Application to the Water Development Program

APPLICATION TO THE WATER DEVELOPMENT PROGRAM

GROUND WATER EXPLORATION GRANTS

WYOMING WATER DEVELOPMENT COMMISSION

6920 Yellowtail Road

Cheyenne, Wyoming 82002

Telephone: (307) 777-7626 Fax: (307) 777-6819 Website:

Grant funding for groundwater studiesis based on WWDC recommendations and is sourced from block appropriationsby the legislature from the Water Development Accounts. The WWDC authorizes ground water grant expenditures as a maximum 75% project cost share to eligible entities before project work can begin. Applications to fund new or continuing groundwater studies must be submitted at least 45 days prior to scheduled WWDC meetings for consideration. Ground water exploration grants are promulgated by statute (W.S. 41-2-119. Groundwater studies); governed by WWDC Rules and Regulations; and managed according to program “Guidelines” (

Applicants seeking ground water exploration grant funding must be an incorporated municipality,water district, water & sewer district, or service & improvement district with taxing and/or assessment authority. Private corporations, individuals, and other special districts are not eligible for assistance. Use of grant funds is limited to feasibility study of and/or explorationfor the use of ground water for municipal and rural domestic purposes. The WWDC grants for groundwater studies are not to exceed $400,000for any one study and/or exploration program. The sponsor receiving the grant shall provide at least 25% of the cost of the feasibility study and/or exploration program from its own funds. The sponsor is solely responsible for acquiring access, easements, or rights-of-way necessary for exploration. All grants terminate 24 months from the date of the award.

Note: If you are seeking Level II or Level III funding for a groundwater source supply project,this is the wrong application. You must complete a Planning or Construction program application for Municipal or Rural Domestic System projects.

APPLICATION REQUIREMENTS

The person signing the application must have authority to commit the entity to a binding contract.
A notarized copy of a resolution supporting this application passed by the board or other governing body of the entity must be provided.
A project area map (8.5” x 11” preferred) showing corporate boundaries, project location and features should be provided. Include or cite any reports or other supporting information available.
The project sponsor must govern a system that includes a minimum of 20 taps with meters on each tap.

ENTITY INFORMATION

______

(Type of Entity – i.e.: Municipality,Water & Sewer District, etc.)

______

(Applicant – Name of Entity)(P.O. Box or Street Address)

______

(City)(County) (State)(Zip Code) (Phone)

______

(Authorized Official - Type or Print Name) (Signature of Authorized Official) (Date)

______

(Contact Person – Type or Print Name)(Phone Number*)

*The best time to reach the contact person is from ______to ______o’clock on ______days of the week.

If the application was prepared by someone other than the contact person, please provide

Name______PhoneNumber______

PERTINENT INFORMATION

The purpose of this section is to gather information on your existing water supply facilities. Answer all questions as completely and accurately as possible. If you need help, please call the Water Development Office at 307-777-7626.

A.PURPOSE

1. Provide a brief statement describing the project for which you are seeking funding, including the reasons the project is needed and how project funds will be spent. Describe the current situation with your source water supply that will be improved by the project. (Attachadditionalinformationifyouwish): ______

______

B.EXISTING WATER SUPPLY SYSTEM

Description of Present Water Supply:

Identify theexisting water rights. Describe the status of these water rights,eg., filings, permits, enlargements, priority dates, appropriations, adjudicated water rights. (A tabulation sheet may be attached for this purpose.)

Groundwater –

Well name Permit No. Location (¼-¼ Sec-Tnsp.-Range) Total Depth Status

______

Primary supply aquifer or formation: ______

Approximate Total Yield in GPM of all wells: ______

b. SurfaceWater - Source Name(s): ______

______

Type of Diversion(s) (headgate, infiltration gallery, pumps, etc.): ______

Approximate Total Yield in CFS of all diversions: ______

c. Springs – Name of spring(s) and Location:______

Approximate Total Yield in GPM or CFS of spring source(s):______

2. Water Storage:Treated (volume and description): ______

Raw (volume and description:______

3. Transmission pipeline - Approx. Distance form Source to Distribution System: ______

Type of pipe material:______Diameter(s):______

Age of pipeline: ______Condition of pipeline: ______

4. Treatment – None: ______Chlorination: ______Filtration: ______Other:______

5. Is water use metered? ______Do you bill by your meters? ______

6. Identify unmetered usage (irrigation of parks, cemeteries, fire protection, etc.) and amount of unmetered usage: ______

7. Do you have an independent raw water irrigation system?______

Source? ______

Raw water system capacity (gallons per day): ______

Average annual raw water usage (gallons):______

8. Are you under any federal (EPA) mandates to improve your system? (eg. Administrative orders, dates, violations, actions taken): ______

______

C.FINANCIAL INFORMATION

1.Service Area Information:

a. Population (2010Census): ______Current Estimate: ______

b. Does the entity have a comprehensive planning boundary? ______

If so, what is the estimated additional population that may be served in the future? ______

c. Taps served within the entity boundaries? ______

d. Taps served outside the entity boundaries? ______

e. Names of other water systems served? ______

______

f. Are there existing planning reports (municipal or county) addressing growth management in the project area? _____. If so, please provide titles and how copies of the reports could be obtained: ______

______

2. Water Usage (Potable water system only)

a. Total number of gallons produced by the water sources annually:______

b. Gallons used per capita per day:

Average Day:______

MaximumDay:______

3. System capacity (Potable water system only):

a. Maximum capacity of the water supply system:

Acre feet per day:______

Gallons per day:______

b. Increased capacity needed:

Acre feet per day:______

Gallons per day:______

c. Estimated system water losses (percentage): ______

d. What is the factor that is presently limiting your ability to provide water (supply, transmission, treatment, distribution, etc.): ______

______

e. What will be the post-project factor that will limit your ability to provide water (supply, transmission, treatment, distribution, etc.): ______

______

f. Describe water conservation efforts (tiered water rates, lawn watering restrictions, etc.): ______

______

4. Rates

a. Tap fees:

Residential: $______

Commercial: $______

b. Average residential monthly water bill: $______/month

c. Water Rates for all tiers and categories of use: ______

______

d. Identify any local conditions that affect your rates? (Example: flow through for frost prevention, etc.): ______

______

5.Financial Statement

Annual revenues generated from water sales:______

Annual revenues from tap fees:______

Annual revenues from other sources:______

Total annual revenues:______

Annual budget for operation and maintenance expenses:______

Annual payments for debt retirement:______

Annual payments to a repair and replacement fund:______Annual payments to an emergency fund: ______

Annual payments for other purposes:______

Total annual payments:______

Balance in repair and replacement fund:______

Balance in emergency fund:______

Annual cost of water quality testing:______

6. Is the operation of the water supply system self supporting in terms of revenues offsetting costs for operation, maintenance, debt retirement, replacement funds and emergency funds. If not, how is the difference subsidized? ______

______

7. How do you intend to fund the sponsor cost share to match WWDC grant funds for this project (e.g., special/general purpose tax, other grant or loan funds, fiscal budget expenditure, etc.) ? If possible, attach latest fiscal year financial statement that would demonstrate available funds. If a suitable source of supply is found, also inform the WWDC in this synopsis how you would intend to finance subsequent production and transmission systems (e.g., WWDC Level III funding, State Drinking Water Revolving Fund loan, State Land & Investment royalty grant/loan, special/general purpose tax, Federal program grant/loan, local sources, etc.)

______

D.WATER SYSTEM OPERATIONS

Provide a brief description the water system operations. Identify your administrator. Howmany operators are employed? Identify computerized or other control systems used in your water management operations. Identify other system automation within your operations.

______

E.COST ESTIMATES

Use the following format in calculating project cost estimates (an alternate format may be prepared and submitted but must be clearly itemized and show total project cost for determining WWDC grant):

Preparation of Hydro-geologic Analysis and/or Well Siting Study$______

Permitting$______

Advertising, ContractorProcurement, Contracts$______

Well Construction* $______

Aquifer (Pump) Testing $______

Water Quality Analysis$______

Project Management/Subcontracts$______

Miscellaneous Applications/Procurements (specify)$______

Reports $______

Total Project Cost $______

Rounded$______

*Including, but not limited to: Mobilization, Bonds & Insurance, Drill-Furnish-Install Casing/Screen, Furnish-Install Filter Pack/Seal, Rig Time, Standby Time, Geophysical/Video Log, Development, Disinfection, Plugging and Abandonment, De-Mobilization, Reclamation. Any inflation costs, as determined by the WWDC, will be applied to the Total Project Cost.

8/1/2014