{"id":4866,"date":"2021-06-07T16:21:23","date_gmt":"2021-06-07T20:21:23","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/drinking-water\/?page_id=4866"},"modified":"2024-05-31T13:41:10","modified_gmt":"2024-05-31T17:41:10","slug":"odw-forms","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/drinking-water\/odw-forms\/","title":{"rendered":"ODW Forms"},"content":{"rendered":"

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Form Name<\/th>Main Page<\/th>Link<\/th>\n<\/tr>\n<\/thead>\n
Request
\n for Resources<\/td>		Capacity Development<\/a><\/td> https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2019\/01\/D-Resources-Available.docx<\/a><\/td>\n<\/tr>\n
Community
\n Business Operations Plan<\/td>		Waterworks Business Operations Plan<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2023\/04\/Community_Business_Operations_Plan_2024.zip<\/a><\/td>\n<\/tr>\n
NTNC Business Operations Plan<\/td>Waterworks Business Operations Plan<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/04\/NTNC-Business-Operations-Plan.zip<\/a><\/td>\n<\/tr>\n
NTNC EZ Plan<\/td>Waterworks Business Operations Plan<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/04\/NTNC-EZ-Plan.zip<\/a><\/td>\n<\/tr>\n
TNC Business Operations Plan<\/td>Waterworks Business Operations Plan<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2020\/09\/TNC-Business-Operations-Plan.zip<\/a><\/td>\n<\/tr>\n
Asset Management Plan Checklist<\/td>Asset Management<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2019\/09\/2018-08-23-AMP-checklist_final_formatted_bem_2.docx<\/a><\/td>\n<\/tr>\n
VDH Asset Inventory<\/td>Asset Management<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/10\/VDH-Asset-Inventory-Template.xlsx<\/a><\/td>\n<\/tr>\n
Planning & Design
\n Fund Instructions<\/td>		Planning & Design Fund Application and Information<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2020\/01\/2020-Instructions_Plan-Design-Fund_Draft_FINAL.pdf<\/a><\/td>\n<\/tr>\n
Planning & Design Fund Application: (PDF)<\/td>Planning & Design Fund Application and Information<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2021\/03\/2021-Application_Plan-Design-Fund_Draft.pdf<\/a><\/td>\n<\/tr>\n
Planning & Design Fund Application: (Word)<\/td>Planning & Design Fund Application and Information<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2021\/03\/2021-Application_Plan-Design-Fund_Draft.docx<\/a><\/td>\n<\/tr>\n
Public Comments & Set-Aside Form: (PDF)<\/td>Drinking Water Funding Program Details & Application<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2021\/03\/A.1-Program-Comment-and-Set-Aside-Suggestion-1.pdf<\/a><\/td>\n<\/tr>\n
Public Comments & Set-Aside Form: (Word)<\/td>Drinking Water Funding Program Details & Application<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2021\/03\/A.1-Program-Comment-and-Set-Aside-Suggestion-1.docx<\/a><\/td>\n<\/tr>\n
Refinance Loan Application (PDF)<\/td>Drinking Water Funding Program Details & Application<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2019\/01\/05a-Refinance-Purchase-Loan-Application_2026-03-22.pdf<\/a><\/td>\n<\/tr>\n
Refinance Loan Application (Word)<\/td>Drinking Water Funding Program Details & Application<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2019\/01\/05a-Refinance-Purchase-Loan-Application_2026-03-22.docx<\/a><\/td>\n<\/tr>\n
1452K Source Water Protection Initiative Application (PDF)<\/td>Drinking Water Funding Program Details & Application<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2019\/01\/08a-Source-Water-Applications_2026-03-23.pdf<\/a><\/td>\n<\/tr>\n
1452K Source Water Protection Initiative Application (Word)<\/td>Drinking Water Funding Program Details & Application<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2019\/01\/08a-Source-Water-Applications_2026-03-23.docx<\/a><\/td>\n<\/tr>\n
Lead Elimination Assistance Program (LEAP) Application (PDF)<\/td>Lead Elimination Assistance Program (LEAP)<\/a><\/td>TBD<\/td>\n<\/tr>\n
Lead Elimination Assistance Program (LEAP) Application (Word)<\/td>Lead Elimination Assistance Program (LEAP)<\/a><\/td>TBD<\/td>\n<\/tr>\n
Lead Elimination Assistance Program (LEAP) Application
\n Instructions<\/td>		Lead Elimination Assistance Program (LEAP)<\/a><\/td>TBD<\/td>\n<\/tr>\n
Construction Funds Application (PDF)<\/td>Drinking Water Funding Program Details & Application<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2021\/04\/06a-Construction-Funds-Application-2021-fillable-chkboxes-pdf.pdf<\/a><\/td>\n<\/tr>\n
Construction Funds Application (Word)<\/td>Drinking Water Funding Program Details & Application<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2021\/02\/06a-Construction-Funds-Application-2021.docx<\/a><\/td>\n<\/tr>\n
Construction Funds Application Instructions<\/td>Drinking Water Funding Program Details & Application<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2021\/02\/07-Construction-Funds-App_Instructions-2021.docx<\/a><\/td>\n<\/tr>\n
VDH Water System Questionnaire<\/td>Information for Waterworks Owners<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/PM-C10-Attachment-1-Potential-Waterworks-Questionnaire_Fillable.pdf <\/a><\/td>\n<\/tr>\n
GW-2 Uniform Water Well Completion Report<\/td>Well Development Procedures<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/07\/GW-2-form-fillable-08-19-2016.pdf<\/a><\/td>\n<\/tr>\n
GW-5 Well Abandonment Form<\/td>Well Development Procedures<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/07\/GW-5-Well-Abandonment-Form-fillable_080416.pdf<\/a><\/td>\n<\/tr>\n
Well Lot Dedication Document Template<\/td>Well Development Procedures<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/04\/WellLotDedication-508c.docx<\/a><\/td>\n<\/tr>\n
Hydraulic Modeling Analysis Certification<\/td>Design Guidance and Review<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/04\/Hydraulic-Modeling-Analysis-Certification-fillable.pdf<\/a><\/td>\n<\/tr>\n
Hydraulic Model Data Summary<\/td>Design Guidance and Review<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/04\/Hydraulic-Model-Data-Summary-fillable-_-1.pdf<\/a><\/td>\n<\/tr>\n
Waterline Review Sheet<\/td>Design Guidance and Review<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2021\/11\/Waterline-Review-Checklist.docx<\/a><\/td>\n<\/tr>\n
Atmospheric Storage Tank Mixer and Aeration Review Sheet<\/td>Design Guidance and Review<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/07\/Tank-Mixing-Aeration-Review-Sheet-fillable-forms.doc<\/a><\/td>\n<\/tr>\n
VDH-ODW Construction Permit Application<\/td>Permit Program & Waterworks Design<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2023\/04\/PM-C5-Attachment-4-Construction-Permit-ApplicationCertification-1.docx<\/a><\/td>\n<\/tr>\n
General Permit for Construction of Water Distribution Mains<\/td>Permit Program and Waterworks Design<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/04\/General-Permit-Approval-Process-and-Implementation.pdf<\/a><\/td>\n<\/tr>\n
VDH-ODW Operation Permit Application<\/td>Permit Program and Waterworks Design<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2021\/03\/PM-C8-Attachment-15-Operation-Permit-Application-3.docx<\/a><\/td>\n<\/tr>\n
Well Yield and Recovery Report<\/td>Well Development Procedures<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2016\/04\/HTO-007-2015-VDH-Well-Yield-and-Drawdown-Test-Procedures.pdf<\/a><\/td>\n<\/tr>\n
D.1a. Simplified Consumer Notification<\/td>Additional Lead and Copper Resources<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2023\/04\/D.1a.-Simplified-Consumer-Notification2024.docx<\/a><\/td>\n<\/tr>\n
Consumer Notification Template for Community Waterworks<\/td>Information for Waterworks Owners<\/a><\/td> https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2025\/05\/D.1.-Consumer-Notification-CWS.rev-3-2025.docx<\/a><\/td>\n<\/tr>\n
Consumer Notification Template for NTNC Waterworks<\/td>Information for Waterworks Owners<\/a><\/td> https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2025\/06\/D.2.-Consumer-Notification-NTNC.rev-3-2025.docx<\/a><\/td>\n<\/tr>\n
Public Education Delivery Certification - Community >3300<\/td><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2022\/01\/E.1.-Public-Edu-CWS3300-pop-rev-1-2022.doc<\/a><\/td>\n<\/tr>\n
Public Education Delivery Certification - Community \u22643300<\/td><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2022\/01\/E.2.-Public-Edu-CWS-3300-pop.doc<\/a><\/td>\n<\/tr>\n
Public Education Delivery Certification - NTNC Waterworks<\/td><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2022\/01\/E.3.-Public-Edu-NTNC.doc<\/a><\/td>\n<\/tr>\n
Well Yield and Recovery template<\/td>Well Development Procedures<\/a><\/td>https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/14\/2022\/04\/well_yield_and_recovery_report_form-fillable.pdf<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n","protected":false},"excerpt":{"rendered":"

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