skip to main content | skip to footer
N.C. Department of Environment and Natural Resources

NC Department of Environment and Natural Resources
Water Infrastructure - Forms and Checklists

Water Infrastructure

 

Forms and Checklists

All documents may be downloaded in Portable Document Format (PDF), which can be viewed using Adobe Acrobat Reader.  Documents generated by the Division of Water Infrastructure are also available for download in Microsoft Word or Microsoft Excel document format so that the Applicant may enter and save information necessary to complete the associated forms and checklists. Some of the following documents, such as the Application Appendix and the Part B, contain multiple forms. If you have any problems downloading any of the following documents, contact the division at (919) 707-9160.

Application

DocumentDescription / Pages / Version
Application (MSWord) & (PDF)North Carolina Common Water/Wastewater Application; 5 pages / 11 July 2013
North Carolina Department of Environment & Natural Resources Application Appendix for Drinking Water Funding Programs (MSWord)Appendix to the application including checklists, forms, and supplemental information for Drinking Water Loan and Grant Programs (High Unit Cost, Emergency Loans, and Drinking Water State Revolving Fund); 36 pages / 22 July 2011
DWSRF Priority Rating System Sheet and Guidance (PDF)Guidance for understanding the DWSRF Priority Rating System; 19 pages / 22 September 2014
State Drinking Water Reserve (HUC/TAG) Priority Rating System Sheet and Guidance (PDF)Guidance for understanding the SDWR (HUC/TAG) Priority Rating System; 22 pages / 22 September 2014
Fund Transfer Certification (MSWord)Compliance with NCGS 159G-37.(b) regarding fund transfers as certified by applicant's Chief Elected Official or Authorized Representative; 1 page / 11 Sept. 2014
LGC 108A/C (MSWord)Selected Fiscal Information as Certified by Financial Officer (108A) and Projection of Water and Sewer Net Revenues (108C); 2 pages each
Municipality MHI Data (PDF)For DWSRF; 14 pages / 2012 ACS
County MHI Data (PDF)For DWSRF; 2 pages / 2012 ACS
Municipality Poverty Rates Data (PDF)For DWSRF and SDWR; 16 pages / 2012 ACS
County Poverty Rates Data (PDF)For DWSRF and SDWR; 4 pages / 2012 ACS
Municipality MHI Data (PDF)For SDWR; 11 pages / 2014 HUD
County MHI Data (PDF)For SDWR; 3 pages / 2014 HUD

Construction Bid / Contract and Compliance Documents

DocumentDescription / Pages / Version
Disadvantaged Business Enterprise (DBE) Forms (Special Conditions Packages)Link to the DBE page

Budget Approval

DocumentDescription / Pages / Version
Part B Form 1951B (MSWord) (PDF)Offer and Acceptance of Loan or Grant for Water Supply System Project, Part B; 10 pages / 30 March 2012

Reimbursement and Repayment

DocumentDescription / Pages / Version
Reimbursement FormLink to Division Clean Water Loan Program page
Repayment Schedule Example (MSExcel) (PDF)Example repayment schedule provided by the Local Government Commission; 1 page / (N/A)

 

Web Content Display Web Content Display

For assistance contact us at (919) 707-9160

Web Content Display Web Content Display

N.C. Division of Water Infrastructure

Mailing Address (USPS): 1633 Mail Service Center, Raleigh, North Carolina, 27699-1633

Street Address (FedEx, UPS): 512 N. Salisbury St, Raleigh, North Carolina, 27604

14655572 FEEDBACK

Your input is valuable to us. Please send us your feedback.

What type of feedback would you like to send?*

Ask a Question Report a Problem Have a Concern Make a Comment

(If you would like us to respond please include your phone or e-mail.)

Your Question has been sent. Thank you!

An internal server error prevented Your Question from being sent.
Please try again later, or call Toll-Free (877) 623-6748 for immediate assistance.

Please complete all highlighted items

Your Problem has been sent. Thank you!

An internal server error prevented Your Question from being sent.
Please try again later, or call Toll-Free (877) 623-6748 for immediate assistance.

Please complete all highlighted items

Your Concern has been sent. Thank you!

An internal server error prevented Your Question from being sent.
Please try again later, or call Toll-Free (877) 623-6748 for immediate assistance.

Please complete all highlighted items

Your Comment has been sent. Thank you!

An internal server error prevented Your Question from being sent.
Please try again later, or call Toll-Free (877) 623-6748 for immediate assistance.

Please complete all highlighted items

*If you are a DENR employee with an I.T. issue, please submit a DOTS ticket.