Reau of Water Supply Protection (NYSDOH BWSP) Application for an Approval of Completed Works 1. Public Water System Name: 3. Project Location (City, Town, Village) 4. Drinking Water State Revolving Fund (DWSRF) Project: 5. Plans approved by NYSDOH BWSP: Yes 2. PWSID Number: Yes No No County If Yes, DWSRF Project Number: If Yes, NYSDOH BWSP Project Log Number: Plans approved by : (check all that apply) NYSDOH Regional Office NYSDOH District Office 6. Con.
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How to fill out the DOH-5025 online
The DOH-5025 form is a vital document for certifying the completion of public water improvement projects in New York State. This guide provides users with step-by-step instructions to successfully fill out and submit the form online.
Follow the steps to complete the DOH-5025 online.
- Press the ‘Get Form’ button to access the DOH-5025 form and open it in the editing interface.
- Enter the public water system name in the designated field.
- Fill in the PWSID number, ensuring that the number is accurate.
- Indicate the project location by providing the city, town, or village.
- Specify whether the project is a Drinking Water State Revolving Fund (DWSRF) project.
- Check 'Yes' or 'No' regarding the approval of plans by the NYSDOH Bureau of Water Supply Protection.
- If applicable, enter the DWSRF Project Number and NYSDOH BWSP Project Log Number.
- Provide the construction start date.
- Indicate the substantial construction completion date and attach a copy of the notice to proceed.
- Write a brief project description that summarizes the key elements of the project.
- Review the statement regarding the certification of project completion, and prepare to affix your seal and signature.
- If there are any deviations from the approved plans, document them in the space provided or attach additional sheets as necessary.
- Enter the name of the engineering firm and print the contact person's name.
- Complete the contact phone number and date signed fields, then affix the NYS Engineer's seal and signature.
- Based on your answers, determine the appropriate address to send the completed form, whether to NYSDOH BWSP or another regional or district office.
Complete your DOH-5025 form online and ensure a smooth submission process.
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