Grant Application

Section 1 – Municipal Information

A. Municipality Details (Required except EIN / Tax ID)

Municipality Name

County

Physical Address (Primary Office and/or Plant Address)

Municipal Phone

Municipal Email

Municipal Website

EIN / Tax ID

Mailing Address for Correspondence

B. Primary Contact (Required)

Name * Please enter a name

Title * Please enter a title

Phone * Please enter a phone number

Email * Please enter a valid email address

C. Secondary Contact (Optional)

Name

Title

Phone

Email

D. Wastewater Facility Details (Required)

Facility Name

NPDES Permit Number

Facility Type (e.g., SBR, RBC, Lagoon, Extended Aeration, Package Plant)

Facility Classification (A, B, C, D + subclasses)

Design Flow (MGD)

Average Daily Flow

Number of Operators

Staffing Model (In-house, Part-time, Contracted)

E. Sampling Requirements (Required)

Please indicate the required sampling frequency for each parameter (e.g., Daily, Weekly, Monthly, Quarterly).

CBOD

TSS

NH3-N

Fecal Coliform

pH

Chlorine (Cl2)

Dissolved Oxygen (DO)

UV

Influent

Other

Other Parameter Frequency

Section 2 – Compliance & Operational History

DEP Certification Status

Open DEP Enforcement Actions (Y/N). If yes, briefly explain:

Summary of major plant issues within the past 12–24 months

Section 3 – Grant Selection

Please check all grants for which the municipality is applying.

Automation Upgrade Grant (Up to $25,000) Lab Fee Grant (Up to $10,000) Third Party Operator Funding Grant (Up to $25,000)

Section 4 – Grant-Specific Requirements

A. Automation Upgrade Grant (Up to $20,000)

Complete this section only if applying for the Automation Upgrade Grant.

Current Technology Status

B. Laboratory Testing Fee Grant (Up to $10,000)

Complete this section only if applying for the Laboratory Testing Fee Grant.

Current Lab Provider (Name)

Contact Person

Title of Contact

Testing Frequency (e.g., Daily, Weekly, Monthly)

Total Annual Lab Cost (Past 12 Months)

Estimated Lab Cost (Next 12 Months)

Total Funding Amount Requested (Up to $10,000)

Reason for Request (Brief Narrative)

Supporting documentation (lab invoices, contracts) is optional at the application stage but is required to finalize the grant.

C. Third Party Operator Funding Grant (Up to $25,000)

Complete this section only if applying for the Third Party Operator Funding Grant.

Current Staffing Model

Third-Party Operator Company Name

Price Being Paid

Current Contract [Y / N] If yes, time left on contract

What Is Included in the Fee (Scope of Services)

Number of Days per Week the Operator Visits the Facility

Does the Agreement Include Emergency Call-Out Coverage?

Section 5 – Certification & Signatures

By signing below, the municipality certifies that all information provided in this application is true, complete, and accurate to the best of its knowledge and belief. The municipality understands that PA Pure may request additional documentation or clarification to evaluate eligibility and that failure to provide such information may delay or disqualify the application.

Submission of this application does not guarantee review, approval, or funding. PA Pure reserves the right to verify any information submitted, to make final determinations regarding eligibility, and to award funding at its sole discretion.

PA Pure is a not-for-profit entity established to support and strengthen wastewater operations across Pennsylvania. All program revenue is reinvested into municipal support initiatives, certification standards, and industry improvement efforts. Grant funding is made possible through donations, revenue-generating services, and possible state/ federal funding sources.

A. Municipal Official