Spreadsheet: 6d75fb36-8c96-4e0c-a3c0-9a96eecb3d6b
Sheet: Sheet1

 |  | Application for Section 319
 |  | Non Point Source Pollution Control Grant -- FY2011
 |  | NC Division of Water Quality
 |  | North Carolina Department of Environment and Natural Resources
1.  Project Title
2a.  Grantee Primary Contact or Project Manager1
Name
Title
Organization
E-mail
Mailing Address
City |  |  |  | State |  | Zip
Telephone |  |  |  | Fax Number
1 A one-page Statement of Qualifications must be provided in Section 2d below
2b. Grantee Execution Address (where contract will be mailed for signature)
Name
Title
Organization
E-mail
Mailing Address
City |  |  |  | State |  | Zip
Telephone |  |  |  | Fax Number
Federal Tax ID Number
2c. Grantee Payment Address (where invoice payments will be mailed)
Name
Title
Organization
E-mail
Mailing Address
City |  |  |  | State |  | Zip
Telephone |  |  |  | Fax Number
2d.  Required Statement of Qualifications (to confirm that anyone designing, installing, or monitoring the proposed project is qualified to do so.  Include in the statement any past and/or ongoing 319 grant funded projects.)
319(h)  [NAME] |  | 0 | 4.  Type of Funding Requested (check one) |  | Competitive Base |  | Restoration  (Incremental)
Match funds or in-kind Match Services |  | 0 | 5.  Type of Project (check one) |  |  |  | Development or implementation of a Watershed Restoration Plan
 |  |  |  |  |  |  | Development or implementation of a TMDL
3.  Total Project Cost |  |  |  |  |  |  | Innovative BMP Technology Demonstration
 |  |  |  |  |  |  | Education/Technology Transfer
 |  |  |  |  |  |  | Other:(please indicate)
6.  Do you propose to install BMPs or other ag management measures that would be eligible for NC Agricultural Cost Share Program (ACSP) funding?  If Yes, please document that the demand for ACSP funding in your county exceeds the supply, prompting your application for a 319(h) grant.
Yes |  |  |  | No
7.  General [NAME] of Project |  | Protect and/or Maintain Water Resource Quality |  | Restore Water Resource Quality |  |  | Educate
(Check all that apply)
8.  Project Start Date |  |  |  | Project End Date
9.  [NAME] |  | Statewide |  | Regional |  |  | Watershed | Site Specific
10.  Project Location – REQUIREMENT: Important to submit as completely as possible, especially the Lat/Long coordinates and 303(d) List Assessment Unit Number.                                                                          (NOTE:Payment of 319 Invoices will be held if all required information is not submitted in quarterly reports and the final reports, AU numbers, Lat/Long, and coordinates for all installed BMP practices)
River Basin(s)
Watershed
Watershed size |  | acres
303(d) listed [NAME](type yes or no, define if yes)
303(d) [NAME](Assess-      ment Unit Number)
HUC(s) (12 digit USGS Hydrologic Unit Codes)
County(ies)
USGS. 7.5 minute topographic quadrangle map(s) in project area
Position coordinates of project location |  | Latitude
 |  | Longitude
YES
NO
11.  NPS Pollution Sources to be addressed (Check all that apply)
 | Agriculture |  |  |  | [NAME] (includes onsite systems)
 | Construction |  |  |  | Hydrologic Modification
 | Silviculture |  |  |  | Marina and Recreational Boating
 | Urban runoff/Stormwater |  |  |  | [NAME]
 | Resource Extraction |  |  |  | Natural Sources
 | Habitat Modification (drainage/filling wetlands, streambank destabilization) |  |  |  | Other: (please specify)
12.  NPS Pollutants to be addressed (check all that apply)
 | Excess Nitrogen |  |  |  | Pesticides
 | Excess Phosphorus |  |  |  | Oil and grease
 | Sedimentation |  |  |  | Temperature
 | Pathogens/Bacteria |  |  |  | pH
 | Metals |  |  |  | Alterations
 | Low dissolved oxygen |  |  |  | Other: (please specify)
13.  Estimate Load Reduction, if checked for excess nitrogen, excess phosphorus and/or sedimentation2
#  pounds of nitrogen saved from project implementation |  |  |  |  | Reference:
#  pounds of phosphorus saved from project implementation |  |  |  |  | Reference:
#  tons of soil saved from project implementation |  |  |  |  | Reference:
Load Reduction Model Used: |  |  |  |  | Reference:
STEPL, Region 5, L-THIA, Other
2 Providing a load reduction estimate is required for all BMP implementation projects, including demonstrations.
14a.  Do you intend for collected data to be used by DWQ for Use Support decisions?
 | Explanation:
14b.  Does this proposal address needs that were identified in a DWQ basin plan? If yes, please identify the specific need and the basin in which the need is outlined.
 | Explanation:
15.  Project Abstract (short concise summary of the project – DO NOT EXPAND SPACE PROVIDED)
16a. BUDGET - 319 Funding Requested
Budget Categories |  | Section 319 Grant Funds only |  |  |  | Total | Justification (Include detailed explanation for each budget line item)
 |  | Year 1 | Year 2 | Year 3 | Year 4
Personnel/Salary
Fringe Benefits
Supplies
Equipment
Travel
Contractual
Other
Total Direct
Indirect ([NAME]. 10% of direct costs, per 40 CFR 35.268
Annual Totals
Grand Total
% of Total Budget
Year 1: January 1, 2012-June 30, 2012 (6 months) – Total MUST equal sum of quarters 1-2 in Milestone Table #20
Year 2: July 1, 2012-June 30, 2013 (12 months) – Total MUST equal sum of quarters 3-6 in Milestone Table #20
Year 3: July 1, 2013-June 30, 2014 (12 months) – Total MUST equal sum of quarters 7-10 in Milestone Table #20
Year 4: July 1, 2014-December 31, 2014 (6 months) – Total MUST equal sum of quarters 11-12 in Milestone Table #20
16b. BUDGET - Match Funding Provided
Budget Categories |  | Non-Federal Match only3 |  |  |  | Total | Justification (Include detailed explanation for each budget line item)
 |  | Year 1 | Year 2 | Year 3 | Year 4
Personnel/Salary
Fringe Benefits
Supplies
Equipment
Travel
Contractual
Other
Total Direct
Indirect ([NAME]. 10% of direct costs, per 40 CFR 35.268
Annual Totals
Grand Total
% of Total Budget
Total Project Budget |  | Total 319 Fund Request + Total Match Funds Received
3Note: Non-Federal match must be a minimum of 40% of the total project budget
Year 1: January 1, 2012-June 30, 2012 (6 months) – Total MUST equal sum of quarters 1-2 in Milestone Table #20
Year 2: July 1, 2012-June 30, 2013 (12 months) – Total MUST equal sum of quarters 3-6 in Milestone Table #20
Year 3: July 1, 2013-June 30, 2014 (12 months) – Total MUST equal sum of quarters 7-10 in Milestone Table #20
Year 4: July 1, 2014-December 31, 2014 (6 months) – Total MUST equal sum of quarters 11-12 in Milestone Table #20
17.  Budget Summary (Combined federal and match funds)
 |  | BMP Installation | Project Management | Education Training or [NAME] | Monitoring | Technical Assistance | Other | Total
Personnel
Fringe Benefits
Supplies
Equipment
Travel
Contractual
Other
Operating
Total
18.  Local and State Match (non-federal) Summary
Total Match amount
Cash Match |  |  |  | $
In-kind Match |  |  |  | $
Source(s) of Cash Match
Source(s) of In-kind Match
19.  Project Partners (may add more, if needed)4
Agency Name
Agency Address
Role/contribution to Project
Contact Person |  |  |  |  |  | Phone No.
E-mail address
Agency Name
Agency Address
Role/contribution to Project
Contact Person |  |  |  |  |  | Phone No.
E-mail address
Agency Name
Agency Address
Role/contribution to Project
Contact Person |  |  |  |  |  | Phone No.
E-mail address
Agency Name
Agency Address
Role/contribution to Project
Contact Person |  |  |  |  |  | Phone No.
E-mail address
Agency Name
Agency Address
Role/contribution to Project
Contact Person |  |  |  |  |  | Phone No.
E-mail address
4 A one-page Statement of Qualifications must be provided in Section 2d to confirm that anyone designing, installing, or monitoring the proposed project is qualified to do so.  Include in the statement any past and/or ongoing 319 grant funded projects.
20.  Project Milestone Schedule
Time Period/Date |  |  | Activities (List specific quantifiable outputs or activities that will be achieved during each quarter) |  |  |  | [NAME] and % of Requested Funding Spent by Quarter5
First Quarter
Jan-Mar 2012
Second Quarter
Apr-June 2012
Third Quarter
July-Sept 2012
Fourth Quarter
Oct-Dec 2012
Fifth Quarter
Jan-Mar 2013
Sixth Quarter
Apr-Jun 2013
Seventh Quarter
July-Sept 2013
Eighth Quarter
Oct-Dec 2013
Ninth Quarter
Jan-Mar 2014
Tenth Quarter
Apr-June 2014
Eleventh Quarter6 |  |  |  |  |  |  | 0.9
July-Sept 2014
Twelfth Quarter |  |  |  |  |  |  | 1
Oct-Dec 2014
5 Please show anticipated dollar amount, percent of grant spent that quarter, and cumulative percent of grant spent.  Unused funds will carry forward to next quarter.  Invoices exceeding budgeted amount for state fiscal year (July-June) won't be reimbursed until next state fiscal year.
6 10% of grant will be held until receipt of Final Project Report
Note: | Sum of funds spent in quarters 1-2 MUST equal year 1 total in Budget Table #16a
 | Sum of funds spent in quarters 3-6 [NAME] equal year 2 total in Budget Table #16a
 | Sum of funds spent in quarters 7-10 MUST equal year 3 total in Budget Table #16a
 | Sum of funds spent in quarters 11-12 MUST equal year 4 total (min. 10% of 319 funds)
21.  [NAME] and goals of the project.  Expand space, if necessary
22.  A detailed description of the project. Note: if project entails developing or implementing a Watershed Restoration Plan, see section 26. Expand space, as necessary
23.  Monitoring/Environmental Data Collection  Describe in section below how project data will be used (i.e. demonstrate effectiveness of BMPs installed, calculate load reductions, data to be used for TMDL development, data to be used for State use support purposes, etc.).  If monitoring is needed to document a demonstration project or water quality improvement, a Quality Assurance Project Plan (QAPP) will be required (reviewed and approved by DWQ).  For a QAPP template, visit the 319 Program website at [NAME].
24.  Public Involvement
25.  List Project Outputs and Products  (All 319 funded projects are required to submit Quarterly Progress Reports and a detailed Final Project Report, which must be submitted no later than the contract expiration date for DWQ review and approval.)  Outputs and deliverables must included anticipated measurable results from the project.
26. Projects Developing or Implementing a Watershed Restoration Plan must include EPA’s 9 Key Elements for Watershed Restoration Plans.  Draft Plans must be submitted to DWQ for review and approval at least *60 days before* end of the project/contract period.
NOTE: Please provide information on the following ONLY if applying for Incremental funds to develop or implement a Watershed Restoration Plan: (use additional pages as necessary)
1 | An identification of the causes and sources or groups of similar sources that will need to be controlled to achieve the load reductions estimated in the watershed
2 | A description of the NPS management measures that will need to be implemented to achieve load reductions as well as to achieve other watershed goals identified in the watershed based plan
3 | An estimate of the load reductions expected for the management measures
4 | An estimate of the amount of technical and financial assistance needed associated costs and or sources and authorities that will be relied upon, to implement the plan
5 | An information/education component that will be used to enhance public understanding of the project
6 | A schedule for implementing the NPS management measures identified in this plan that is reasonably expeditious
7 | A description of interim, measurable milestones for determining whether NPS management measures or other control actions are being implemented
8 | A set of criteria that can be used to determine whether loading reductions are being achieved overtime and substantial progress is being made towards attaining water quality standards
9 | A monitoring component to evaluate the effectiveness of the implementation efforts over time measured against the criteria established under item 8.
27. References and [NAME]