01/25/2012 Env Bd Packet - Laserfiche WebLink

Home Search

MDH Environmental Health Division Drinking water Protection Section P.O. Box 64975 St Paul, Minnesota 55164 -0975 .Source Water Protection Plan Implementation Grant Application August 2011 Notice: This application must be completed in order to score your grant request. Public Water Supply System (name of primary applicant): Lino Lakes PWS1D: 10200023 Note: List all of the public water supply systems involved if more than one is applying: Name of the Grant Contact: ?^r.... Phone No.4,5.1./. '.A O. Ext: E -mail address: Mailing Address Co. TEP i Federal Tax ID #: 111 - C f> 3 -( ( le ..:.4r '.c:;.. t - .m • U. 1.-;tno La Sp MA) 53atLf' Person Authorized to Sign Grant Agreement on Behalf of the Public Water Supply System: Name: 3� Title: E t3 z r ioTotal Grant Amount Being Requested (S10,000 maximum): $ . 6.000 Work Item (s) to be performed under this grant For each work item to be funded under the rant, please provide the following information (use an additional page if necessary). 1. Work Item — describe the work that will be performed: Update list of properties within DWSMA that may have an undocumented or unused well or a private well that may be cross connected with the municipal water distribution system. The work will be done by comparing well records, water system maps, and aerial images to identify properties that have no recorded water supply, a well on undeveloped and uncultivated land, or that have both wells and city water. la. Amount Requested for performing this work: $ ...6,000. 1 b. Product(s) produced or anticipated .outcomes of performing this work item: Database and map of properties within the DWSMA that may have un undocumented, unused, or cross - connected well for subsequent investigation and notification. 1 c. Please reference the MEASURE / OBJECTIVE number and attach the pa6e(s) in the source water protection plan that contains the source water protection measure / objective that will be supported by this work item: (Failure to submit the required documentation may result in disqualification) Chapter 5, Sections 2A, 2B, and 4B (p.16 -17) and Chapter 6 Section 1.