Part 1 Water System Eligibility – Does the Group A water system that the Yes No Yes Project is eligible – grant funds will be applied to service a No Project is – population of 10,000 or less? ineligible Part 2 Risk Category – Risk Category 1 - The proposed project will eliminate a documented 40 Microbial Risk Points Risk Category 2 - The proposed project eliminates Primary Inorganic 32 Chemical Risk Points Risk Category 3 - The proposed project eliminates Other Primary 24 Chemical Risk Points Risk Category 4 - The proposed project eliminates Secondary Chemical 16 Seawater Intrusion Risk Points Risk Category 5 - The proposed project is for Infrastructure Sustainability 8 Points Total Risk Category Score Part 3 - Readiness to Proceed Indicate the status of the water system Approved Approved 5 points – plan or small water system management Not Approved 0 – program for this project: Not Approved points Does your system have sufficient water Yes No Yes 5 points – rights for this project? No 0 points – If no, please explain the status of your water rights application with the Department of Ecology: Do you own and/or have control of the Yes No Yes 5 points – project site? No 0 points – Please describe (ownership, easement, etc.): Is Engineering/Design completed for this Yes No Yes 5 points – project? No 0 points – Indicate the status of the Complete Complete 5 points – cultural/historical review for this project, Underway Underway 2 points – including whether there are known sites Not started Not started 0 points – in the proposed project area. Has your system secured construction Yes No Yes 5 points – funding to complete this project? No 0 points – Indicate estimated project construction 2015 2015 5 points – start date 2016 2016 2 points – 2017 or later 2017 0 points – Will you be applying for a Drinking Water Yes No Yes 5 points – State Revolving Fund Loan for this No 0 points – project in the next two years?
Part 1 – Water System Eligibility Does the Group A water system that the grant funds will be applied to service a population of 10,000 or less? Yes No Yes – Project is eligible No – Project is ineligible Part 2 – Risk Category Risk Category 1 - The proposed project will eliminate a documented Microbial Risk 40 Points Risk Category 2 - The proposed project eliminates Primary Inorganic Chemical Risk 32 Points Risk Category 3 - The proposed project eliminates Other Primary Chemical Risk 24 Points Risk Category 4 - The proposed project eliminates Secondary Chemical Seawater Intrusion Risk 16 Points Risk Category 5 - The proposed project is for Infrastructure Sustainability 8 Points Total Risk Category Score Part 3 - Readiness to Proceed Indicate the status of the water system plan or small water system management program for this project: Approved Not Approved Approved – 5 points Not Approved – 0 points Does your system have sufficient water rights for this project? If no, please explain the status of your water rights application with the Department of Ecology: Yes No Yes – 5 points No – 0 points Do you own and/or have control of the project site? Please describe (ownership, easement, etc.): Yes No Yes – 5 points No – 0 points Is Engineering/Design completed for this project? Yes No Yes – 5 points No – 0 points Indicate the status of the cultural/historical review for this project, including whether there are known sites in the proposed project area. Complete Underway Not started Complete – 5 points Underway – 2 points Not started – 0 points Has your system secured construction funding to complete this project? Yes No Yes – 5 points No – 0 points Indicate estimated project construction start date 2015 2016 2017 or later 2015 – 5 points 2016 – 2 points 2017 – 0 points Will you be applying for a Drinking Water State Revolving Fund Loan for this project in the next two years? Yes No Yes – 5 points No – 0 points