2011-09-14 CC Packet - Laserfiche WebLink

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2. Work Item — describe the work that will be performed: The City will financially assist those that qualify to have their abandoned or private well sealed. • 2a. Amount Requested for performing this work: $ ...10,000 2b. Product(s) produced or anticipated outcomes of performing this work item: Would decrease the amount of abandoned wells that are not sealed therefore reducing the potential for pollution of groundwater 2c. Please reference the MEASURE / OBJECTIVE number and attach the page(s) 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 Detailed Budget and Schedule: Please describe all sub - activities that are included in the project with the corresponding costs and estimated date of completion; use an additional page if necessary (Example: if the activity is public education you will need to detail how many training sessions, how much will be spent for supplies, how many participants, or brochures, what is the consultant fee, etc.) Sub- activity Amount requested Estimated start date • Mailing $0 9/12/11 Sealing of Private Wells $10,000.00 N/A Total (amount being requested) $10,000.00 Certification: I certify that the information herein is true and accurate to the best of my knowledge and I submit this application on behalf of the applicant public water supply system. Signature: Title: Date: • Note: If you are awarded a grant, NO work should begin until all required signatures have been obtained on the grant agreement, and grantee receives a signed copy of the grant agreement. 27