PROJECT TITLE APPLICANT/LEAD ORGANIZATION NAME

Section 319(h) FY2016 Grant Application

See page 11 of the FY2016 General Guidelines for complete Application Instructions
Delete this page and all instructions (blue italics in parenthesis) from the final application packet.

Follow ALL instructions and complete ALL sections of the application. If a section of the application does not pertain to the project, enter “Not Applicable” or “(N/A).” DO NOT LEAVE ANY SECTIONS BLANK. Incomplete applications may not be considered for funding.

All required templates can be downloaded from the GAEPD website:

  • Application (Microsoft WORD file):
  • Do NOT submit Application in Adobe or .pdf format.
  • Type applications single-spaced in 11-point standard font.
  • Number pages, and include the project and applicant names on each page.
  • Reference all digital supporting documents in Section 12. Project Attachments.
  • Make certain that electronic file labels agree with references to those attachments throughout the application.
  • Project Implementation and Drawdown Schedule (Microsoft EXCEL file):
  • Do NOT submit Drawdown Schedule in Adobe or .pdf format.
  • Format in color and sized 11 x 17 inches
  • Complete according to the template provided. Detailed instructions plus an example are included in the file.
  • Label the Drawdown Schedule file appropriately so that it can be easily paired with the Application file.

APPLICATION PACKETS MUST BE SUBMITTED AS DIGITAL FILES SAVED TO A CD.

  • Include all required files and supporting materials.
  • Label files to correspond with references in the application.
  • Do not submit paper copies of the application or any supporting documents
  • ONLY submit one paper copy of the:
  • Check List of Inclusions
  • Project Cover Page

MAIL OR DELIVER APPLICATION PACKETS TO:

Section 319(h) FY2016 Grant Application

ATTN: Connie Gilliam

Georgia EPD

Watershed Protection Branch

Nonpoint Source Program

2 Martin Luther King Jr. Drive

Suite 1462 East

Atlanta, GA 30334

FASCIMILES OR EMAIL SUBMISSIONS WILL NOT BE ACCEPTED.

SECTION 319(h) FY2016 GRANT PROPOSAL

CHECK LIST OF INCLUSIONS

Required Paper Copies to Submit with Digital Application Packet

______Check List of Inclusions

______Project Cover Page

Required in Digital Application Packet to be Considered for Funding

______Project Application

Document File Label: ______

______Project Implementation and Drawdown Schedule (sized 11x17 inches in color)

Document File Label: ______

______Signature for Budget Disclaimer: Non-Federal Source & No Overlap of Match Funds

Document File Label: ______

Include in Digital Application Packet to be Competitive for Funding

______Letters of Commitment that Quantify Match Values (on letterhead)

Document File Label: ______

______DRAFT QA/QC Water Quality Monitoring Plan (for GAEPD review)

Document File Label: ______

______Letter of Assurance: Project Is Above & Beyond NPDES Permits (onletterhead)

Document File Label: ______

______Watershed-Based Plan to be Implemented

Document File Label: ______

______Attachments, Appendices, Exhibits (research studies, TMDLs, etc.)

Document File Label: ______

Document File Label: ______

______Photographs, Figures, Tables (field surveys, water quality data)

Document File Label: ______

Document File Label: ______

______Maps (project area, watersheds, streams, counties, cities, roads)

Document File Label: ______

Document File Label: ______

(Page Intentionally Left Blank)SECTION 319(h) FY2016 GRANT PROPOSAL

PROJECT COVER PAGE

Project Information

Project Title: ______

Applicant: ______

Primary Contact: ______

Date of Pre-Application Meeting with GAEPD Staff: ______

Summary of Watershed-Based Plan

  1. Is the project implementing an existing watershed-based plan that addresses USEPA’s Nine Elements of Watershed Planning?

YES ___ NO ___

If YES, identify the title of the plan and provide a copy as an Attachment to the application:

TITLE: ______

  1. Was the watershed-based plan developed using Section 106, 604(b) or 319(h) Grant funds?

YES ___ NO ___

  1. List the page numbers and section headings/subheadings where each of the Nine Elements of Watershed Planning can be found in the attached watershed-based plan.

(Add Pages and Sections as needed. Keep each Summary to a maximum of 5 sentences)

ELEMENT(A): IDENTIFICATIONOFPOLLUTANT & IMPAIRMENT CAUSES & SOURCES

Pages_____ Section______Summary:

Pages_____ Section______Summary:

ELEMENT(B): POLLUTANTLOADREDUCTIONESTIMATES EXPECTED FROM BEST MANAGEMENT PRACTICES (BMP)

Pages_____ Section______Summary:

Pages_____ Section______Summary:

ELEMENT(C): NONPOINT SOURCE (NPS) BESTMANAGEMENTPRACTICES (BMP) & CRITICAL TARGET AREAS FOR BMP INSTALLATION

Pages_____ Section______Summary:

Pages_____ Section______Summary:

ELEMENT(D): FINANCIALTECHNICAL ASSISTANCE TO IMPLEMENT BMP, ASSOCIATED COSTS & SOURCES OF FUNDS

Pages_____ Section______Summary:

Pages_____ Section______Summary:

ELEMENT (E): EDUCATION OUTREACH TO ENCOURAGE PUBLIC PARTICIPATION IN PLAN IMPLEMENTATION

Pages_____ Section______Summary:

Pages_____ Section______Summary:

ELEMENT (F): BMP IMPLEMENTATIONSCHEDULE

Pages_____ Section______Summary:

Pages_____ Section______Summary:

ELEMENT (G): INTERIMMILESTONES TO DETERMINE PROGRESS OF BMP IMPLEMENTATION

Pages_____ Section______Summary:

Pages_____ Section______Summary:

ELEMENT (H): SET OF CRITERIA TO MONITOR AND ASSESS BMP

Pages_____ Section______Summary:

Pages_____ Section______Summary:

ELEMENT (I): COMPONENT TO DETERMINE PLANIMPLEMENTATION EFFECTIVENESS

Pages_____ Section______Summary:

Pages_____ Section______Summary:

(Page Intentionally Left Blank)

PROJECT DESCRIPTION

  1. Project Title:

(See page16of the FY2016 General Guidelines for Sections 1 - 2Instructions)

  1. Lead Organization:Name

Address

Address2

City, GA Zip

Phone

Fax

Email

Primary Contact:Name

Title

Organization

Address

Address2

City, GA Zip

Phone

Fax

Email

Project Start Date:

Project End Date:

Federal Amount Requested:

Match Amount to be Contributed:

Total Project Amount:

  1. Project Goals:

(See page 16 of the FY2016 General Guidelines for Section 3Instructions)

(Insert Text)

  1. Project Background:

(See pages 17 & 18of the FY2016 General Guidelines for Section 4 Instructions)

(Insert Text)

  1. Project Activities:

(See pages18 & 19, Example Project Activities template pages 20 &21, Tables 3 & 4, and Appendix B of the FY2016 General Guidelines for Section 5Instructions)

(Access GeorgiaNonpoint Source (NPS) Management Program document at)

(Repeat Format Below as Needed)

Project Activity:

(Insert Text)

NPS Management Program

(Insert Reference & Summary)

Task 1:

(Insert Text)

Deliverables:

(Insert Text)

Measures of Success:

(Insert Text)

Task 2:

(Insert Text)

Deliverables:

(Insert Text)

Measures of Success:

(Insert Text)

Project Activity:

(Insert Text)

NPS Management Program

(Insert Reference & Summary)

Task 3:

(Insert Text)

Deliverables:

(Insert Text)

Measures of Success:

(Insert Text)

Task 4:

(Insert Text)

Deliverables:

(Insert Text)

Measures of Success:

(Insert Text)

  1. Roles and Responsibilities of Participating Organizations:

(See pages22 & 23of the FY2016 General Guidelines for Section 6Instructions)

(Describe Specific Responsibilities in Required Table Format)

(Add to Bulleted Functions Already Entered)

(Make Sure that EachParticipating Organization is Appropriate to Perform the Entered & Added Functions)

(Attach Letters of Commitment)
Organization Name / Specific Responsibilities
(Lead Organization) /
  • Execute grant contract with GAEPD
  • Account for (state if contribute to) 40% (state if greater) of total project costs in matching funds or in-kind services
  • Pay funds to appropriate contractor(s) and vendor(s)
  • Request reimbursements from GAEPD on a quarterly basis
  • Track the progress of project activities completed, grant funds expended, and match values provided in accordance with the drawdown & implementation schedule
  • Complete and submit quarterly progress reports and invoices to GAEPD by January 15th, April 15th, July 15th, and October 15th of each project year
  • Complete submit close-out report at conclusion of project
(ADD OTHERS AS APPROPRIATE)
GAEPD /
  • Provide 60% of total project costs
  • Review and approve project deliverables
  • Participate in meetings, as appropriate
  • Review and assist as needed with 319(h) Grant protocols
  • Provide project oversight and contract management
  • Provide monitoring guidance and training

(Participating OrganizationQualified/Capable to Perform Entered Functions) /
  • Serve on Project Advisory/Steering Committee
  • Contribute in-kind services to Match as described in attached Letter of Commitment
(ADD OTHERS AS APPROPRIATE)
(ParticipatingOrganizationQualified/Capable to Perform Entered Functions) /
  • General Stakeholder
  • Letter of Commitment describing functions attached
(ADD OTHERS AS APPROPRIATE)
(Local Governments) /
  • Serve on Project Advisory/Steering Committee
  • Render in-kind services to Match as described in attached Letter of Commitment
(ADD OTHERS AS APPROPRIATE)
(Participating OrganizationQualified/Capable to Perform Entered Functions) /
  • Technical Support
  • Render in-kind services to Match as described in attached Letter of Commitment
(ADD OTHERS AS APPROPRIATE)
  1. Project Location:

(See pages23 & 24of the FY2016 General Guidelines for Section 7Instructions)

(See Appendix F for List & Map of Priority Watersheds)

a)Project Area Description and Map:

(Insert Map or Attach as Appendix and Reference Appendix Here and in Section 12)

b)Project Area Size (Acres):

c)County or Counties:

d)Land Uses within the Watershed(s) or Project Area (Percentages):

(Insert Percentages for Land Use Categories within the Watershed)

(Provide Source & Date of Land Use Data to Verify the Distribution Numbers)

Agricultural______

Commercial Forestry______

Urban/Residential______

Mining/Extraction______

Forest/Natural Areas______

Water/Wetlands______

TOTAL__ 100% _

Data Source & Date: ______

e)Hydrologic Unit Code(s), Watershed Name(s) and Priority Watershed(s):

(Repeat Format Below as Needed)

HUC #: ______Name: ______Priority: ____

HUC #: ______Name: ______Priority: ____

  1. Nonpoint Source Pollution Impairments and Healthy Waters:

(See pages24 & 25of the FY2016 General Guidelines, and USEPA Healthy Waters Initiative for Section 8Instructions)

a)Section 305(b)/303(d) List of Waters:

(Insert in Required Tabular Format All Water Bodies on the Georgia 2012 305(b)/303(d) List of Waterswhich are Directly Addressed by the Project)

Water Body Segment Name
(Segment Length (Miles) or Embayment Acreage) / County Location(s) / Criterion Violated or Water Quality Concern (Healthy Water) / Listing
Status
Category
4a, 5 or 1

a)(need to fix numbering/delete)

b)Secondary Pollutant(s):

  • (Ancillary or additional nonpoint source pollutants or water quality impairments)

(Insert Text

  • (Other documented nonpoint source impacts,
  • pollutants or water quality threats applicable to Project)

(Attach Relevant Documentation of Impact – Photos, Monitoring Data, Research)

(Repeat Format Below as Needed for Each Segment)

  1. Monitoring:

(See pages26 & 27and Appendix Cof the FY2016 General Guidelines for Section 9 Instructions)

(Request GAEPD guidelines on “How to Plan for and Proceed with 319(h) Grant-Funded Monitoring”from Grants Unit staff)

(Check one box below)

DRAFT QA/QC Water Quality Monitoring Plan Attached (listed in Section 12.)

Project Will Not Include Water Quality Monitoring

  1. (need to fix numbering outline)
  2. Project Budget:

(See pages26 - 30of the FY2016 General Guidelines for Section 10 Instructions)

(Sign and date one-sentence Disclaimer provided at bottom of Project Budget)

(Supply Narrative related to Project Activities & Tasks to Justify Expenses and Match Value for Appropriate Item Class Category Entries)

Please double-check all budget calculations!
Item / Item Class Category / 319(h)
Grant Funds
(60% Maximum) / Non-Federal Matching Funds
(40% Minimum) / Total
A / Personnel (Add Rows and Repeat Format as needed):
One (1) Staff Position - 0.0 FTE ($00,000/year) for x years
Description of Duties:
One (1) Staff Position - 0.0 FTE ($00,000/year) for x years
Description of Duties:
Sub Total:
B / Fringe Benefits (Add Rows and Repeat Format as needed):
One (1) Staff Position - 0.0 FTE at 00% for x years
One (1) Staff Position - 0.0 FTE at 00% for x years
Sub Total:
C / Travel (Add Rows and Repeat Format as needed):
Staff Position:
Purpose of Travel:
Miles x Mileage Rate ($.56/mile)
Staff Position:
Purpose of Travel:
Miles x Mileage Rate ($.56/mile)
Sub Total:
D / Equipment (Only if separate items $5,000)
(Add Rows and Repeat Format as needed):
Equipment:
Purpose/Use:
Equipment:
Purpose/Use:
Sub Total:
E / Supplies (Add Rows and Repeat Format as needed):
Supplies:
Purpose/Use:
Supplies:
Purpose/Use:
Sub Total:
F / Contractual (Add Rows and Repeat Format as needed):
Contractor Name:
Description of Duties (Install BMPs, Education, Technical Assistance, Monitoring):
Number and Type of BMP:
Number and Type of BMP:
Contractor Name:
Description of Duties (Install BMPs, Education, Technical Assistance, Monitoring):
Number and Type of BMP:
Number and Type of BMP:
Sub Total
G / Construction:
(Does not apply to GAEPD Section 319(h) Grants) / N/A / N/A / N/A
H / Other:
Sub Total
I / Total Direct Charges:
(Sum of A-H)
J / Indirect Charges:
(0% Eligible for Reimbursement with Federal Dollars) / N/A / Up to 100%
K / Total:
(Sum of I and J)

Disclaimer: Match contributions are from non-federal sources and do not overlap current or future projects funded by either 319(h) or other federal grants.

Signed: ______Title: ______Date: ______

Organization: ______

Narrative Justification for Item Class Categories:

  • Personnel (A):(Insert Text)

Narrative Justification (A):(Insert Text)

  • Fringe Benefits (B):(Insert Text)
  • Travel (C):(Insert Text)

Narrative Justification (C):(Insert Text)

  • Equipment (D):(Insert Text)

Narrative Justification (D):(Insert Text)

  • Supplies (E):(Insert Text)

Narrative Justification (E):(Insert Text)

  • Contractual (F):(Insert Text)

Narrative Justification (F):(Insert Text)

  • Construction (G):(GAEPD Section 319(h) Grant federal funds CANNOT be applied to this category, which refers to infrastructure and related building costs)
  • Other (H):(Insert Text)

Narrative Justification (H):(Insert Text)

  • Indirect Charges (J):(GAEPD Section 319(h) Grant federal funds CANNOT be applied to this category. However, 100% of afederally-approved indirect cost rate associated with the project may be applied to match.

(Insert Text)

Narrative Justification (J):(Insert Text)

  1. Project Implementation & Drawdown Schedule:

(See pages3031of the FY2016 General Guidelines for Section 11Instructions)

(Insert Text into EXCEL template provided on the GAEPD website at)

(Please note that the template is coded with formulas to automatically calculate the quarterly percentages for both federal dollars spent in Row 4 and match accrued in Row 7)

(Label the schedule file so that it can be easily paired with the application file)

  1. Project Attachment(s):

(See page32 of the FY2016 General Guidelines for Section 12Instructions)

(Reference All Project Supporting Documents with Designations, Titles, and Sequential Numbers or Alphabetical Letters)

1

Section 319(h) FY2016 Project Proposal