This page contains the list of items and forms that must be submitted by privately owned water systems, including cooperatives, manufactured housing parks and other small community systems to obtain funding from the American Recovery and Reinvestment Act of 2009 (ARRA) Drinking Water State Revolving Fund (DWSRF).
To expedite the processing of your application, we ask that you submit any and all items from the checklists below as soon as possible. This will allow us to move forward with required internal and interagency reviews and approvals. All information is to be sent to the following:
Cynthia Klevens, PE
NHDES Drinking Water and Groundwater Bureau
29 Hazen Drive; PO Box 95
Concord, NH 03302-0095
(603) 271- 3108
(603) 271-5171 (fax)
cynthia.klevens@des.nh.gov
Checklists and Application Forms for Privately Owned/Small Community Water Systems
Loan Application Checklist
Technical Design Application Checklist
Form 1 – Application for the ARRA Drinking Water State Revolving Loan 
Form 2 – Authority to Borrow and Designation of Authorized Representative
Form 3 – Environmental Review Template
Form 4 – Public Water System Self-assessment
Form 5 – State of New Hampshire W-9 Vendor Code request
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