• MOR 006A -- DBP Report: All GW systems that disinfect (PDF) -- MS Excel
• MOR 007 -- Chlorine Dioxide Report: All Chlorine Dioxide systems (PDF) -- MS Excel
• MOR 008 -- Fluoride Report: All systems that add fluoride (PDF) -- MS Excel
• MOR 009 -- DBP Report: All SW and GUI unfiltered systems serving >10,000 people, with >4 TTHM and HAA5 sampling points (PDF) -- MS Excel
• MOR 010 -- SWTR Report: All SW and GUI unfiltered systems that use multiple disinfectants (PDF) -- MS Excel
• MOR 011 -- SWTR Report: All SW and GUI systems that use Slow Sand or another type of alternative filtration (PDF) -- MS Excel
• MOR 012 -- Chemical usage and daily production: Small Water System Chlorination Report Form (PDF) -- MS Excel
• MOR 012 Instructions (PDF)
• MOR 013 -- Corrosion Control Report: Small and Medium System Corrosion Control Report Form (PDF) -- MS Excel
• MOR 014 -- UV Report: Small Water System Monthly Operating Report for UV Treatment (PDF) -- MS Excel

New System Approval

• Community Public Water System serving 250 or more people (PDF)
• Community Public Water System serving fewer than 250 people (PDF)
• Non-Transient Non-Community Public Water System (PDF)
• Transient Public Water System (Groundwater Supply) (PDF)
• Transient Public Water System (Surface Water Supply) (PDF)

Professional Licensure

Water Operators

• License Application (PDF)
• License Reinstatement (PDF)
• Paper Exam Application (PDF)
• Water Operator Complaint (PDF)

Well Drillers & Pump Installers

• Apprentice Pump Installer Application (PDF)
• Apprentice Water Well Driller Application (PDF)
• Company Registration Application (PDF)
• Company Renewal Application (PDF)
• Journeyman Pump Installer Exam Application (PDF)
• Journeyman Water Well Driller Exam Application (PDF)
• Master Pump Installer Exam Application (PDF)
• Master Water Well Driller Exam Application (PDF)
• Well Driller and Pump Installer License Renewal Form (PDF)
• Well Driller Complaint Form (PDF)

Training Providers & Vendors

• Course Application (PDF)
• Provider Application (DOC)
• Training Contact Hours Attendance Sheet (PDF)

Sampling

• Chain of Custody (HETL) (PDF)
• Coliform and Nitrate Sampling Worksheet (XLS)
• Form 141-A (RTF)
• Form 141-A (PDF)
• Sample Site Plan Templates (PDF)
• PWSs serving fewer than 1,000 consumers (PDF)
• PWSs serving more than 1,000 consumers (PDF)

Seasonal Public Water Systems

• Startup Procedure for Seasonal Public Water Systems Using Groundwater (PDF)
• Startup Procedure for Seasonal Public Water Systems Using Groundwater (Form)
• Startup Procedure for Seasonal Public Water Systems Using Surface Water (PDF)
• Startup Procedure for Seasonal Public Water Systems Using Surface Water (Form)

Source Protection

• DIY Wellhead Protection Plan (PDF)
• Model Wellhead Protection Ordinance (PDF)
• Notice of Intent to Hydrofrack (PDF)
• Wellhead Protection Plan Template for Small Water Systems (PDF)

Subsurface Wastewater

• Affidavit of Site Preparation - HHE-238B (MS Word)
• Certificate of Approvals - HHE-239 (PDF)
• Engineered System Application - HHE-220 (PDF)
• Holding Tank Application - HHE-233 (DOCX)
• Holding Tank Deed Covenant - HHE-300 (PDF)
• Inspection Checklist for LPIs (PDF)
• Internal Plumbing Permit Application - HHE-211 (PDF) Standard (Complete by Hand)
• Local Plumbing Inspector (LPI) Appointment - HHE-FL5 (PDF)
• Minimum Lot Size Law Waiver Application - HHE-236 (DOCX)
• New Vendor & Vendor Update (PDF)
• Notice of Intent to Install a SSWW Disposal System...Expanded Structure - HHE-234 (DOCX)
• Notice of Permit (DOCX)
• Personal Reference for Site Evaluator Exam - HHE-217 (DOCX)
• Pre-Treatment Maintenance Agreement - HHE-300A (PDF)
• Product Registration - HHE-221 (PDF)
• Single Replacement Tank Only - HHE-200A (PDF)
• SSWW Disposal System Application - HHE-200, Page 1 (PDF)
• SSWW Disposal System Application - HHE-200, Page 2
• SSWW Disposal System Application - HHE-200, Page 2 (extra soil logs) (PDF)
• SSWW Disposal System Application - HHE-200, Page 2 (no grid) (PDF)
• SSWW Disposal System Application - HHE-200, Page 3 (PDF)
• SSWW Disposal System Application - HHE-200, Page 3 (no grid) (PDF)
• Statement of Compliance for Engineered Systems - HHE-220A (PDF)
• Statement of Rule Compliance - HHE-238A (DOCX)
• Variance Request Form - HHE-204 (PDF)
• Voluntary Septic System Inspection (EXL)v
• Water Use Records Percentile Calculator Spreadsheet (EXL)

Synthetic Organic Chemicals (SOC)

• SOC Waiver Application (PDF)

System Changes

• Certification / Request for System Classification as Transient (NC) (PDF)
• Point of Contact (POC) Change Form (PDF)
• Public Water System Change Applications (PDF)
• Public Water System Designated Operator Form (PDF)

Well Drilling

• Setback Reduction Notification (PDF)
• Specialty Well Application (PDF)

'Fillable' PDF Forms

Some of the forms on this page can be printed and completed by hand or filled-in using your computer (specific PDFs only).

To ensure all functions operate properly, the forms should be downloaded, then opened and completed using Adobe® Reader. Click here to download and install the application. This is a safe and free download from Adobe®.

IMPORTANT: If using the 'fillable PDF' option on a PC, do not attempt to complete these forms in a web browser such as Chrome or Edge, as some functions may not be available. Mac users may find those functions work best when the form has been opened in the Safari browser.

To use PDF forms on your computer, simply follow these easy steps:

1. Download the form and save it to your computer, either on your desktop or in a folder you can easily access.
2. Open the blank form at its location on your computer using the PDF Reader.
3. 'Save As', re-naming the form using pertinent information that will help identify the document in the future (e.g., permit number, issue date, client name/address, etc.).
4. Using your computer keyboard, fill-in all applicable fields; use the TAB key to navigate through the document.
5. Click 'Save'.
6. You may return to the form at a later time to revise and/or complete your work. Be sure to 'Save' subsequent additions/revisions.
7. Print for signature and/or mailing or attach to an email for electronic submittal.

If you have questions about any DWP forms or documentation, please contact your PWS Inspector or call the Drinking Water Program at (207) 287-2070.