"Clean Water State Revolving Fund Planning Loan Application" - Oregon

Clean Water State Revolving Fund Planning Loan Application is a legal document that was released by the Oregon Department of Environmental Quality - a government authority operating within Oregon.

Form Details:

  • Released on August 1, 2019;
  • The latest edition currently provided by the Oregon Department of Environmental Quality;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Oregon Department of Environmental Quality.

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Clean Water State Revolving Fund
Planning Loan Application
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
Planning Loan Application / Updated August 2019 (IIL)
(IIL)
Clean Water State Revolving Fund
Planning Loan Application
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
Planning Loan Application / Updated August 2019 (IIL)
(IIL)
5.
Project contact:
Name
Dept./Organization
Title
Telephone
Email Address
6.
Project Location:
Address
City, State
Zip + 4
County
Congressional District(s)
Latitude WGS84
Longitude WGS84
If no address, describe the location:
Location not known
7.
Water quality permit information (if applicable):
Administratively
No
Type
Number
Renewed
Current
New
Extended
Permit
National Pollutant
Discharge Elimination
System permit number
(EPA reference number
beginning with "OR")
Water Pollution Control
Facility permit number
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:
2
Planning Loan Application / Updated August 2019 (IIL)
(IIL)
Project Description
Use this section to describe the objectives, components and expected outcomes of the plan. The loan agreement will
refer to this section in defining what expenses can be reimbursed.
12. Planning effort description
Name of project:
Project objective:
Provide the complete scope of planning effort:
Describe the major project components of the planning effort (the means of achieving the objectives):
List all of the water quality and public health objectives addressed by the proposed planning effort:
3
Planning Loan Application / Updated August 2019 (IIL)
(IIL)
Describe how planning will address these issues (achieve objectives):
Describe the intended outcome of this plan and any other pertinent information that explains why this
project is proposed:
4
Planning Loan Application / Updated August 2019 (IIL)
(IIL)
13. Will the planning effort include sustainability, establishing long-term reliability and viability of a facility
or a water resource (refer to
OAR 340-054-0010(32)
for the definitions of sustainability and natural
infrastructure)?
Yes
No
If yes, please describe:
14. Will the planning effort take advantage of an opportunity with respect to project timing,
finances, partnerships or other advantageous condition?
Yes
No
If yes, please explain:
Planning Loan Application / Updated March 2019
5
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