Form TCEQ-10233 "Tceq Public Water System Plan Review Submittal Form" - Texas

What Is Form TCEQ-10233?

This is a legal form that was released by the Texas Commission on Environmental Quality - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2019;
  • The latest edition provided by the Texas Commission on Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form TCEQ-10233 by clicking the link below or browse more documents and templates provided by the Texas Commission on Environmental Quality.

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Download Form TCEQ-10233 "Tceq Public Water System Plan Review Submittal Form" - Texas

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TCEQ Public water system plan review submittal form
(Complete, Seal and Attach to Submittal Package)
WATER SYSTEM INFORMATION
Date:
TCEQ PWS Identification No.:
(Facilities will be assigned this PWS No.)
Water System Name:
Owner Information:
Water System Owner:
(AC)
Address:
Phone:
Responsible
Title:
Official:
Mechanism &
Source of
County (System
Financing: (i.e.
Location):
loans, rates, self-
financed, etc.)
Subdivision Sec.,
Phase, Unit, Etc.
ENGINEER INFORMATION
Engineer Name:
Registration No.:
Firm Name:
Firm No.:
(AC) Phone:
(AC) Fax:
Firm Address:
SUBMITTAL INFORMATION
Is this submittal for a new
Yes:
No:
public water system?
If no, proceed to the Project Information section on Page 2. If no PWS number exists, the owner must submit a core data
form and business plan, if required, in accordance with §290.39(f) and (g).
NEW (PROPOSED) WATER SYSTEMS
(Only complete this section if this submittal is for a NEW water system)
For new (proposed) system submittals, please provide 2 copies of the submittal and attach the following:
A list of all water utilities within ½ mile of the proposed service area boundaries (reference 30 TAC
290.39(c)(1)).
Copies of written responses from each of the entities listed above (reference 30 TAC 290.39(c)(1)).
Copies of formal applications for service from each of the following (reference 30 TAC 290.39(c)(1)):
Any municipality if the system is within its ETJ.
Any district or other political subdivision whose corporate boundaries are within ½ mile of the
proposed service area boundaries.
Any other water service provider whose certificated service area boundary is within ½ mile of
the proposed service area boundaries.
TCEQ-10233 From (Revised 02/2019)
Page 1 of 3
TCEQ Public water system plan review submittal form
(Complete, Seal and Attach to Submittal Package)
WATER SYSTEM INFORMATION
Date:
TCEQ PWS Identification No.:
(Facilities will be assigned this PWS No.)
Water System Name:
Owner Information:
Water System Owner:
(AC)
Address:
Phone:
Responsible
Title:
Official:
Mechanism &
Source of
County (System
Financing: (i.e.
Location):
loans, rates, self-
financed, etc.)
Subdivision Sec.,
Phase, Unit, Etc.
ENGINEER INFORMATION
Engineer Name:
Registration No.:
Firm Name:
Firm No.:
(AC) Phone:
(AC) Fax:
Firm Address:
SUBMITTAL INFORMATION
Is this submittal for a new
Yes:
No:
public water system?
If no, proceed to the Project Information section on Page 2. If no PWS number exists, the owner must submit a core data
form and business plan, if required, in accordance with §290.39(f) and (g).
NEW (PROPOSED) WATER SYSTEMS
(Only complete this section if this submittal is for a NEW water system)
For new (proposed) system submittals, please provide 2 copies of the submittal and attach the following:
A list of all water utilities within ½ mile of the proposed service area boundaries (reference 30 TAC
290.39(c)(1)).
Copies of written responses from each of the entities listed above (reference 30 TAC 290.39(c)(1)).
Copies of formal applications for service from each of the following (reference 30 TAC 290.39(c)(1)):
Any municipality if the system is within its ETJ.
Any district or other political subdivision whose corporate boundaries are within ½ mile of the
proposed service area boundaries.
Any other water service provider whose certificated service area boundary is within ½ mile of
the proposed service area boundaries.
TCEQ-10233 From (Revised 02/2019)
Page 1 of 3
TCEQ Public water system plan review submittal form
(Complete, Seal and Attach to Submittal Package)
Documentation that all application requirements, including fee payments, are current.
Business plan: Please complete the financial ability form, provide a cost summary for the proposed project, and
submit a business plan (reference 30 TAC 290.39 (f)). The business plan must confirm capital available to construct
the system according to TCEQ requirements. Acceptable financial information can include some of the following:
Financial statements (preferably audited), CPA compilation report, tax returns, statements of net worth, bank
statements.
If the project is being funded with loan proceeds, provide a loan commitment letter from the lender specific to this
project.
If the plan submittal is for a community system, also provide a copy of the Certificate of Convenience and Necessity
(CCN) application submitted to the Public Utility Commission of Texas (PUC), and complete items referenced in 30
TAC 290.39 (f) (1 - 13).
Justification for constructing a separate system (if one of the entities listed above is willing to provide service).
TCEQ Core Data Form (No. 10400).
Emergency Preparedness Plan (No. 20536) if serving water in Harris or Fort Bend Counties and have overnight
accommodations.
Certificate of Convenience and necessity (CCN)
Certificates of Convenience and Necessity (CCN) applications are processed by the Public Utility Commission of Texas
(PUC) and are required for privately owned systems and water supply corporations. If a CCN is required and a CCN does
not exist, the applicant must obtain a CCN number or have the application accepted for filing at the PUC before a PWS
project submittal can be technically reviewed. In addition, if a submittal is for a project located outside the CCN area, a
CCN amendment application must be submitted before a project may be reviewed for construction approval. Please refer
to PUC for additional information at: http://www.puc.texas.gov/industry/water/guidance/UtilRulesGuidance.aspx
(Rules
and Guidance for Water and Sewer
Utilities).
Will the proposed PWS be owned by either an investor
owned utility (IOU) or water supply corporation (WSC)? If
YES:
NO:
yes, please indicate which type of entity
________________________.
Has a CCN application been submitted to the PUC? If yes,
please provide the date of acceptance
YES:
NO:
_______________________.
List the name, license number and class of the operator for the
proposed system:
Project Information
If a system does NOT have a PWS number, the sections above must be filled out
All engineering documents must be sealed, signed, and dated by a Texas registered professional engineer. An
engineering report that includes the number of connections to be served must accompany each project.
Please check each box that is applicable.
If this submittal is a revision of previously submitted plans,
please provide the assigned TCEQ log number:
New Projects/Facilities
Modifications to Existing Facilities
Water well construction – Proposed
Surface water treatment plant modifications
Well completion data for approved well
Storage capacity modifications
Ground water treatment plant – New
Distribution system modifications
Surface water treatment plant – New
Pressure maintenance facilities modifications
Proposed Innovative/Alternative Treatment
Disinfection facilities or other modifications
Request for rule exception
Preliminary engineering report without plans
TCEQ-10233 From (Revised 02/2019)
Page 2 of 3
TCEQ Public water system plan review submittal form
(Complete, Seal and Attach to Submittal Package)
Texas Water Development Board Project No.:
As-Built Plans & Engineering Report
Other (please describe):
Signature and certification
The following certification indicates I have the authority to make submittals on
Signature/P.E. Seal Required below:
behalf of the PWS referenced on Page 1. I hereby certify that the above
information is, to the best of my knowledge, true and correct:
Engineer’s Signature:
Engineer’s Printed
Name:
Date:
Please call (512) 239-4691 if you have questions regarding this form. Your
cooperation will help us provide better service. Additional helpful information
and rules are available at the Public Water System Plan Review website.
TCEQ-10233 From (Revised 02/2019)
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