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					TEXAS WATER DEVELOPMENT BOARD
James E. Herring, Chairman Lewis H. McMahan, Member Edward G. Vaughan, Member J. Kevin Ward Executive Administrator Jack Hunt, Vice Chairman Thomas Weir Labatt III, Member Joe M. Crutcher, Member

October 9, 2009

Re: Solicitation of Project Information for Inclusion in the State Fiscal Year (SFY) 2011 Drinking Water State Revolving Fund (DWSRF) Intended Use Plan (IUP) Dear Water System Official: The Texas Water Development Board (TWDB) is pleased to offer the opportunity for existing public drinking water systems to save money by seeking financial assistance through the DWSRF loan program. This program provides low-interest financing for projects involving publicly and privately owned public drinking water systems. These loans are designed to fund projects that will bring existing public water systems into compliance with drinking water rules and regulations. In addition, special loan subsidies are available for entities that qualify as disadvantaged. Loans are also available for source water protection projects. To be eligible for a DWSRF loan, entities must have their projects listed in the SFY 2011 DWSRF IUP; however, having a project listed in the IUP does not obligate an entity to apply for funding. For a project to be listed in the SFY 2011 DWSRF IUP, each entity must: • Complete the Project Information Form and all applicable forms even if you sent in a response last year, and • Submit the completed forms to the TWDB no later than Friday, January 8, 2010 (see Project Submission Guidelines for submission information). The solicitation forms and additional guidance are available on the TWDB's DWSRF Home Page located at www.twdb.state.tx.us/assistance/financial/fin_infrastructure/dwsrf.asp. Paper copies of the solicitation packet may be requested by contacting Barbara Vanecek at 512-463-7026 or barbara.vanecek@twdb.state.tx.us. DWSRF projects are selected for funding on the basis of a priority rating system. The solicitation forms are designed to help potential loan applicants describe proposed projects and the problems to be addressed. The Texas Commission on Environmental Quality (TCEQ) uses the information provided on the forms to numerically rate each project and develop a priority list which is submitted to the TWDB. To qualify for funding, a project must correct the violations or conditions that contribute to its rating. It is important that the applicable forms are completed to ensure that the proposed project is accurately rated. Congress is currently considering legislation that may affect requirements of the DWSRF program. Conditions that may be applied to projects funded in SFY 2011 include: 1) compliance with Davis-Bacon Act wage rules and 2) a Buy American provision that would require all iron, steel, and manufactured goods used in a project to be produced in the United States. In addition, although not finally enacted, there is a high degree of confidence that, in SFY 2011, the DWSRF program will be required to set aside 20% of funds available from the DWSRF capitalization grant for green projects (see Project Submission Guidelines for more information).

Our Mission To provide leadership, planning, financial assistance, information, and education for the conservation andresponsible development of water for Texas.
P.O. Box 13231 • 1700 N. Congress Avenue • Austin, Texas 78711-3231 Telephone (512) 463-7847 • Fax (512) 475-2053 • 1-800-RELAYTX (for the hearing impaired) www.twdb.state.tx.us • info@twdb.state.tx.us TNRIS - Texas Natural Resources Information System • www.tnris.state.tx.us A Member of the Texas Geographic Information Council (TGIC)

SFY 2011 DWSRF Solicitation October 9, 2009 Page 2 To be eligible for funding, a proposed project must be consistent with the regional and state water plans. The State Water Plan is based on regional plans developed by the 16 regional water planning groups that represent the different geographic areas of the state. If you have any questions regarding your proposed project and the State Water Plan, please contact your regional water planning group, or the TWDB at 512-936-0814. Information about the State Water Plan may also be found online at www.twdb.state.tx.us/wrpi/swp/swp.htm. From October through December 2009, TWDB staff members are conducting technical assistance workshops in the cities listed below to discuss both the DWSRF and Clean Water SRF programs and assist entities with completing the solicitation forms. Please contact the TWDB if you are interested in attending a workshop. You can also request help in filling out the DWSRF forms through the TCEQ Financial, Managerial, and Technical (FMT) Assistance contact listed below.
SRF Technical Assistance Workshops Date City October 27, 2009 Tuesday Abilene October 28, 2009 Wednesday Amarillo November 5, 2009 Thursday Austin November 10, 2009 Tuesday El Paso November 19, 2009 Thursday Beaumont December 3, 2009 Thursday Dallas

Contact Information General Questions Workshop Information State Water Plan and Regional Water Planning Source Water Protection TCEQ FMT Assistance TCEQ Public Drinking Water Section Austin Field Office Harlingen Field Office Houston Field Office Mesquite Field Office San Antonio Satellite Office

Marvin Chaney Earline Baker Ann Omoegbele Sean Ables Margot Taunton

512-463-8750 marvin.chaney@twdb.state.tx.us 512-463-4053 earline.baker@twdb.state.tx.us 512-936-0814 ann.omoegbele@twdb.state.tx.us 512-239-1758 sables@tceq.state.tx.us 512-239-6403 mtaunton@tceq.state.tx.us 512-239-4691 pdws@tceq.state.tx.us

David Buaas Juan Bujanos Dee Rice Raphael Castro David Firgens

512-936-0804 david.buaas@twdb.state.tx.us 956-421-3599 juan.bujanos@twdb.state.tx.us 281-895-0722 dee.rice@twdb.state.tx.us 972-289-9890 raphael.castro@twdb.state.tx.us 210-223-2264 david.firgens@twdb.state.tx.us

We look forward to your participation. Sincerely,

Stacy Barna Director of Program Development Project Finance

Texas Water Development Board

SFY 2011 DWSRF IUP Solicitation Packet

Project Submission Guidelines
All forms must be postmarked, delivered, emailed, or faxed no later than 6:00 PM on Friday, January 8, 2010. Submission Deadline Page 4 of the Project Information Form must include: • a signature by an authorized representative, and • the seal of a registered Professional Engineer if the requested loan amount exceeds $100,000. Texas Water Development Board Attn: DWSRF IUP Project P.O. Box 13231 Austin, TX 78711 Barbara Vanecek 512-463-7026 Texas Water Development Board Attn: DWSRF IUP Project 1700 N. Congress Ave., Rm. 581 Austin, TX 78701 IUPsubmissions@twdb.state.tx.us 512-475-2086

Submission Options USPS Mail
Staff review is significantly delayed when projects are submitted in multiple formats. Therefore, please select only one submission option. Although the Project Information Form must be signed, it is not necessary to submit an original signature.

Overnight Mail

Email Fax

Solicitation Forms DW-007 SRF-008 DW-009 DW-010

Project Information Form (required) Disadvantaged Communities Worksheet Consolidation Project Worksheet Source Water Assessment and Protection Program Worksheet

These forms are available online at: www.twdb.state.tx.us/assistance/financial/fin_infrastructure/dwsrf.asp

Who Can Apply for DWSRF Loans • Existing community public water systems including political subdivisions, nonprofit water supply corporations, and privately owned community water systems • Nonprofit, non-community, public water systems • State agencies Projects for which DWSRF Loans Can Be Used • Correction of water system deficiencies including water quality, capacity, pressure, and water loss • Upgrading or replacing water systems • Providing new or existing water service to other water systems through consolidation projects • Purchasing capacity in water systems • Source water protection projects • Green projects (pursuant to EPA guidance) Projects for which DWSRF Loans CANNOT Be Used • Projects primarily intended to facilitate growth • Projects for systems in significant noncompliance, unless funding will ensure compliance • Water rights, unless owned by a system being purchased through consolidation • Projects for systems that lack adequate financial, management, and/or technical capability, unless assistance will ensure compliance • Construction of reservoirs • Dams or rehabilitation of dams • Routine laboratory fees • Fire protection projects

Project Submission Guidelines (10/09)

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SFY 2011 DWSRF IUP Solicitation Packet

Project Submission Guidelines
How Projects Are Rated Proposed projects (except for source water protection projects) are rated by the Texas Commission on Environmental Quality (TCEQ) and are given a Combined Rating Factor. The Combined Rating Factor is based on health and compliance factors, physical deficiency factors, consolidation factors, and an affordability factor. Rated projects are listed in priority order and submitted to the TWDB. The TWDB uses the list to develop the Intended Use Plan (IUP) and to establish a funding line. Entities with projects ranked above the funding line are invited to apply for a DWSRF loan and are given three months from the date of the invitation letter to submit an application. Funding Options DWSRF funds are available upon invitation to all entities listed above the funding line. All applicants for the funding options listed below must comply with federal procurement and environmental review requirements, and will be assessed a loan origination fee of 2.25%. The loan origination fee is used to pay for administration of the loan. Disadvantaged Communities This funding option provides eligible entities with an interest rate of 0% or 1%, and possible principal forgiveness of 15% or 35%. The maximum repayment period is 30 years. The TWDB can provide this funding option to: • A political subdivision that meets the criteria for a disadvantaged community; • An area located outside the boundaries of a political subdivision that meets the criteria for a disadvantaged community. In these cases, the political subdivision must apply on behalf of the area located outside its boundaries; or • An owner of a community water system ordered by TCEQ to provide service to a disadvantaged community. A Disadvantaged Communities Worksheet must be submitted to be considered for this funding option. Privately owned water systems are not eligible for Disadvantaged Communities funding except in cases where TCEQ orders a political subdivision to provide service to a privately owned water system that serves a disadvantaged community. A disadvantaged community is defined as an area in which the project will provide service that has an adjusted annual median household income that is no more than 75% of the state adjusted annual median household income; and • if the service area is not charged for sewer services, has a household cost factor for water rates that is greater than or equal to 1.0%; or • if the service area is charged for water and sewer services, has a combined household cost factor for water and sewer rates that is greater than or equal to 2.0%. For the SFY 2011 DWSRF funding cycle, 75% of the state adjusted annual median household income is $36,862. Mainstream This funding option offers an interest rate subsidy up to 1.50% below market interest rates, excluding the loan origination fee. The maximum repayment period is 20 years. Source Water Protection Program This program provides loans to assist communities in implementing source water protection best management practices (BMPs) recommended by TCEQ. The TWDB will set aside 10% of the total DWSRF program funds for source water protection projects.

Project Submission Guidelines (10/09)

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SFY 2011 DWSRF IUP Solicitation Packet

Project Submission Guidelines
Green Projects The TWDB anticipates that legislation will be enacted that requires the DWSRF program to set aside 20% of funds received from the DWSRF capitalization grant to be used for green projects, referred to as green reserve funding. The recent American Recovery and Reinvestment Act defined green projects as projects that address, either partially or completely, green infrastructure, water conservation and efficiency, alternative and high energy efficiency, or other environmentally innovative activities. The TWDB is requesting that entities submit information relevant to the green aspects of any proposed projects along with a green business case if they wish to be considered for green reserve funding. Refinancing Refinancing of a completed project is eligible provided that the project was planned in accordance with TWDB rules. The project rating will be based on the conditions that existed prior to the start of construction. All completed projects that involve refinancing will be listed in the IUP as a separate group and placed below projects for which construction has not been completed. Because refinancings must be rated separately, a completed project cannot be combined with a project for which construction has not been completed. Completed projects to be refinanced must include an amount for bond insurance in the Estimated Cost section of the Project Information Form. The debt obligation to be refinanced must have been incurred after July 1, 1993. SRF funds may not be used to refinance a previous TWDB loan. Privately owned public water systems are not eligible for refinancing. Cost Categories for Project Information Form (DW-007), Section 5 A. Treatment Includes any of the following: disinfection, filtration, treatment waste handling, and any other treatment (i.e., GAC, aeration, iron/manganese removal, chemical storage tanks, and sedimentation). B. Transmission & Distribution Includes raw and finished water transmission, distribution lines, valves, back flow prevention, water meters, and/or pumping stations. C. Source Includes wells, wellhead pumps, and surface water intakes. D. Storage Includes elevated, ground, and pressure tanks for finished/treated water. E. Purchase of Systems Includes all of the eligible costs funded by the DWSRF to purchase systems (e.g., as part of a consolidation/regionalization project). F. Restructuring Includes costs associated with changes in organizational structure, management, accounting, rates, or other procedures conducted to meet financial, managerial, and technical requirements. G. Land Acquisition Includes eligible costs funded by the DWSRF to acquire land. H. Source Water Protection Includes costs associated with implementing source water protection BMPs. I. Other Includes other costs that cannot be classified into the categories above.

Project Submission Guidelines (10/09)

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SFY 2011 DWSRF IUP Solicitation Packet

Project Submission Guidelines
Acronyms AMHI BMP CCN CPI DWSRF EPA FMT GAC IUP MCL MGD PSI PWS SFY SRF SWAP SWSA TCEQ TWDB USPS WSC Annual Median Household Income Best Management Practice Certificate of Convenience and Necessity Consumer Price Index Drinking Water State Revolving Fund Environmental Protection Agency Financial, Managerial, and Technical Granulated Activated Carbon Intended Use Plan Maximum Contaminant Level Million Gallons per Day Pressure per Square Inch Public Water System State Fiscal Year State Revolving Fund Source Water Assessment and Protection Source Water Susceptibility Assessment Texas Commission on Environmental Quality Texas Water Development Board United States Postal Service Water Supply Corporation

Project Submission Guidelines (10/09)

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SFY 2011 DWSRF IUP Solicitation Packet

Project Information Form
Submission Deadline: January 8, 2010, 6:00 PM To be considered for rating and inclusion in the SFY 2011 DWSRF IUP, all items on this form are required to be filled out. Incomplete forms may prevent projects from being rated. For questions, contact: Marvin Chaney Margot Taunton 512-463-8750 512-239-6403 marvin.chaney@twdb.state.tx.us mtaunton@tceq.state.tx.us

Section 1. GENERAL INFORMATION Name of Entity (City, Town, County, District, PWS, WSC, etc.) County

PWS ID No.

CCN No.

Engineering Firm Contact Information Entity Contact Information Contact Person Title Mailing Address Phone No. Fax Number Email Address Section 2. TYPE OF PROJECT (Please mark all that apply.) PWS Capital Improvement Project Disadvantaged Communities Program
Must submit Form SRF-008.

(Seal of registered Professional Engineer required on Page 4.)

Name of Firm Contact Person Title Mailing Address Phone No. Fax Number Email Address

Source Water Protection Program
Must submit Form DW-010.

Consolidation Project (benefits more than one PWS)
Must submit Form DW-009 for each PWS involved.

Section 3. SERVICE AREA INFORMATION Submit a map of your current and, if applicable, proposed service area(s). To determine population served: For • • an incorporated entity (i.e., a city or town), indicate the number of people who reside within the territorial boundaries of, or receive wholesale or retail water service from, the entity based on the most recent decennial US Census. For • • an unincorporated entity (i.e., a county, district, river authority, system, or corporation), indicate the number of people who reside within the territorial boundaries of, or receive wholesale or retail water service from, the entity based on the most recent decennial US Census. You must provide a table that 1) identifies the number of household connections within each applicable census boundary* that covers your service area and 2) prorates the population accordingly. The map of the service area must by overlaid by a map of the census boundary(ies) identified in the table.
* Please use the smallest geographic type (e.g., census tract, block group, block) for which the most recent decennial US Census data is available.

Population Served

Number of Household Connections

Section 4. REFINANCING (You must include an amount for bond insurance in Section 10.) DWSRF funds may be used to refinance completed projects only. See the Project Submission Guidelines for additional information. Yes Will DWSRF funds be used to refinance existing debt related to this project and received from a source other than the TWDB? No

Form DW-007 (10/09)

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Texas Water Development Board

SFY 2011 DWSRF IUP Solicitation Packet

Project Information Form
Name of Entity:
Section 5. PRINCIPAL PROJECT DESCRIPTION
The principal project consists of one or more construction projects that are intended to address specific system conditions. The cost of the principal project must be greater than 50% of the cost of all projects included on the Project Information Form (see Section 7 for listing additional projects).

PWS ID No.:

Provide a brief description of the principal project and how it will address the items in Section 6 to which you respond ―Yes.‖ Current Health and Compliance Factor and/or MCL Violations and Physical Deficiencies Proposed Project Solutions Cost Category (See Guidelines.)

Section 6. RATING INFORMATION Total Storage Capacity (in gallons)

—

These questions pertain only to the principal project. Total Production Capacity (MGD) Yes No

Please attach any documentation that supports the responses to the following questions. (Refer to TCEQ notice of violation letter, if applicable.) 1. 2. 3. 4. 5. Has your system experienced documented outages in the water distribution system? Does the system lack adequate disinfection? Is the system’s documented water production capability less than 85% of the minimum required by TCEQ? Is the system’s documented treated water storage capacity less than 85% of the minimum required by TCEQ (including total storage, elevated storage, and/or pressure tank)? Has the system experienced documented instances of water distribution pressures: a. b. 6. 7. less than 20 PSI? less than 35 PSI?

Yes

No

Is the system experiencing documented water distribution losses of greater than 25%? Has your system experienced documented instances of water contaminants exceeding the primary or secondary maximum contaminant level (MCL)? Yes No

Benefits to Other Public Water Systems – Consolidation Projects 8. Will the proposed principal project benefit any other public water systems (i.e., one you are currently serving or propose to serve)? • If you answer ―Yes,‖ you must also submit the Consolidation Project Worksheet (DW-009) for each water system that will benefit from this project. • If you answer ―No,‖ skip to Section 7. Name of Public Water System that Will Benefit from This Project PWS ID No. Currently Served Yes No

Propose to Serve* Yes No

* You must attach written documentation of the agreement with the PWS that you propose to serve.

Form DW-007 (10/09)

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SFY 2011 DWSRF IUP Solicitation Packet

Project Information Form
Name of Entity:
Section 7. ADDITIONAL PROJECT DESCRIPTION Additional projects that are vital to the integrity of the system may be eligible to receive funding, as long as their costs represent 50% or less of the total project costs. The priority list is ranked based on the principal project only, not the additional projects. Additional projects are optional. Provide a brief description of any additional project and how it will address any problems or needs of your water system(s) that are not identified in Sections 5 and 6. Additional Project Problem/Need Addressed

PWS ID No.:

Section 8. GREEN PROJECT INFORMATION Until further notice, entities must use the green project guidance created by the Environmental Protection Agency (EPA) for the American Recovery and Reinvestment Act to respond to this section. Should the EPA require additional information for green projects, TWDB staff will contact entities who answered "Yes" to question 1 below.
For assistance in responding to this section, see the following EPA guidance:  Attachment 8. DWSRF Project Descriptions and Examples for Green Project Reserve (3/2/2009)  The Green Project Reserve (6/22/2009)

Yes

No

1.

Does your principal or additional project contain, either partially or completely, green elements as defined by EPA guidance?

If you answered "No" to Question 1, skip to Section 9. If you answered "Yes," proceed to Question 2. 2. 3. Please enter the estimated cost of the green portion of your project(s). Please describe the green elements of your project(s) and provide a green business case below.

Section 9. PROJECT CONSTRUCTION DATES (Must provide either known dates or best estimate.) Start Date (mm/dd/yyyy) Completion Date (mm/dd/yyyy)

Form DW-007 (10/09)

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SFY 2011 DWSRF IUP Solicitation Packet

Project Information Form
Name of Entity:
Section 10. ESTIMATED COSTS Cost Category 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Treatment Transmission and Distribution Source Storage Purchase of System Restructuring Land Acquisition Source Water Protection Project Engineering General, Legal, Financial Contingency Other (Describe cost.) Principal Project Cost Additional Project Cost Total Cost

PWS ID No.:

Subtotal (Add lines 1-12.) Financing from Local Funds Financing from Other Sources Subtotal, SRF-Funded Amount (Subtract lines 14 and 15 from line 13.) TWDB Loan Origination Fee (Calculate 2.25% of line 16.) Grand Total (Add lines 16 and 17.) Requested Loan Amount (Round up line 18 to the nearest $5,000.)

Section 11. AUTHORIZATION AND SIGNATURE Printed Name and Title of Entity’s Authorized Representative Telephone No.
Seal of Registered Professional Engineer Certifying Estimated Costs (Required if Requested Loan Amount exceeds $100,000.)

Signature of Authorized Representative

Date (mm/dd/yyyy)

Form DW-007 (10/09)

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SFY 2011 DWSRF IUP Solicitation Packet

Disadvantaged Communities Worksheet
Submission Deadline: January 8, 2010, 6:00 PM Name of Entity: PWS ID No.:

A Disadvantaged Community Worksheet must be submitted to be considered for this funding option. This worksheet involves the use of socioeconomic data to determine if the service area meets adjusted annual median household income and affordability criteria.

Section 1. SOURCE OF DATA Determining the adjusted annual median household income (AMHI) and average household size for the service area can be achieved by: • using the most recent decennial US Census data, or • conducting a survey as outlined in the Socioeconomic Survey Guidelines (WRD-285). Please check the method below that you will use to determine the AMHI and average household size.
Find your service area’s census information online at: factfinder.census.gov

Most Recent Decennial US Census Data

If your service area is not a city or town, you must provide a table that 1) identifies the number of household connections within each census boundary* that covers your service area and 2) prorates the AMHI and average household size accordingly. You must also provide a map of the service area that is overlaid by a map of the census boundary(ies) identified in the table. If applicable, the data in this table and map may be combined with the data in the table and map for Section 3 of the Project Information Form. * Please use the smallest geographic type (e.g., census tract, block group, block) for which the most recent decennial US Census data is available.

Survey

An entity must submit documentation that substantiates the inadequate or absent census data that led to the need to conduct a survey. See Socioeconomic Survey Guidelines (WRD-285).

Section 2. ADJUSTED ANNUAL MEDIAN HOUSEHOLD INCOME Use the following formula to calculate the adjusted AMHI for your service area: x (Service area’s 2000 AMHI)

196.34
(7/09 Texas CPI) = (Adjusted AMHI)

159.5
(2000 Texas CPI)

75% of the state adjusted annual median household income is $36,862. If the adjusted AMHI for your service area is: • greater than $36,862, do not submit this form. Your service area does not qualify for funding as a disadvantaged community. • less than or equal to $36,862, proceed to Section 3. Section 3. ANNUAL WATER AND SEWER COSTS Average Monthly Water Flow per Household A. Average monthly gallons per person B. Average household size C. Avg. monthly water flow per household (AxB) Average Monthly Water Bill D. Avg. monthly water flow per household (C) E. Initial base water rate (first F. Additional rate (each addtl. G. gallons) gallons) P. 2,325 L. Average Monthly Sewer Flow per Household Average monthly gallons per person 1,279 M. Average household size N. Avg. monthly sewer flow per household (LxM) Average Monthly Sewer Bill O. Avg. monthly sewer flow per household (N) Initial base sewer rate (first gallons) gallons)

Q. Additional rate (each addtl. R. S. T. 12 V.

Other charges (e.g., taxes, surcharges, or other fees) used to subsidize the water system Average Annual Water Bill

Other charges (e.g., taxes, surcharges, or other fees) used to subsidize the sewer system Calculate average monthly sewer bill Average Annual Sewer Bill Average monthly sewer bill (S) 12 Average annual sewer bill (TxU)

H. Calculate average monthly water bill I. Average monthly water bill (H)

J. Number of months in a year K. Average annual water bill (IxJ)

U. Number of months in a year

Form SRF-008 (10/09)

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SFY 2011 DWSRF IUP Solicitation Packet

Disadvantaged Communities Worksheet
Name of Entity:
Section 4. HOUSEHOLD COST FACTORS Annual Loan Costs Using the federal discount rate of 4.875% and a loan term of 20 years, amortize the requested loan amount and submit a copy of the amortization schedule with this form. W. X. Y. Annual payment on SRF loan (from amortization schedule) Number of household connections (from page 1 of Project Information Form) Annual loan cost per customer (W/X)

PWS ID No.:

• If the service area is charged for water service and not sewer service, use the following formula to calculate the
household cost factor: +
(K. Average annual water bill) (Y. Annual loan cost per customer)

x (100) =

%

[Adjusted AMHI (from Section 2)]

If • • the service area is charged for both water and sewer services, use the following formula to calculate the combined household cost factor: +
(K. Average annual water bill) (V. Average annual sewer bill)

+
(Y. Annual loan cost per customer)

x (100) =

%

[Adjusted AMHI (from Section 2)]
Your service area meets the criteria for a disadvantaged community if the adjusted AMHI for your service area is less than or equal to $36,862 and; • the household cost factor is greater than or equal to 1.0% if the service area is charged for water service and not sewer service, or • the combined household cost factor is greater than or equal to 2.0% if the service area is charged for both water and sewer service. If your service area meets the criteria for a disadvantaged community, include with your submission all worksheets documenting your calculations.

Form SRF-008 (10/09)

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Texas Water Development Board

SFY 2011 DWSRF IUP Solicitation Packet

Consolidation Project Worksheet
Submission Deadline: January 8, 2010, 6:00 PM Name of Entity: PWS ID No.:

This form is intended to identify other public water systems that would benefit from the proposed project. It specifically applies to all public water systems that you own, currently serve, or propose to serve. Submit a form for each public water system affected. You must provide written documentation of agreement with the public water systems you propose to serve. Incomplete forms may prevent the project from being ranked or may reduce the total number of points your project receives.
CURRENT OR PROPOSED SYSTEMS SERVED Water System Name PWS ID No. Population Served Number of Connections What % of their water do you provide?

Consolidation Checklist 1. Do you currently own this public water system? 2. Do you propose to take over ownership of this public water system? 3. Are you providing or will you provide water service to this system through an interconnection with your system? 4. Has the system experienced documented instances of water distribution outages? 5. Does the system lack adequate disinfection? 6. Is the system’s documented water production capability less than 85% of the minimum required by TCEQ? 7. Is the system’s documented treated water storage capacity less than 85% of the minimum required by TCEQ (including total storage, elevated storage, and/or pressure tank)? 8. Has the system experienced documented instances of water distribution pressures below 20 PSI? 9. Has the system experienced documented instances of water distribution pressures between 20 and 35 PSI? 10. Has your system experienced documented instances of water contaminants exceeding the primary and secondary Maximum Contaminant Level (MCL)? 11. Is the system experiencing documented water distribution losses of greater than 25%? For each ―Yes‖ response to questions 4-11, indicate the solution proposed by this project. Identified Problem (from above checklist) Proposed Solution

Yes

No

Form DW-009 (10/09)

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SFY 2011 DWSRF IUP Solicitation Packet

Source Water Assessment and Protection Program Worksheet
Submission Deadline: January 8, 2010, 6:00 PM Name of Entity: PWS ID No.:

Public water systems (PWSs) may apply for DWSRF Source Water Protection funds to implement best management practices (BMPs) recommended by TCEQ. To be eligible for consideration, PWSs must be willing to participate in TCEQ’s Source Water Assessment and Protection (SWAP) program. If you do not already have an approved source water protection plan, contact TCEQ.

For questions, contact TCEQ Public Drinking Water Section: System Information 1. Does your PWS have confirmed detections of organic chemicals?

512-239-4691

pdws@tceq.state.tx.us Yes No

2. Does your PWS have confirmed detections of nitrates (N) greater than 2 mg/l? 3. Did any of the Contaminant Occurrence, Nonpoint Source, Point Source, or Area of Primary Influence columns of your Source Water Susceptibility Assessment (SWSA) list a ―High‖ rating for nitrates? 4. Did any of the Contaminant Occurrence, Nonpoint Source, Point Source, or Area of Primary Influence columns of your SWSA list a ―High‖ rating for any organic chemicals? System Vulnerability − Groundwater 1. Does your groundwater PWS lack sufficient clay (30 feet or more) layers between the ground surface and the top of the aquifer? 2. Does your groundwater PWS receive a ―Low‖ rating in the Structural Integrity column of your SWSA? System Vulnerability − Surface Water 1. Does your surface water PWS have confirmed organic chemical detections? 2. Does your surface water PWS have intakes located in a small watershed (i.e., approximately 100 square miles or less)? Ability to Implement Best Management Practices (BMPs) 1. Does your PWS have the ability and authority to implement land use controls including but not limited to ordinances and land acquisition? 2. Does your PWS have the ability to implement other non-land use controls such as public education, contingency planning, and conducting toxic and/or hazardous waste collection events? 3. Does your PWS have the ability to plug/cap abandoned water wells within a delineated source water protection area? 4. Does your PWS have confirmed siting and/or well construction problems listed on the most recent TCEQ sanitary survey, and will the proposed project correct these problems? Yes No Yes No Yes No

Form DW-010 (10/09)


				
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