2011-09-14 CC Packet - Laserfiche WebLink

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InIKIEWEEILI Environmental Health Division M 1)H Drinking Water Protection Section P.O. Box 64975 St. Paul, Minnesota 55164 1 Ti 7111 111 rum/ ] Source Water Protection Plan Implementation Grant Application • August 2011 Due September 13 Notice: This application must be completed in order to score your grant request. Public Water Supply System (name of primary applicant): City of Centerville PWSID: 10200036 Note: List all of the public water supply systems involved if more than one is applying: City of Centerville Name of the Grant Contact: Mike Jeziorski Phone No. 651- 429 -3232 E -mail address: mjeziorski @centervillemn.com Mailing Address 1880 Main St Centerville, MN 55038 Federal Tax ID #:...41- 1267014 Person Authorized to Sign Grant Agreement on Behalf of the Public Water Supply System: Name: Mike Jeziorski Title: Finance Director Total Grant Amount Being Requested ($10,000 maximum): $ 10,000 • Work Item (s) to be performed under this grant For each work item to be funded under the grant, please provide the following information (use an additional page if necessary). 1. Work Item — describe the work that will be performed: Private Well Sealing Information — The city will send a letter to 34 property owners located in the DWSMA that summarizes their responsibility in having wells sealed. The information will include reasons for sealing private wells along with the financial assistance available in doing so. Estimated cost of $1,000. 1 a. Amount Requested for performing this work: $ 0 ib. Product(s) produced or anticipated outcomes of performing this work item: Determine the level of private wells that are hooked onto City water and that need to be sealed. 1 c. Please reference the MEASURE / OBJECTIVE number and attach the pages) in the source water protection plan that contains the source water protection measure / objective that will be supported by this work item: Part 2 , Chapter 5, Item I and II • 26