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Worksheet Use Only for Clean Water Construction Project Evaluation Form. Please use the eSRF online portal for submitting PEFs.0
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DescriptionUse pull downs to determine scoreComments
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Part IV - Project Ranking
Project Tier
Based on the Tier descriptions presented in the Instruction and Guidance document, what Tier do you believe best characterized your project?		0 Not Requested or Not Documented
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A. Public Health Impacts
What is the nature of the resource affected?

1) Public Drinking Water Supply		0 Not Requested or Not Documented
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2) Private Drinking Water Supply0 Not Requested or Not Documented
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3) Private Homes0 Not Requested or Not Documented
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4) Public Streets or Parklands0 Not Requested or Not Documented
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5) Swimming Areas0 Not Requested or Not Documented
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6) Boating Areas0 Not Requested or Not Documented
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7) Sensitive Population Affected0 Not Requested or Not Documented
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8) Population Affected0 Not Requested or Not Documented
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9) EJ communities (either affected by it, or serviced by project)0 Not Requested or Not Documented
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B. Environmental Criteria
What is the nature of the environmental problem encountered?

1) Aquatic Toxicity		0 Not Requested or Not Documented
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2) Nutrients0 Not Requested or Not Documented
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3) Bacteria0 Not Requested or Not Documented
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4) Turbidity0 Not Requested or Not Documented
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5) Dissolved Oxygen0 Not Requested or Not Documented
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6) Temperature0 Not Requested or Not Documented
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7) Noxious Aquatic Plants0 Not Requested or Not Documented
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8) Aesthetics0 Not Requested or Not Documented
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9) If project addresses emergent contaminants, the Emergent Contaminant Questionnaire is required to be filled out and attached as part of PEF documentation. 0 Answer with note in comment and upload supporting documentation.
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What environmental resource(s) is affected?

10) Public Water Supply - Surface Water Zone A or Zone B		0 Not Requested or Not Documented
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11) Public Water Supply - Ground Water Zone I or Zone II0 Not Requested or Not Documented
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12) Outstanding Resource Water (ORW)0 Not Requested or Not Documented
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13) Area of Critical Environmental Concern (ACEC)0 Not Requested or Not Documented
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14) Commercial Fishery/Shellfish Area0 Not Requested or Not Documented
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15) Endangered Species Habitat0 Not Requested or Not Documented
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16) Sole Source Aquifer (SSA)0 Not Requested or Not Documented
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17) Ocean Sanctuary: Cape Cod, Cape Cod Bay, Cape and Islands, North Shore, and/or South Essex0 Not Requested or Not Documented
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18) Recreational Fishery/Shellfish Area0 Not Requested or Not Documented
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19) Federally/State Designated River or Estuary or Freshwater Pond0 Not Requested or Not Documented
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C. Program and Implementation Criteria

Consistency with EOEEA/MassDEP Watershed Management Plans or priorities

1) Implements a recommendation		0 Not Requested or Not Documented
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2) Compliance and enforcement0 Not Requested or Not Documented
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3) Multi-Community or regional solution0 Not Requested or Not Documented
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4) Innovative Technology (only within the past 5 years)0 Not Requested or Not Documented
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5) Energy Efficiency - this project is recommended by an Audit0 Not Requested or Not Documented
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6) Renewable Energy - this project is recommended by an Audit0 Not Requested or Not Documented
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7) Resilience and Adaptation0 Not Requested or Not Documented
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8) First Time PEF submittal for clean water or drinking water by LGU for an SRF construction project or first time in more than 5 years.0 Not Requested or Not Documented
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D. Best Management Practice (BMP) as defined on the Clean Water Trust's website

1) Does the public water system have an asset management plan or a plan that is utilized for rehabilitation or replacement of water works and maintenance equipment?
If the Asset Management Plan does not include all 5 components it is not eligible to receive any points. The Asset Management Plan must be no more than 15 years old to be awarded points.		0 Not Requested or Not Documented
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2) Has the applicant adopted the BMP of Enterprise Fund and Full Cost Pricing? 0 Not Requested or Not Documented
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3) Has the applicant adopted the BMP of Inter-Municipal Agreement (as Host Community)?0 Not Requested or Not Documented
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E. Qualifying EPA Green Projects

1) List the project item codes from the checklist below that qualify as green in comments section		0 Answer with note in comments
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2) List the total value of the green items in comments section0 Answer with note in comments
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3) List the percentage green on the project in comments section0 Answer with note in comments
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