"Point Source Project Loan Application (Design and Construction Projects)" - Oregon

Point Source Project Loan Application (Design and Construction Projects) is a legal document that was released by the Oregon Department of Environmental Quality - a government authority operating within Oregon.

Form Details:

  • Released on March 1, 2022;
  • The latest edition currently provided by the Oregon Department of Environmental Quality;
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Clean Water State Revolving Fund
Point Source Project Loan Application
(Design and Construction Projects)
Contact:
Regional Project Officer
Answer all requests for information in this application. List “N/A” for items that do not apply. Do not leave any section of
this application blank.
DEQ will accept completed applications that are printed, signed and mailed to DEQ, postmarked by the application due
date.
Applicant Information
1.
Public agency/Legal applicant:
Name
Address
City, State
Zip + 4
County
Congressional District(s)
Telephone
Email Address
DUNS Number (9 Digits)
2. Cite your agency’s authority to take on debt, noting the exact Oregon Revised Statute reference located on
the
state
website,
3. Only public agencies are eligible for the Clean Water State Revolving Fund. Does your agency meet the
definition of a “public agency” as defined by
ORS
468.423? If you are unsure,
contact DEQ at 503-229-LOAN.
Yes
No
4.
Identify your type of public agency:
Tribal government
City
County
Sanitary district/Sanitary authority
State agency
Irrigation district
School district
County service district
Metropolitan service district
Other special district (please specify):
Intergovernmental agency (please specify):
Note: Eligibility includes certification of no disbarment and no suspension through the
System of Award
Management. Certification is required at time of loan signing.
1
Point Source Loan Application / Updated March 2022
Clean Water State Revolving Fund
Point Source Project Loan Application
(Design and Construction Projects)
Contact:
Regional Project Officer
Answer all requests for information in this application. List “N/A” for items that do not apply. Do not leave any section of
this application blank.
DEQ will accept completed applications that are printed, signed and mailed to DEQ, postmarked by the application due
date.
Applicant Information
1.
Public agency/Legal applicant:
Name
Address
City, State
Zip + 4
County
Congressional District(s)
Telephone
Email Address
DUNS Number (9 Digits)
2. Cite your agency’s authority to take on debt, noting the exact Oregon Revised Statute reference located on
the
state
website,
3. Only public agencies are eligible for the Clean Water State Revolving Fund. Does your agency meet the
definition of a “public agency” as defined by
ORS
468.423? If you are unsure,
contact DEQ at 503-229-LOAN.
Yes
No
4.
Identify your type of public agency:
Tribal government
City
County
Sanitary district/Sanitary authority
State agency
Irrigation district
School district
County service district
Metropolitan service district
Other special district (please specify):
Intergovernmental agency (please specify):
Note: Eligibility includes certification of no disbarment and no suspension through the
System of Award
Management. Certification is required at time of loan signing.
1
Point Source Loan Application / Updated March 2022
5.
Project contact:
Name
Dept./Organization
Title
Telephone
Email Address
6.
Interim financing:
Yes
No
If yes, which agency will provide long-term financing:
7.
Water quality permit and certificate information (if applicable):
Administratively
No
Type
Number
Renewed Current
New
extended
permit/cert
National Pollutant Discharge
Elimination System permit
number (EPA reference number
beginning with "OR")
Water Pollution Control Facility
permit number
401 certification
8.
Will this project require:
Permit renewal
New permit
N/A
9.
Permit includes:
A compliance schedule associated with loan request
A Mutual Agreement and Order (MAO) associated with loan request
Loan request is being made to address potential compliance concerns
10. CWSRF loan request amount:
11. Total estimated project cost:
Project Description
(Attach additional documentation if necessary)
Use this section to describe the objectives components and expected outcomes of the project. The loan agreement will
refer to this section in defining what expenses can be reimbursed.
12. Project type (check one or both, as appropriate):
Design
Construction
Note: A DEQ-approved facility plan no older than five years, or pre-design report, is required prior to
application approval.
Point Source Loan Application / Updated March 2022
2
13. Project description:
Name of the project:
Describe proposed project, specifying the water quality and public health objectives to be addressed:
Describe the major project components (for example, type of structures to be built):
Point Source Loan Application / Updated March 2022
3
Describe how the proposed project will achieve the objectives:
Give any other pertinent information that explains why this project is proposed:
Point Source Loan Application / Updated March 2022
4
14. Project will improve water quality by addressing one or more of the following (Check all that apply)*:
Temperature
Bacteria
Dissolved oxygen
Nutrients
Contaminated sediments
NPDES/WPCF permit
Oregon Health Authority requirement
Toxic substances
Other:
*Provide documentation, as described in Application Instructions, to support water quality improvement.
15. Is the facility currently in compliance with its permit(s)?
Yes
No
If yes, answer question #16.
If no, skip to question #17.
16. Is the facility at risk of noncompliance with its permit(s)
Yes
No
If yes, describe how the project will ensure continued compliance of facility and how long the system is expected
to maintain compliance:
17. Indicate the noncompliance issue, if any, the project will address:
Water quality standards
Public health
Limits for wastewater or stormwater discharge to surface water or groundwater
Waste discharge limits for reuse of biosolids or wastewater
18. Does the project address a water quality improvement or restoration need for a small community, defined as
10,000 or fewer people?
Yes
No
If yes, enter the population estimate*:
*Use current estimate from Portland State University
Population Research Center
Point Source Loan Application / Updated March 2022
5
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