DDW-2024-006432

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4
5
2
6
Req'd flow (gpm):
[PNF = Project Notification Form; PWS = Public Water System; DDW = Division of Drinking Water;
ERC = Equivalent Residential Connection; PE = Professional Engineer; SRF = State Revolving Fund]Revised: Apr 2016
Duration (hrs):
Fax No:
E-Mail Address:
E-Mail Address:
Fire Suppression Authority [if system has fire hydrants]
Address:
City, State, Zip:
Phone No:
Phone No:Fax No:
Address:
City, State, Zip:
PE responsible for design of this Project [if not same as item 3]
Name of Construction Inspector(s) and frequency of inspection
Part Time:Full Time:
Advertise for Bids:
Begin Construction:
Anticipated Construction Schedule:
Bid Opening:
Complete Construction:
E-Mail Address:
System Number:
File No:
Date Rec'd:
PROJECT NOTIFICATION FORM (PNF)
Use with Plan Submittal [R309-500-6(1)] or when requesting Waiving of Plan Submittal [R309-500-6(3)]
Phone No:
Address:
City, State, Zip:
PE designated as Direct Responsible Engineer for Entire System
(if applicable)
Upon completion, Submit by Email, fax or mail to:
Present No. of ERC's physically connected to system:
Population Served:
No. of ERC's this project will add to system:
Addressee for Official Correspondence [Mayor, Public Works Director, etc...]
Name of PWS [owner of system as recorded with DDW]
Address:
City, State, Zip:
Address:
City, State, Zip:
State of Utah - Division of Drinking Water - Heather Bobb - [e-mail]
P.O. Box 144830 - Salt Lake City, Utah - 84114-4830 [phone] fax [phone]
Description of Project [in sufficient detail for DDW to identify]
E-Mail Address:
Please provide the following information for all Drinking Water Projects by existing PWS's
Phone No:
9
3
7
Name:
Company Name:
Name:
Title:
System Name:
10 Funded by State or Federal Agency?
(Specify)
Drinking Water Board (SRF or FSRF) Loan #:
Community Impact Board
None
Other
Is this PNF for plan review waiver 3b?
[see R309 500-6(3b) to verify]Yes No
If Yes, you must have a designated PE responsible
for the system and previously approved
Construction Standards.
If Yes, specify rule reference here:
Does this project meet any of the criteria to be exempt
from the hydraulic modeling rule requirements?
[see R309 511-4(1)(a)(i) through (iv) to verify]
Yes No
Name:
Name:
Name:
[for example, R309-511-4(1)(a)(ii)]
8 Is this PNF for plan review waiver 3a?
[see R309 500-6(3a) to verify]Yes No
If Yes, you must have a previously approved
Master Plan and Construction Standards.
If this is a new PWS, please complete the Supplemental PNF available on our website: drinkingwater.utah.gov then Forms
Present No. of ERC's system is obligated to serve: