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

Nonpoint 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 April 1, 2022;
  • The latest edition currently provided by the Oregon Department of Environmental Quality;
  • Ready to use and print;
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  • 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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Clear Form
Clean Water State Revolving Fund
Nonpoint 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
Public agency/Legal applicant:
1.
Name
Address
City, State
Zip + 4
County
Congressional District(s)
Telephone
Email Address
DUNS Number (9 Digits)
Cite your agency’s statutory authority to take on debt: _______________________________________
2.
Only public agencies qualify for the Clean Water State Revolving Fund. Does your agency meet the
3.
definition of a “public agency” as defined by
ORS
468.423? If you are unsure, contact DEQ at 503-
229-5622:
Yes
No
Identify your type of public agency:
4.
Tribal government
City
County
Sanitary district/sanitary authority
Irrigation district
State agency
School district
County service district
Metropolitan service district
Nonpoint Source Loan Application
Updated: April 2022
1
Clear Form
Clean Water State Revolving Fund
Nonpoint 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
Public agency/Legal applicant:
1.
Name
Address
City, State
Zip + 4
County
Congressional District(s)
Telephone
Email Address
DUNS Number (9 Digits)
Cite your agency’s statutory authority to take on debt: _______________________________________
2.
Only public agencies qualify for the Clean Water State Revolving Fund. Does your agency meet the
3.
definition of a “public agency” as defined by
ORS
468.423? If you are unsure, contact DEQ at 503-
229-5622:
Yes
No
Identify your type of public agency:
4.
Tribal government
City
County
Sanitary district/sanitary authority
Irrigation district
State agency
School district
County service district
Metropolitan service district
Nonpoint Source Loan Application
Updated: April 2022
1
Other special district (please specify): __________________________________________________
Intergovernmental agency (please specify): ______________________________________________
Project contact:
5.
Name
Dept./Organization
Title
Telephone
Email Address
Interim financing:
6.
Yes
No
If yes, identify the funder: _____________________________________________________________
Is this a Sponsorship Option loan request?
7.
Yes
No
If yes, what CWSRF funded project will sponsor this proposed nonpoint source project?
Water quality permit information (if applicable)
8.
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
Will the project require:
9.
Permit renewal
New permit
N/A
Anticipated new permit or certification (please specify):
Permit includes:
10.
A compliance schedule associated with loan request
Permit includes a Mutual Agreement and Order (MAO) associated with loan request
Loan request is being made to address potential compliance concerns
Nonpoint Source Loan Application
Updated: April 2022
2
CWSRF loan request amount: ___________________________________
11.
Total estimated project cost: ____________________________________
12.
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.
Project type (check one or both, as appropriate):
13.
Design
Construction
Project description:
14.
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):
Nonpoint Source Loan Application
Updated: April 2022
3
Describe how the proposed project will achieve the objectives:
Give any other pertinent information that explains why this project is proposed:
Project will improve water quality by addressing one or more of the following (Check all that apply)*:
15.
Temperature
Bacteria
Dissolved oxygen
Nutrients
Contaminated sediments
NPDES/WPCF permit
Nonpoint Source Loan Application
4
Oregon Health Authority requirement
Toxic substances
Other: ___________________________________________________________________________
*Provide documentation, as described in Application Instructions, to support water quality improvement.
Is the facility currently in compliance with its permit(s)?
16.
Yes
No
If yes, answer question #17.
If no, skip to question #18.
Is the facility at risk of noncompliance with its permit(s)?
17.
Yes
No
If yes, describe how the project will ensure continued compliance of facility and how long the system is
expected to maintain compliance:
What noncompliance issue, if any, will this project address?
18.
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
Describe how the project will address the indicated noncompliance issue(s):
Does the project address a water quality improvement or restoration need for a small community,
19.
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
Nonpoint Source Loan Application
Updated: April 2022
5
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