Doh 348 Form PDF Details

In the realm of public water supply improvements within the State of New York, the DOH 348 form serves as a vital document, facilitating the application process for the approval of plans concerning the enhancement and establishment of water supply systems. Embodied within this form are fundamental sections that capture a wide array of necessary information, including the identification of the applicant, the precise location of the proposed or existing water works, and the specific district or community that will be served. Notably, the DOH 348 form distinguishes between modifications to existing systems and the creation of new systems, demanding a detailed analysis of capacity development for the latter. This entails a comprehensive approach to ensuring the viability and sustainability of new water supply systems. Importantly, the form also solicits data on the projected costs associated with various components of the water supply improvement project such as treatment, storage, distribution, pumping, and the corresponding engineering and legal expenses. Types of projects that can be undertaken are diverse, ranging from corrosion control and chlorination to more specialized endeavors like U.V. light disinfection and fluoridation. Additionally, the form requires applicants to provide information on the total population served by the project, consumption data, and detailed contact information for both the design engineer and the applicant. It underscores the necessity of professional certification by including a section for the signature and stamp of a New York State licensed professional engineer, affirming the adherence of plans and specifications to established standards and the sanitary code. Finally, the inclusion of links to critical resources for capacity development and the Drinking Water State Revolving Fund highlights the form’s role in not just the procedural but also the informational support to applicants navigating the complex landscape of public water supply improvements.

QuestionAnswer
Form NameDoh 348 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdoh348, ny state travelers health form, doh 4359 form, new york state travelers health form

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NEW YORK STATE DEPARTMENT OF HEALTH

 

 

 

 

 

Application for Approval of Plans for

Bureau of Water Supply Protection

 

 

 

 

 

 

 

Public Water Supply Improvement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicant

 

 

 

Location of works (C,V,T)

 

County

 

 

Water District (specific area served)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of ownership

 

 

 

Private – Other

 

Authority

 

Interstate

 

 

 

Municipal

Commercial

Private – Institutional

 

Federal

 

International

 

 

 

Industrial

Water Works Corp.

Board of Education

 

State

 

Native American Reservation

 

 

 

 

 

 

Modifications to existing system. If checked, provide PWS ID # NY ___ ___ ___ ___ ___ ___ ___

 

 

 

 

 

 

 

 

 

 

 

 

New System. If checked, provide capacity development (viability) analysis*

 

 

 

 

 

 

 

If this project involves a new system, new water district, or a district extension provide boundary description location details in digital format on CD

or Floppy Disk. If digital boundary location details are not available provide a text description.

 

 

 

 

 

Digital GIS Data Provided

Digital CAD Data Provided

 

Other Digital Data Provided

Text Description Provided

N/A

 

 

 

 

 

 

 

 

 

Funding Source

Private

DWSRF**

Federal

 

Other__________________________________

If DWSRF is checked, provide DWSRF # ___ ___ ___ ___ ___

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Estimated Project Cost

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Source

$_____________

 

Treatment

$____________

Storage

 

$_____________

Distribution

$_____________

 

Pumping

$_____________

 

Engineering $____________

Legal/Permitting

$_____________

Total

$_____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Project

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Corrosion Control

 

U.V. Light Disinfection

 

Distribution

 

 

 

Source

 

 

Pumping Unit

 

Fluoridation

 

 

Storage

 

 

 

Transmission

 

 

Chlorination

 

Other Treatment

 

Other

 

 

 

Project Description:__________________________________________________________________________________________________

__________________________________________________________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Population

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total population

 

 

 

% population

 

 

 

 

% population served

 

 

 

of Service area _________________

actually served ________________

 

affected by project _______________

 

 

 

 

 

 

 

 

 

 

 

 

Latest total consumption data (in MGD)

 

 

 

 

14. NYS Professional

 

 

 

 

 

 

 

 

 

 

 

 

 

Licensed Engineer

 

 

 

 

 

 

 

 

 

 

 

 

 

Stamp & Signature ***

 

 

 

 

Avg. day _________________Year ___________________

 

 

 

 

 

 

 

 

 

 

Max. day _________________Year ___________________

 

 

 

 

 

 

 

 

 

 

Peak hr.

_________________Year ___________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of design engineer

 

 

 

 

 

 

 

 

 

 

 

 

 

__________________________________________________________________________________________________________

 

Address _____________________________________________________

 

Telephone No. _______________________________

E-Mail _____________________________________________________

Fax No. ______________________________________

 

 

 

 

 

 

 

 

 

 

 

Name and title of applicant or designated representative

 

 

 

 

 

 

 

 

 

 

 

__________________________________________________________________________________________________________

 

Address __________________________________________________________________________________________________________

 

_____________________________________________________

 

 

 

_____/_____/_____

 

 

 

 

 

Signature of applicant

 

 

 

 

 

 

Date

 

 

 

 

 

 

NOTE: All applications must be accompanied by 3 sets of plans, 3 sets of specifications and an engineer’s report describing the project in detail. The project must first

be discussed with the appropriate city, county, district or regional public health engineer. Signature by a designated representative MUST be accompanied by a letter of

authorization.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Additional information regarding capacity development may be found at:

http://www.health.state.ny.us/nysdoh/water/main.htm

 

 

 

**Current DWSRF project listings may be found at:

 

 

http://www.health.state.ny.us/nysdoh/water/main.htm

 

 

 

***By affixing the stamp and signature the Design Engineer agrees that the plans and specifications have been prepared in accordance with the most recent version of

the recommended standards for water works and in accordance with the NYS Sanitary Code.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOH-348 (02/05)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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