ODW Forms

 

Form NameMain PageLink
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 Planhttps://www.vdh.virginia.gov/content/uploads/sites/14/2023/04/Community_Business_Operations_Plan_2024.zip
NTNC Business Operations PlanWaterworks Business Operations Planhttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/NTNC-Business-Operations-Plan.zip
NTNC EZ PlanWaterworks Business Operations Planhttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/NTNC-EZ-Plan.zip
TNC Business Operations PlanWaterworks Business Operations Planhttps://www.vdh.virginia.gov/content/uploads/sites/14/2020/09/TNC-Business-Operations-Plan.zip
Asset Management Plan ChecklistAsset Managementhttps://www.vdh.virginia.gov/content/uploads/sites/14/2019/09/2018-08-23-AMP-checklist_final_formatted_bem_2.docx
VDH Asset InventoryAsset Managementhttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/10/VDH-Asset-Inventory-Template.xlsx
Planning & Design
Fund Instructions
Planning & Design Fund Application and Informationhttps://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 Informationhttps://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 Informationhttps://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 & Applicationhttps://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 & Applicationhttps://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 & Applicationhttps://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 & Applicationhttps://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 & Applicationhttps://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 & Applicationhttps://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 NotificationAdditional Lead and Copper Resourceshttps://www.vdh.virginia.gov/content/uploads/sites/14/2023/04/D.1a.-Simplified-Consumer-Notification2024.docx
Construction Funds Application (PDF)Drinking Water Funding Program Details & Applicationhttps://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 & Applicationhttps://www.vdh.virginia.gov/content/uploads/sites/14/2021/02/06a-Construction-Funds-Application-2021.docx
Construction Funds Application InstructionsDrinking Water Funding Program Details & Applicationhttps://www.vdh.virginia.gov/content/uploads/sites/14/2021/02/07-Construction-Funds-App_Instructions-2021.docx
VDH Water System QuestionnaireInformation for Waterworks Ownershttps://www.vdh.virginia.gov/content/uploads/sites/14/2018/11/Questionnaire_6-8-15.pdf
GW-2 Uniform Water Well Completion ReportWell Development Procedureshttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/07/GW-2-form-fillable-08-19-2016.pdf
GW-5 Well Abandonment FormWell Development Procedureshttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/07/GW-5-Well-Abandonment-Form-fillable_080416.pdf
Well Lot Dedication Document TemplateWell Development Procedureshttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/WellLotDedication.docx
Hydraulic Modeling Analysis CertificationDesign Guidance and Reviewhttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/Hydraulic-Modeling-Analysis-Certification-fillable.pdf
Hydraulic Model Data SummaryDesign Guidance and Reviewhttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/Hydraulic-Model-Data-Summary-fillable-_-1.pdf
Waterline Review SheetDesign Guidance and Reviewhttps://www.vdh.virginia.gov/content/uploads/sites/14/2021/11/Waterline-Review-Checklist.docx
Atmospheric Storage Tank Mixer and Aeration Review SheetDesign Guidance and Reviewhttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/07/Tank-Mixing-Aeration-Review-Sheet-fillable-forms.doc
VDH-ODW Construction Permit ApplicationPermit Program & Waterworks Designhttps://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 MainsPermit Program and Waterworks Designhttps://www.vdh.virginia.gov/content/uploads/sites/14/2016/04/General-Permit-Approval-Process-and-Implementation.pdf
VDH-ODW Operation Permit ApplicationPermit Program and Waterworks Designhttps://www.vdh.virginia.gov/content/uploads/sites/14/2021/03/PM-C8-Attachment-15-Operation-Permit-Application-3.docx
Well Yield and Recovery ReportWell Development Procedureshttps://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 WaterworksInformation 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 WaterworksInformation 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 >3300https://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 ≤3300https://www.vdh.virginia.gov/content/uploads/sites/14/2022/01/E.2.-Public-Edu-CWS-3300-pop.doc
Public Education Delivery Certification - NTNC Waterworkshttps://www.vdh.virginia.gov/content/uploads/sites/14/2022/01/E.3.-Public-Edu-NTNC.doc
Well Yield and Recovery templateWell Development Procedureshttps://www.vdh.virginia.gov/content/uploads/sites/14/2022/04/well_yield_and_recovery_report_form-fillable.pdf