Please fill out the survey by June 30, 2021.

Applicants should submit one application per facility. Please note that the application must be filled in and submitted in one sitting - it may not be saved and reopened at a later time so it is important to have all relevant information available when you begin. Review the sample template application at https://www.srbc.net/our-work/what-we-do/water-level-monitoring-grants.html that is provided for guidance about the information requested and appropriate level of detail. SRBC may request additional information if needed during its review. If you have questions or need assistance, please contact Paula Ballaron at PBallaron@srbc.net.

Asterisks indicate required fields.

The following documents may be used as a reference while completing this application:

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* 1. Please enter company/organization information

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* 2. Please provide your contact information

PROJECT IDENTIFICATION
Please submit one application per facility. For facilities with docket approvals, list all groundwater withdrawal docket approvals and their expiration dates. Grandfathered facilities should enter their certificate number. Other circumstance include those facilities that have applied for coverage as grandfathered but are still under review, and facilities that are under an order to make application for groundwater wells.

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* 3. SRBC Docket Number

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* 4. Expiration Date (MM/DD/YYYY)

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* 5. Grandfathering Certificate Number

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* 6. Other Circumstance

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* 7. Requested Grant Amount (limited to a maximum of $1500 per source and $7500 per facility):

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* 8. Is the project owned by a municipality or municipal authority?

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* 9. Is the project a Public Water Supplier?

If  the previous answer is "Yes" and the project is a public water supplier, please answer the next two questions.

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* 10. What is the size of the population served?

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* 11. If you are a Non-municipal Public Water Supplier, please list any other facilities you own and the population served by each.

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* 12. Is the project owned by a private entity (a Non-public project sponsor)?

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* 13. If yes, was your gross annual revenue from the prior tax year less than $1,000,000? ­­­­

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* 14. Do you currently measure water level in the project’s well(s)?

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* 15. If so, what is the method used to measure?  Are water levels recorded and how?

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* 16. Provide a Description of how the grant would be used, identifying which wells are included. (300 words or less):

Note grants may be used for projects that are not currently able to collect water level data from its well(s) or may be used to upgrade equipment: due to equipment failure; to achieve better accuracy; to achieve better efficiency; or to automate water level measurement/recording.

BUDGET

Review the sample template application at https://www.srbc.net/our-work/what-we-do/water-level-monitoring-grants.html for guidance about the appropriate level of detail. SRBC reserves the right to ask for a detailed list of expenses, upon request.

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* 17. Expense Description for the Project:

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* 18. Amount of Expenses

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* 19. Total Amount of Expenses

To be eligible for reimbursement, all items must be purchased and services performed after July 1, 2021.

The undersigned certifies, under penalty of law (or perjury), as provided by as provided by Section 210.45, of the New York Penal Law, 18 Pa. C.S. § 4904, Section 9-101 Maryland Crimes Code, and 28 U.S.C. § 1746, that they are authorized to execute this Grant Application on behalf of the Applicant and that all information provided is true and accurate.
Signature – to agree, type in your name to act as an electronic signature.

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* 20. Signature of Applicant:

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* 21. Date

About the Susquehanna River Basin Commission


The Susquehanna River Basin Commission is a federal/interstate governmental agency responsible for protecting and wisely managing the water resources within the 27,500 square-mile Susquehanna River Basin without regard to political boundaries. The Susquehanna rises and flows through New York, Pennsylvania, and Maryland into the Chesapeake Bay. For more information on the Commission, visit srbc.net or follow us on Twitter: @SRBC

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