DWP Forms for Download
Click on a link below to view forms relative to that heading.
Note: All forms are in PDF format unless otherwise indicated.
Capacity Development
Capacity Development Review Checklist – View or Download
Very Small Water System Capacity Development Review Checklist – View or Download
Drinking Water Orders
Boil Water Order Posting Template (Arabic) – View or Download
Boil Water Order Posting Template (English) – View or Download
Boil Water Order Posting Template (French) – View or Download
Boil Water Order Posting Template (Somali) – View or Download
Boil Water Order Posting Template (Spanish) – View or Download
Do Not Drink Order Posting Template (Arabic) – View or Download
Do Not Drink Order Posting Template (English) – View or Download
Do Not Drink Order Posting Template (French) – View or Download
Do Not Drink Order Posting Template (Somali) – View or Download
Do Not Drink Order Posting Template (Spanish) – View or Download
Do Not Use Order Posting Template (Arabic) – View or Download
Do Not Use Order Posting Template (English) – View or Download
Do Not Use Order Posting Template (French) – View or Download
Do Not Use Order Posting Template (Somali) – View or Download
Do Not Use Order Posting Template (Spanish) – View or Download
Emergency Response
Emergency Response Plan Template - Pop <3000 – View or Download
Emergency Response Plan Template - Pop >500 – View or Download
Incident Action Checklist - Flooding – View or Download
Funding
Asset Security
Water System Asset Security Grant Application – View or Download
Water System Asset Security Grant Reimbursement Form - 2024 – View or Download
Water System Asset Security Grant Reimbursement Form - 2023 – View or Download
Water System Asset Security Grant Reimbursement Form - 2022 – View or Download
Capacity Development
Capacity Development Grant Application – View or Download
Capacity Development Grant Reimbursement Form – View or Download
Capacity Development TRF Application – View or Download
Very Small System Capacity Development Grant Application – View or Download
Very Small System Capacity Development Grant Reimbursement Request – View or Download
Compliance
Very Small System Compliance Loan Fund Application – View or Download
Drinking Water State Revolving Fund (DWSRF)
Application Form for DWSRF-Eligible Projects – View or Download (Web Form)
DBE Program Subcontractor Participation Form (DWP Form 6100-2) – View or Download
DBE Program Subcontractor Performance Form (DWP Form 6100-3) – View or Download
DBE Program Subcontractor Utilization Form (DWP Form 6100-4) – View or Download
DWSRF Project Specifications Checklist – View or Download
DWSRF Request for Reimbursement Form – View or Download (XLS)
Program Report of DBE Subcontractor Utilization Form – View or Download
SRF Application Form (2023) – View or Download
Use of American Iron and Steel (AIS) DeMinimis Spending Record – View or Download (XLSX)
Weekly Payroll Labor Standards Compliance Review Form – View or Download
Land Acquisition
Land Acquisition Loan Application – View or Download
Lead Service Line Inventory
Lead Service Line Inventory Assistance Grant Application – View or Download
PFAS (Emerging Contaminants)
Small Public Water System Emerging Contaminant Grant Application – View or Download
Small Public Water System Emerging Contaminant Grant Requirements – View or Download
Very Small System Emerging Contaminant Planning Grant Application – View or Download
Very Small System Emerging Contaminant Planning Grant Reimbursement – View or Download
Source Protection
Source Protection Grant Application – View or Download
Source Protection Grant Reimbursement Form – View or Download
Wellhead Protection Grant Reimbursement Form – View or Download
System Consolidation
System Consolidation Grant Application – View or Download
Total Coliform
Very Small System Total Coliform Grant Application – View or Download
Very Small System Total Coliform Grant Reimbursement Form – View or Download
Laboratory Accreditation
Application for Initial Laboratory Accreditation – View or Download (DOCX)
Application for Renewal Laboratory Accreditation – View or Download (DOCX)
Application for Revision Laboratory Accreditation – View or Download (DOCX)
Method Analyte Table for Application – View or Download (XLSX)
Lead & Copper
Form 141-A – RTF – PDF
Lead Customer Notification Template for Community Systems – View or Download
Lead Customer Notification Template for NTNC Systems with Five Sites – View or Download
Lead Customer Notification Template for NTNC Systems with Ten Sites – View or Download
Service Line Inventory Form (Small Systems) – View or Download
Service Line Inventory Template (Large Systems) – View or Download (XLSX)
Service Line Inventory Public Notices –
• Notice of Service Line Inventory Completion:
No Lead, Galvanized Requiring Replacement (GRR), or Unknown service lines were found. View or Download (DOCX)
• Direct Notice to Customer Served:
Individual home where Lead, Galvanized (GRR), and/or Unknown service lines were identified. View or Download (DOCX)
• Optional Notice of Service Line Inventory Completion:
System where Lead, Galvanized (GRR), and/or Unknown service lines were identified. View or Download (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. View or Download (DOCX)
Level Assessments
Level 1 Assessment Form – View or Download
Level 2 Assessment Form – View or Download
Monthly Operating Reports
MOR 001 – Chemical usage and daily production: All Surface Water (SW) and Groundwater Under the Influence (GUI) systems – MS Excel – PDF
MOR 002 – Chemical usage and daily production: All Groundwater (GW) systems – MS Excel – PDF
MOR 003 – SWTR Report – All SW and GUI systems using conventional and direct filtration – MS Excel – PDF
MOR 004 – SWTR Report: All SW and GUI unfiltered systems that use Chlorine only – MS Excel – PDF
MOR 005 – DBP Report: All SW and GUI systems serving >10,000 people – MS Excel – PDF
MOR 006 – DBP Report: All SW and GUI systems serving <10,000 people – MS Excel – PDF
MOR 006A – DBP Report: All GW systems that disinfect – MS Excel – PDF
MOR 007 – Chlorine Dioxide Report: All Chlorine Dioxide systems – MS Excel – PDF
MOR 008 – Fluoride Report: All systems that add fluoride – MS Excel – PDF
MOR 009 – DBP Report: All SW and GUI unfiltered systems serving >10,000 people, with >4 TTHM and HAA5 sampling points – MS Excel – PDF
MOR 010 – SWTR Report: All SW and GUI unfiltered systems that use multiple disinfectants – MS Excel – PDF
MOR 011 – SWTR Report: All SW and GUI systems that use Slow Sand or another type of alternative filtration – MS Excel – PDF
MOR 012 – Chemical usage and daily production: Small Water System Chlorination Report Form – MS Excel – PDF – Instructions
MOR 013 – Corrosion Control Report: Small and Medium System Corrosion Control Report Form – MS Excel – PDF
MOR 014 – UV Report: Small Water System Monthly Operating Report for UV Treatment – MS Excel – PDF
New System Approval
NSA - Community Public Water System serving 250 or more people – View or Download
NSA - Community Public Water System serving <250 people – View or Download
NSA - Non-Transient Non-Community Public Water System – View or Download
NSA - Transient Public Water System (Groundwater Supply) – View or Download
NSA - Transient Public Water System (Surface Water Supply) – View or Download
Professional Licensure
Water Operators
License Application – View or Download
License Reinstatement – View or Download
Paper Exam Application – View or Download
Water Operator Complaint – View or Download
Well Drillers & Pump Installers
Apprentice Pump Installer Application – View or Download
Apprentice Water Well Driller Application – View or Download
Company Registration Application – View or Download
Company Renewal Application – View or Download
Journeyman Pump Installer Exam Application – View or Download
Journeyman Water Well Driller Exam Application – View or Download
Master Pump Installer Exam Application – View or Download
Master Water Well Driller Exam Application – View or Download
Well Driller and Pump Installer License Renewal Form – View or Download
Well Driller Complaint Form – View or Download
Training Providers & Vendors
Course Application – View or Download
Provider Application – View or Download (DOC)
Training Contact Hours Attendance Sheet – View or Download
Sampling
Chain of Custody (HETL) – View or Download
Coliform and Nitrate Sampling Worksheet – View or Download (XLS)
Form 141-A – RTF – PDF
Sample Site Plan Template – DOCX – PDF
Sampling Site Plan Approval Checklist - Pop <1000 – View or Download
Sampling Site Plan Approval Checklist - Pop >1000 – View or Download
Seasonal Public Water Systems
Approved Start-Up Procedure - Groundwater – View or Download
Approved Start-Up Procedure - Surface Water – View or Download
Source Protection
DIY Wellhead Protection Plan – View or Download
Model Wellhead Protection Ordinance – View or Download
Notice of Intent to Hydrofrack – View or Download
Wellhead Protection Plan Template for Small Water Systems – View or Download
Subsurface Wastewater
System Changes
Certification / Request for System Classification as Transient (NC) – View or Download
Point of Contact (POC) Change Form – View or Download
Public Water System Change Applications – View or Download
Public Water System Designated Operator Form – View or Download
Well Drilling
Setback Reduction Notification – View or Download
Specialty Well Application – View or Download
‘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:
- Download the form and save it to your computer, either on your desktop or in a folder you can easily access.
- Open the blank form at its location on your computer using the PDF Reader.
- ‘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.).
- Using your computer keyboard, fill-in all applicable fields; use the TAB key to navigate through the document.
- Click ‘Save’.
You may return to the form at a later time to revise and/or complete your work. Be sure to 'Save' subsequent additions/revisions.
- 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.
Updated 11/7/2024
