HomeMy WebLinkAboutPublic Water System Plan ReviewPUBLIC WATER SYSTEM PLAN REVIEW SUBMITTAL FORM
(Complete and Attach to Submittal Package)
Date: April 12, 2012
TCEQ PWS Identification No.*:
Water System Name: Welibor
Water System Owner: Wellbo
Address: P.O. Box 260, Welit
County (system
Engineer:
Firm Nam
Firm Addl
No. or Application No.**:11340
division Sec., Phase, Unit, etc. Creek Meadows —Section 3 Ph 1
& Source of Financing: Private
istration Number: 88683
* If no PWS Number exists, the owner must submit a business plan, if required, in accordance with §290.39(f) and (g).
"* If a required CCN number does not exist, an acceptable application to obtain a CCN number must be made before a project submittal can be
technically reviewed. In addition, if a submittal is for a project located outside the CCN area, a CCN amendment application must be submitted before a
project may be reviewed for construction approval. Please refer to 30 TAC Chapter 291 for additional information regarding CCNs.
If this is a new (proposed) system, you must attach the following with this submittal: NOT APPLICABLE
❑ Attach a list of all water utilities within % mile of the proposed service area boundaries
❑ Copies of formal applications for service from each of the following
❑ any municipality if the system is within its ETJ;
❑ any district or other political subdivision whose corporate boundaries are within'/ mile of the proposed
service area boundaries
❑ any other water service provider whose certificated service area boundary is within''/3 mile of the proposed
service area boundaries
❑ Documentation that all application requirements including payment of fees were complied with.
❑ Copies of written responses from each of the entities listed above.
❑ Business plan, if required by 30 TAC 290.39(f) & (g). The business plan financial requirements for non -community
water systems must confirm capital availability to construct the system according to TCEQ requirements. This
would consist of a balance sheet that shows liabilities as well as assets, not just a bank confirmation of a deposit
account. Alternatively, if the project is being constructed with loan funds, then a loan commitment letter from the
lender specific to that project will suffice.
❑ Justification for constructing a separate system (unless none of the entities listed above exist)
❑ Plans and specifications with an engineering report all sealed by design engineer.
Type of Project (please check the appropriate boxes)
✓
Distribution System Modifications
❑
Storage Capacity Modifications
❑
Well completion data on previously approved well
❑
Water Well Construction, Proposed
❑
Pressure Maintenance Facilities Modifications
❑
Proposed Innovative Process Study
❑
Disinfection Facilities or Other Modifications
❑
Ground Water Treatment Plant, New
❑
Preliminary Engineering Report w/o plans
❑
Surface Water Treatment Plant, New
❑
Modification of Surface Water Treatment Plant
❑
Tex. Water Dev. Board Proj. No._
IF THIS SUBMITTAL IS A REVISION OF PREVIOUSLY SUBMITTED PLANS, PLEASE ENTER THE ASSIGNED TCEQ
LOG NUMBER: . Please call (512) 239-6960 if you have questions regarding this form. Your
cooperation will help us provide better service. Additional helpful information and rules are available at our website:
http.//www. tceq.state. tx. us/permitting/waterperm/ud/planrev. html
I hereby certify that the above information is, to the best of my knowledge, true and correct. = F of t
5 ........
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Rabon A. Metcalf, P.E. April 12, 2012 i......... ET i
Printed Engineer's Name Date 58s
Revised 9/12/02 I Ilk NA ����` �� t
C:\USERS\RABON\RME\PROJECTS\260-0438 OGG-CREEK MEADOWS-S3P1\ENGINEERING\TCEQ FOR3.i-WATER