Steven Bellone, Suffolk County Executive

PROJECT TITLE:

Steven Bellone, Suffolk County Executive

Theresa Ward, Deputy County Executive and Commissioner,

Department of Economic Development and Planning

Gilbert Anderson, P.E., Commissioner, Department of Public Works

James L. Tomarken, MD, Commissioner, Department of Health Services

DuWayne Gregory, Presiding Officer, Suffolk County Legislator, 15th District

Philip Berdolt, Commissioner, Department of Parks, Recreation, & Conservation

Sarah Lansdale, Director, Division of Planning and Environment

Bob DeLuca, Group for the East End

Kevin McDonald, Citizens Advisory Committee for the Peconic Estuary Program

Water Quality Protection and Restoration Program and Land Stewardship Initiative May 2017

Application Form

APPLICATION CHECKLIST

Please include all of the following items when submitting your application. Only complete applications will be considered.

A detailed description of the proposed project by task.

A detailed breakdown of anticipated project costs based on expense type by task. Applications from Towns and Villages must demonstrate a match of at least 50% of the total project cost.

A separate file with any design/engineering work.

Curriculum vitae of all project personnel.

Project timeline.

Applications from Towns and Villages must attach a complete set of Labor forms.

Applications from Towns and Villages must have a County Department or Office as its Sponsor.

Applications from Towns and Villages must include a resolution that authorizes the municipality to submit the application and also agrees to the matching funds requirement.

Applications from Towns and Villages must include a SEQRA resolution that conducts a coordinated review and makes a SEQRA determination as lead agency.

Applications from Towns and Villages must be sent to a County Legislator for consideration.

Please be sure to sign the application on Page 17.

APPLICATION

Part 1 – Applicant Information

1.  Application Number (leave blank - will be assigned by the WQPRP Review Committee)

2.  Applicant Name

3.  Federal Taxpayer ID#

4.  Phone Fax Email

5.  Mailing Address

No. & Street
City / Zip Code

6.  Contact Person and Title

7.  Contact Mailing Address and Information (if different from applicant)

No. & Street
City / Zip Code
Phone / Email

8.  Suffolk County Department or Office Sponsor

Contact Person and Title

Mailing Address

No. & Street
City / Zip Code
Phone / Email

Part 2 – Project Information

1.  Project Name

2.  Project Location/Address

No. & Street
City
Zip Code / Phone

3.  Suffolk County Tax Map Number(s)

4.  Project Type

-Page 6 of 17-

Water Quality Protection and Restoration Program and Land Stewardship Initiative May 2017

Application Form

Nonpoint Source Abatement and Control – Remediation and/or Preservation

Pollution Prevention Initiatives

Other Nonpoint Source Pollution Remediation

-Page 6 of 17-

Water Quality Protection and Restoration Program and Land Stewardship Initiative May 2017

Application Form

5.  Eligibility Questionnaire

a)  Is the property owned by Suffolk County, a Town, or a Village for parks purposes?

Yes No

b)  Is the property located within a 25-year surface water contributing area and/or within a 50-year capture zone to public supply wells?

Yes No

c)  Does the property have an existing septic system or cesspool?

Yes No

d)  Is the property independent of a public sewer or located outside of a sewer district?

Yes No

e)  Is there sufficient and available unpaved area to install the innovative alternative system components (approx. 40’ by 40’ for properties in the high groundwater area and 30’ by 30’ for systems with single leaching pool)?

Yes No

f)  Will the landowner provide accessibility to the property and onsite wastewater disposal system components for tours, inspection, maintenance, and sampling?

Yes No

g)  Is the maximum grade slope less than 5%?

Yes No

h)  Is the location for the wastewater system at least 100 feet from any wetland or surface water body (UNLESS setback attainment is not possible)?

Yes No

i)  Does the local municipality understand that operation, maintenance, and sampling will be required to ensure proper system function for the life of the system?

Yes No

If you answered NO to any of the above questions you may be ineligible for this funding opportunity.

Part 3 - Project Budget

Please provide a detailed breakdown of anticipated project costs based on expense type by task. Construction inspection may be included in construction costs.

Expenditure Category / County Grant / Municipal Match and Potential Additional Funding / Estimated Total Project Costs
CONSTRUCTION & SITE IMPROVEMENTS
In-House Labor (detailed below)
Task 1 - / $ / $ / $
Task 2 - / $ / $ / $
Task 3 - / $ / $ / $
Task 4 - / $ / $ / $
Task 5 - / $ / $ / $
In-House Labor Total / $ / $ / $
Equipment/Materials/Supplies
(list major categories)
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
Equipment/Materials/Supplies Total / $ / $ / $
Contractual Services
Task 1 - / $ / $ / $
Task 2 - / $ / $ / $
Task 3 - / $ / $ / $
Task 4 - / $ / $ / $
Task 5 - / $ / $ / $
Contractual Services Total / $ / $ / $
CONSTRUCTION TOTAL / $ / $ / $

In-House Labor Details - Totals Including County Share and Match

Title / Hourly Wage / Number of Hours / Total Cost
$/hr / $
$/hr / $
$/hr / $
$/hr / $
$/hr / $
$/hr / $

Design and engineering expenses are eligible for funding for COUNTY PROJECTS ONLY. Town and Village submissions may show match in this section.

Expenditure Category / County Grant / Municipal Match and Potential Additional Funding / Estimated Total Project Costs
DESIGN & ENGINEERING
In-House Labor (detailed below)
Task 1 - / $ / $ / $
Task 2 - / $ / $ / $
Task 3 - / $ / $ / $
Task 4 - / $ / $ / $
Task 5 - / $ / $ / $
In-House Labor Total / $ / $ / $
Materials/Supplies
(list major categories)
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
Materials/Supplies Total / $ / $ / $
Contractual Services
Task 1 - / $ / $ / $
Task 2 - / $ / $ / $
Task 3 - / $ / $ / $
Task 4 - / $ / $ / $
Task 5 - / $ / $ / $
Contractual Services Total / $ / $ / $
ENGINEERING TOTAL / $ / $ / $

In-House Labor Details

Title / Hourly Wage / Number of Hours / Total Cost
$/hr / $
$/hr / $
$/hr / $
$/hr / $
$/hr / $
$/hr / $
Total Project Cost / $
Total WQPRP Funds Requested / $

Specify if there are any County Personnel being utilized for or funded through this project. Please identify the title, division or office, and department of the County personnel; if the personnel are currently part of the County’s existing staff; the intended duration of participation in the project; and the expenditure of funds related to the project with regard to said personnel. Projects cannot establish a permanent full-time position within a County Department without demonstrating how that position will be funded after the project’s completion.

Title / Division &
Department / Current Staff / Duration
(Seasonal/Temporary/Permanent)
(Part-time/Full-time) / Expenditure of Project’s Funding
Yes / No

Part 4 - Other Funding Sources

Local / $ / Include municipal resolution.
State / $ / Name
Federal / $ / Name
Other / $ / Name

Part 5.1 - Project Description

Provide a detailed description of the proposed project BY TASK.

Please include in your description (incomplete applications will NOT be considered):

1.  Existing conditions: Describe current park use.

2.  Proposed conditions: Describe any future expansion or expanded uses planned.

3.  Onsite system: Describe the existing septic system (installation date, type, how often serviced, approximate flow rate, etc). Please provide any plans/drawings of the current system.

4.  Number of parking spots and total number of annual visitors to the park.

5.  Proposed technology (must be approved, in advance, by Suffolk County Department of Health Services).

6.  Please provide another file with any design/engineering work. PLEASE NOTE – ANY AND ALL DESIGN AND ENGINEERING WORK MUST BE APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES BEFORE ANY CONSTRUCTION MAY COMMENCE.

7.  Please include any other pertinent information (i.e. relation to ecologically sensitive areas for ground and surface waters, etc).

Refer to Sections V and VI of the Information for Applicants document for more information. (Your response below will be limited to 6,000 characters.)

Part 5.2 - Project Workplan

Please detail project strategy below. (Your response will be limited to 500 characters per question.)

1.  The anticipated project milestones and expected project benefits.
2.  The pollutant of concern (POC) and the pollutant load reduction estimate (STEPL).
Existing models which may be used by the grantee for estimating Nonpoint Source (NPS) pollutant load reductions are the Revised Universal Soil Loss Equation (RUSLE), and the EPA "Region 5 Model" (also referred to as STEPL, or the Spreadsheet Tool for Estimating Pollutant Load).
The Revised Universal Soil Loss Equation is described, with step-by-step instructions and examples, in the New York State Standards and Specifications for Erosion and Sediment Control, August 2005, in Appendix A. This manual is available at the following website (scroll through for Appendix A): http://www.dec.ny.gov/docs/water_pdf/bluebook.pdf
An additional website describing improvements to RUSLE, known as RUSLE2, is located at: http://fargo.nserl.purdue.edu/rusle2_dataweb/RUSLE2_Index.htm
The EPA Region 5 Model (STEPL) is described at the following website:
http://it.tetratech-ffx.com/steplweb/models$docs.htm
The EPA Region 5 Model (STEPL) Input Data Server can be found at:
http://it.tetratech-ffx.com/steplweb/steplweb.html
3.  Detailed documentation illustrating the need to implement this project.
4.  Detail on any construction inspection/monitoring to be done. Please note: The Suffolk County Department of Health Services may require pre- and post-construction testing.
5.  Outputs/deliverables.

Part 6 – Project Criteria

The parameters followed by a Priorities Waterbodies List (PWL) in the Environmental Significance of Proposal section of Part 6.1A below are identified explicitly in “The 2000 Atlantic Ocean, Long Island Sound Basin Waterbody Inventory and Priority Waterbodies List” (NYSDEC, April 2002). Please see Sections V and VI of the Information for Applicants document for help in selecting which criteria apply to your project.

Part 6.1A – Nonpoint Source Abatement and Control – Remediation or Preservation Projects

Applies to agricultural and non-agricultural nonpoint source abatement and control projects that remediate existing pollution or agricultural and non-agricultural nonpoint source abatement and control projects and pollution prevention initiatives that prevent potential pollution and/or preserve water quality.

1. Waterbody Classification (PWL) PLEASE CHOOSE ONE

a) A, SA, GA, AA special

Specially protected high quality drinking water and shellfish waters

b) A, A special, GA (other), GSA

Other drinking water

c) B, SB, C(T), C(TS)

Contact recreation, trout and trout propagation

d) C, SC, I

Other fishing

e) D, SD, GSB

Other water uses

2. Project Size (watershed area) PLEASE CHOOSE ONE

a) >15 acres

b) 10 to 15 acres

c) 5 to 10 acres

d) 0 to 5 acres

3. Community and User Group Support PLEASE CHOOSE ONE

a) Significant support

One or more groups (other than that nominating the project) have voiced support or endorsed the proposed project; must attach support letters.

b) No opposition

No support or opposition evident regarding the proposed restoration, or comparable opposition and support.

c) Significant opposition

Strong opposition by one or more groups or individuals which could likely delay or prevent the proposed project from being initiated or completed.

4. Post Project Maintenance PLEASE CHOOSE ONE

a) some maintenance required (less than once per 2 years)

b) regular maintenance required (greater than once per 2 years)

c) frequent maintenance required (greater than once per year)

5. Contributing Areas PLEASE CHOOSE ONE

What is the travel time to surface waters for the groundwater being protected and or remediated by this project?

a) Less than 1 year

b) 2-3 years

c) greater than 3 years

6. Hydrogeologic Classifications PLEASE CHOOSE ONE

What is the hydrogeologic zone(s) (Suffolk County “208” study) for the project area?

a) I - III

b) IV or V

c) VI - VIII

7. Targeted Pollutants PLEASE CHOOSE ALL THAT APPLY

What are the primary pollutants addressed by this groundwater project?

a) nitrogen

b) organic solvents

c) pesticides

d) other toxic materials such as heavy metals

Part 6.2 - Programmatic Significance

The development of project proposals should capitalize on existing information and the recommendations found in PEP, LISS, SSER or a specific local watershed management plan.

You may view the Estuary Management Plans at:

•  PEP http://www.peconicestuary.org/ccmp/index.php

•  LISS http://www.longislandsoundstudy.net/mgmtplan.htm

•  SSER http://www.nyswaterfronts.com/Final_Draft_HTML/Main_Page.htm

If your project falls under a seperate local watershed management plan, please identify the management plan and provide a link or other means to access the document.

1. Estuary/Watershed Management Plan Relevance

a)  Does the project implement a specific estuary or watershed management plan recommendation? Yes No

b)  If you chose “yes”, please identify the recommendation(s) as quoted in the appropriate management plan (provide page number) in the space below.

2.  Severity of the water quality problem or issue addressed by the project

a)  Is the project located in a TMDL watershed? Yes No

b)  Does the project aim to reduce a POC per TMDL requirement? Yes No

c)  Will the project reduce a POC for a 303(d) waterbody? Yes No