"Plans and Specifications Review Checklist - Drinking Water and Clean Water State Revolving Fund" - Kentucky

Plans and Specifications Review Checklist - Drinking Water and Clean Water State Revolving Fund is a legal document that was released by the Kentucky Energy and Environment Cabinet - a government authority operating within Kentucky.

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KENTUCKY FEDERALLY ASSISTED
DRINKING WATER AND CLEAN WATER STATE REVOLVING FUND
PLANS AND SPECIFICATIONS REVIEW CHECKLIST
Revised July 2016
Loan Recipient:
_______________________________________
Loan No.:
Contract ID: _
Name:
_______________________________________
Design Firm:
_______________________________________
The information provided is accurate for the above referenced contract to the best of my knowledge
and belief.
Design Engineer:
_________________________
________________________________
Signature:
_________________________
Date: ___________________________
Please submit three copies of the plans and specifications with the other required construction permit
forms and documents to the Division of Water. All plans and specifications must be prepared, sealed,
signed and dated by a Professional Engineer licensed to practice in the state of Kentucky.
Questions marked with (DOW) are to be completed by the Division of Water (DOW) Review Engineer.
I have reviewed the information provided by the design engineer, verified the accuracy, and completed
the (DOW) questions.
(DOW) Review Engineer: ___ _________________________
Signature: _______________ _________________________ Date:
Page 1 of 17
KENTUCKY FEDERALLY ASSISTED
DRINKING WATER AND CLEAN WATER STATE REVOLVING FUND
PLANS AND SPECIFICATIONS REVIEW CHECKLIST
Revised July 2016
Loan Recipient:
_______________________________________
Loan No.:
Contract ID: _
Name:
_______________________________________
Design Firm:
_______________________________________
The information provided is accurate for the above referenced contract to the best of my knowledge
and belief.
Design Engineer:
_________________________
________________________________
Signature:
_________________________
Date: ___________________________
Please submit three copies of the plans and specifications with the other required construction permit
forms and documents to the Division of Water. All plans and specifications must be prepared, sealed,
signed and dated by a Professional Engineer licensed to practice in the state of Kentucky.
Questions marked with (DOW) are to be completed by the Division of Water (DOW) Review Engineer.
I have reviewed the information provided by the design engineer, verified the accuracy, and completed
the (DOW) questions.
(DOW) Review Engineer: ___ _________________________
Signature: _______________ _________________________ Date:
Page 1 of 17
KENTUCKY FEDERALLY ASSISTED
DRINKING WATER AND CLEAN WATER STATE REVOLVING FUND
PLANS AND SPECIFICATIONS REVIEW CHECKLIST
Revised July 2016
Loan Recipient:
________________________________________ Loan No.:
Projected Sources of Funds
Source
Amount
_______________________________________
$ _________________________
_______________________________________
$ _________________________
_______________________________________
$ _________________________
_______________________________________
$ _________________________
Contract Period, Number of Days __________
Estimated Construction Amount $
__________________
SRF Loan Amount $
SRF Eligible $
___________________
SRF Non-eligible $
___________________
Detailed description of proposed project:
Page 2 of 17
KENTUCKY FEDERALLY ASSISTED
DRINKING WATER AND CLEAN WATER STATE REVOLVING FUND
PLANS AND SPECIFICATIONS REVIEW CHECKLIST
Revised July 2016
Does the eligible portion include:
These questions are for ALL projects
Yes
No
N/A
Demolition: Is it limited to that required for new construction?
Replacement of existing utilities: Is no "betterment" proposed?
Paving: Is it limited to the trench width and cutbacks?
Standby generators: Has justification been provided?
These questions are for CW Projects only
Yes
No
N/A
Collector sewers: Is more than 50% of the expected flow from a community
constructed prior to October 18, 1972?
Property service lines: Are they limited to the "Tee or Wye" and the service line
needed to reach the property line and owned by the utility?
Sewer cleaning machines: Has justification been provided?
Sewer line inspection television equipment: Has justification been provided?
The following items are considered ineligible for SRF projects. Are any of these included in the
specifications?
These questions are for ALL projects
Yes
No
N/A
Bonus payments?
Immediately available hand tools?
Mowers, snow blowers, trimmers?
Replacement of facilities previously funded by EPA or SRF, which are still within the
useful life unless EPA or SRF has approved abandonment?
Redundant facilities (unless required by state or federal reliability requirements)?
Routine maintenance items (oil, grease, filters, etc.)?
Utility vehicles/golf carts?
List all SRF loan ineligible items in the project:
Page 3 of 17
KENTUCKY FEDERALLY ASSISTED
DRINKING WATER AND CLEAN WATER STATE REVOLVING FUND
PLANS AND SPECIFICATIONS REVIEW CHECKLIST
Revised July 2016
General
These questions are for ALL projects
Yes
No
N/A
1a.
Are permits to construct required from other Federal or State Agencies? If
yes, indicate which Agencies.
1b.
Have the required permits been issued? Provide the DOW with copies.
1c.
Have the required permits been applied for?
2.
If the project includes work that will cumulatively disturb more than 200
linear feet of a blue line stream as shown on a USGS 7.5-min. topographic
map, has an application for 401 Certification been submitted to the DOW
Water Quality Section?
3.
If the project involves construction within a floodplain, including stream
crossings, has an application for the appropriate permits been submitted to
the DOW Floodplain Management Section?
4.
If the loan recipient has requested to buy equipment and be exempt from
sales tax, are the specifications written to accommodate this?
5.
Have all required easements been obtained?
NOTE: Clear Site Certificate is required before construction starts.
6.
If this project is a result of a DOW enforcement action, have all mandated
construction related activities been addressed in the scope of work for this
project? Notify the Division of Enforcement.
These questions are for DW Projects only
Yes
No
N/A
7.
Are electric motors and components above the 100-year flood elevation?
8.
Are buildings protected from the 100-year flood and usable at the 25-year
flood level?
9.
Does this project eliminate any existing water treatment plants?
10a. If this proposed project includes a sludge lagoon system has the DOW
Groundwater Section been contacted regarding the need for a Groundwater
Protection Plan (GWPP)?
10b. Is a GWPP required? Provide copies of correspondence.
Page 4 of 17
KENTUCKY FEDERALLY ASSISTED
DRINKING WATER AND CLEAN WATER STATE REVOLVING FUND
PLANS AND SPECIFICATIONS REVIEW CHECKLIST
Revised July 2016
These questions are for CW Projects only
Yes
No
N/A
11.
Does this design meet the 401 KAR 5:005, Section 13 reliability
requirements?
12.
Has the design engineer provided demonstration of how the design meets
the reliability requirements? This shall include calculations, which indicate
that the permit limits can be met with the largest unit of each process out of
service during times of anticipated cleaning and repair.
13.
Does this project eliminate any existing wastewater treatment plants?
These questions are for the DOW Review Engineer to answer
Yes
No
N/A
14.
Does the DOW review engineer concur with the description of SRF ineligible
items?
15.
Are the plans and specifications sealed, signed, and dated by a professional
engineer?
16a. Has the DOW written or issued an Environmental Statement (Environmental
Impact Statement (EIS), Categorical Exclusion Document (CED), or a Finding
of No Significant Impact (FONSI))?
16b. Is the scope of the SRF project identified in the plans and specifications
consistent with the Environmental Statement?
17.
Has a site certificate been received?
NOTE: Clear Site Certificate is required before construction starts.
18.
Does the WWTP discharge to a blue line stream or are easements provided
to a blue line stream?
19.
Is the discharge from the WWTP within five miles upstream of a water plant
intake?
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