Water Boards
Clean Water
STATE WATER RESOURCES CONTROL BOARD
Division of Financial Assistance
P. O. Box 944212, Sacramento, CA 94244-2120
TECHNICAL APPLICATION PACKAGE
The Technical Application and attachments may be submitted in one of the following three ways.
Applicants are encouraged to utilize the Financial Assistance Application Submittal Tool (FAAST) to streamline the application submittal and review process, but if that will create a hardship, email or mail can be utilized instead:
1) Apply online via the FAAST: https://faast.waterboards.ca.gov https://www.waterboards.ca.gov/videos/faast.html.
If you need assistance, you can also contact the FAST Help Desk, which is staffed Monday through Friday 8am through 5pm, at 1-866-434-1083 or FAAST [email protected].
If you have a CWSRF Project Manager assigned to your submitted application, the Project Manager will receive an email notifying them that you have submitted additional information for review.
2) To submit a CWSRF Technical Package via email, please use the following email address:
[email protected].
3) To submit a CWSRF Technical Application Package via mail, please use the following address:
State Water Resources Control Board
Division of Financial Assistance
P.O. Box 944212
Sacramento, CA 94244-2120
Financial Assistance Application Page 1 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund
Technical Package Instructions
Applicant (Entity) Name - Enter the entity that will be the legal signatory to a financing agreement.
Project Title - Enter the title of the project.
Contact Person and Phone - Enter the name and phone number of the day-to-day contact for the project. This person should be able to answer questions and coordinate the submission of additional information about the project and application.
Section I - Water Rights
1. Check (V) the box indicating whether the Project will change the point of discharge, place of use, or purpose of use of treated wastewater and decrease the flow in any portion of a watercourse pursuant to Water Code section 1211.
If the NO box is checked, proceed to question 2.
If the YES box is checked, a Petition for Change must be filed with the State Water Board, Division of Water Rights, if the project will decrease the flow in the affected watercourse. Provide a copy of the Petition for Change (label as Attachment T5a) or the date that you anticipate filing the Petition.
2. Check (v) the box indicating whether the Project will divert flow from a stream or other surface water body to another location.
If the NO box is checked, proceed to question 3.
If the YES box is checked, a Petition for Change or application for a Water Right or License must be filed with the State Water Board, Division of Water Rights. Provide copies of the Petition for Change, application for a Water Right or License or copy of the Change of Use approval, or Water Right Permit or License, as appropriate (label as Attachment T5b), or the date that you anticipate filing the Petition for Change or application for a Water Right or License.
If you have questions regarding whether a petition or application is required, you may contact your CWSRF Project Manager or Patricia Fernandez with the Division of Water Rights at (916) 319-9141 or [email protected].
3. Check (v) the box indicating if your entity isF a water diverter and subject to section 5103 of the Water Code. Subdivision (e) (1) states that on or after January 1, 2012, monthly records of water diversion must be reported to the State Water Board's Division of Water Rights.
Section II - Delta Plan
1. Check (V) the box indicating if the project is a "covered action" under section 85225 of the Water Code. More information about what constitutes a "covered action" is available online at https://coveredactions.deltacouncil.ca.gov/?page=1.
2. If the project is a "covered action," there is a self-certification process for demonstrating consistency with the Delta Plan, which must be submitted by the lead agency to the Delta Financial Assistance Application Page 2 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Func
Stewardship Council. More information about this process is available online at https://coveredactions.deltacouncil.ca.gov/?page=1. Check (v) the box indicating if you have submitted the consistency certification required under section 85225 of the Water Code. If the project is not a "covered action," check (Y) "N/A."
3. Check (r) the box indicating if any person has appealed the consistency certification per section 85225.10 of the Water Code. More information about this appeal process is available at https://coveredactions.deltacouncil.ca.gov/?page=1. If the project is not a "covered action", check (r) "N/A."
Section III - Architectural and Engineering (A/E) Procurement Check (v) the box indicating if you follow a qualifications-based procurement process for A/E procurement (for services such as program management, construction management, feasibility studies, engineering, surveying, or mapping).
If yes, check (Y) the box indicating if your A/E procurement process complies with one or both of the following codes:
• 440 United States Code Section 1101 et seq.
• California Government Code Section 4525 et seq. (as it relates to state agencies) Section IV - Green Project Reserve (GPR)
1. Check (r) the box indicating if this project or a portion of this project is eligible for CWSRF GPR. United States Environmental Protection Agency (U.S. EPA) Guidance regarding GPR eligibility is available online at: https://www.epa.gov/sites/production/files/2015- 04/documents/green project reserve eligibility guidance.pdf
2. Indicate the percentage of total project cost within each GPR category. Only the components of the project that clearly advance one or more of the objectives articulated in the four GPR categories should be counted as GPR eligible. If the Project qualifies for more than one GPR category, please indicate the percentage in each category, and then the total percentage of the project that qualifies for GPR. The above U.S. EPA guidance lists categorically eligible project types under each of the four categories. If your project is not categorically eligible, you may consider preparing a business case to document GPR eligibility. The decision criteria and required content for business cases are provided in the U.S. EPA guidance link above.
Section V - Attachments
• T1 - Project Report: Submit a Project Report or its equivalent containing all of the items in the Suggested Project Report outline relevant to the proposed project; the Project Report outline is attached to the Technical Package application form. The Project Report must be signed and stamped by a registered Professional Engineer if it contains engineering as defined in Business and Professions Code Division 3 Chapter
7. Please contact your assigned Project Manager, if known, or the CWSRF general telephone number at (916) 327-9978 with specific questions about the contents of the Project Report.
• T2a - General Plan Compliance Certification: The CWSRF Policy requires all funded projects to be consistent with the applicant's adopted General Plan or to serve an area in which at least 75% of the cities and counties have adopted land use and housing Financial Assistance Application Page 3 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund
elements for their General Plans. All applicants must complete the General Plan Compliance Certification confirming these conditions.
/ T2b - Certification for Compliance with Water Metering Form: Water Code sections 525 through 529.7 may prohibit some agricultural and urban water purveyors, from receiving State funds if metering requirements are not met. If you are an agricultural or urban water supplier as defined in the Water Code you must comply with this requirement. Please consult with your legal counsel and review sections 525 through 529.7 of the Water Code before completing this certification. • T2c - Certification for Fiscal Sustainability Plan: Section 603(d) (1)(E) of the Clean Water Act requires CWSRF financing recipients for treatment works projects to develop and implement a Fiscal Sustainability Plan (FSP). Applicants for treatment works projects must complete the Certification for Fiscal Sustainability Plan to either certify that an FSP has been developed and implemented or to certify a date by which an FSP will be developed and implemented
• T2d - Certification for Cost and Effectiveness and Water and Energy Conservation and Efficiency: Section 602(b)(13) of the Clean Water Act requires municipalities, intermunicipals, interstate and State agencies who are recipients of CWSRF funds to certify that they have performed a cost and effectiveness analysis and have selected the proposed project or activity for its potential to maximize the efficient use, reuse, recapture of water and to maximize conservation of water and energy. v T3 - Climate Change Worksheet: The purpose of the Climate Change Worksheet is to ensure that applicants identify how the proposed facility is vulnerable to the effects of climate change and the impacts the facility may have on the climate. Investigation into adaption and mitigation measures that lead to responsible resolutions made by the agency will ultimately improve the investments made by the state.
Worksheet - The worksheet is broken into three sections: Vulnerability, Adaptation, and Mitigation. Each section has check boxes. Check all boxes applicable to the facility regarding climate change vulnerability, and all boxes considered by the applicant regarding adaptation and mitigation. Each section includes an "Other" box followed by an area to define the unnamed option. This option is available to encourage creative ideas and in the event an agency identifies unique options.
Attachments - Each section will be followed up by an attachment. The attachments are intended to provide a detailed description of the vulnerabilities and response measures selected, risk level, critical conditions, intended responses, and explanations why certain vulnerabilities and response measures are not considered essential enough for response measures to be implemented.
The attachments may include detailed plans to incorporate the measures mentioned such as alternative options, scope of work, budget, construction estimates and schedule.
Definitions - Climate change vulnerability, mitigation, and adaptation are terms that many individuals find ambiguous, and the differences between them may be challenging to understand.
Climate Change Vulnerability: This term is used to identify climate change effects to which the facility may be susceptible. Some effects overlap. For example, a treatment facility built on the coast may be vulnerable to sea level rise. It would Financial Assistance Application Page 4 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund
be a poor investment for the state to invest in a treatment facility with an expected useful life of 50 years when the facility is projected to be under water in 20 years due to sea level rise. Coincidentally, as sea level rises, the neighboring groundwater aquifers may be vulnerable to saltwater intrusion and water quality issues. The two effects are related, and both should be discussed in the attachment.
Adaptation: This term is used to identify measures taken as a direct response to climate change effects. Multiple measures can be taken in response to a single vulnerability. For example, in response to sea level rise an agency may investigate constructing sea walls or levees in order to prevent flooding. Flood contingencies should also be explored to protect the facility if the levees fail or in the event of severe storm surges.
Mitigation: This term is used to identify measures taken to slow or stop changes to the environment caused by greenhouse gas emissions in the atmosphere.
Measures identified in adaptation may also be used for mitigation. For example, water conservation may be an adaptation response to drought vulnerability and also a mitigation measure by reducing the energy consumed to move excessive volumes of water. Green roofing as an adaptation measure will help to reduce the heat island effect of an urban community, and as a mitigation measure will reduce the energy consumed to heat and cool the building.
• T4- Regional Water Quality Control Board Requirements: Submit any permit requirements and/or enforcement orders that have been issued by the Regional Water Board relative to the proposed project. If the proposed project is not subject to permit requirements and/or enforcement orders, please indicate this in the commentbox. • T5a - Petition for Change and Order (if applicable)
• T5b - Petition for Change/Water Right Application, Permit or License/Change of Use Approval (if applicable)
/ T6 - Certification for Water Conservation and Water Management: All applicants must either certify that they are a water supplier and have complied with the California Water Code and all provisions of Division 6 of the Water Code (sections 10000 through 12999) or certify that they have verified that the water suppliers in its service or project area have complied with the provisions of Division 6 of the Water Code (sections 10000 through 12999) and that any ordinances, rules, or regulations have been duly adopted and are in effect as of this date.
v T7 - T11 - Hold for later use
Attachments T12 and T13 are applicable to Water Recycling Funding Program projects ONLY:
• T12 - Recycled Water Market Assurances: Recycled Water Market Assurances document the users' commitments to use the recycled water. For existing users, provide either an adopted mandatory use ordinance or letters of intent to execute a user contract. / T13 - User Connection Schedule: Provide the anticipated connection schedule and estimated recycled water deliveries for all recycled water users.
Financial Assistance Application Page 5 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Func
Attachment T1
Project Report
The Project Report must be signed and stamped by a registered Professional Engineer. (Suggested Content for Publicly-Owned Treatment Works Projects; applicants seeking financing for water recycling projects should also review the suggested report outline in Appendix B of the Water Recycling Funding Program Guidelines)
1. Project Area
A. Vicinity and service area map(s) showing:
1. Detailed map(s) of project site(s) and service area boundary;
2. Relevant hydrologic, geologic, and topographic features;
3. Relevant ground and surface water resources; and
4. Existing collection, distribution, storage, and treatmentfacilities B. Current land use and land use trends
C. Current system users and any new users
D. Current population and population trends
Il. Wastewater Characteristics, Existing Facilities, and Current Water Quality A. Description of existing facilities, including treatment/reuse processes/schematic(s), design criteria, current capacities, current flows, current water quality characteristics and beneficial uses of the water resources affected by the facility, and the current discharge location(s) B. Description of all entities responsible or contributing to the existing facilities C. Sources of wastewater to the facility
D. Sources of industrial or other problem constituents and current control measures E. Information about any discharge violations
F. Wastewater influent characteristics and variations
G. Wastewater effluent characteristics and variations
H. Past efforts to address the problem through operational improvements I. Current asset, operation, and maintenance management systems J. An evaluation of excessive infiltration/inflow (I/l) to the system. If the average daily flow is above 120 gallons per capita per day, a Sewer System Evaluation Survey is required.
III. Treatment Objectives for Discharge or Reuse
A. Reason for the project and its objectives/expectedbenefits B. Performance characteristics required for efficient treatment C. Health-related water characteristics required for discharge, operational, and on-site requirements
D. Wastewater discharge or reuse requirements and anticipated changes inrequirements E. Relevant operation and on-site requirements
F. Projected future flow rates or other changes to the influent wastewater characteristics G. Additional facilities or actions needed to comply with waste discharge requirements Project Alternatives Analysis
A. Planning and design parameters and assumptions
1. Relevant design criteria, and planning period
2. Life-cycle (net present worth) cost parameters: construction, building, or materials cost index; discount (or interest) rate; project useful lives) B. Detailed alternatives analysis, including the no action alternative. Particularly for small communities, regional or consolidation alternatives should always be considered.
Alternatives analysis should take the following into consideration:
Financial Assistance Application Page 9 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund
1. Comparison of all alternatives based on life cycle costs for eachalternative with breakdown of total capital, operation and maintenance (O&M), and replacementcosts
2. Comparison of how the project alternatives address the state planning priorities in section 65041.1 of the Government Code
3. Comparison of climate change considerations for each alternative Comparison of opportunities for water and energy efficiency for each alternative.
Consider utilizing resources available on the United State Environmental Protection Agency website: http://water.epa.gov/infrastructure/sustain/waterefficiency.cfm V. Selected Project
A. A detailed description of the recommended project alternative and basis for selection, including a description of any water and energy efficiencies. The selected alternative should maximize the potential for efficient water use, reuse, recapture, and conservation of water and energy, taking into account the cost of construction, operations and maintenance, and replacement.
B. Design criteria and useful life of the project
C. Lite cycle cost estimate based on time of construction. Include project cost breakdown, cost index, discount rate, useful life (years), life cycle cost, total capital, annual O&M, replacement cost, etc.
D. Detailed schedule
E. Permits required for project implementation
F. Description of any key issues to be resolved, particularly items likely to significantly impact the project budget or schedule, i.e., environmental review, land acquisition, special studies or monitoring needs, change of governance or formation of new governance, negotiation of agreements, operator recruitment or training needs, etc.
Project Report
(Suggested Content for Non-Infrastructure Projects)
I. Project Area
A. Vicinity map(s) showing:
1. Detailed map(s) of project site(s) and areas affected by the project;
2. Relevant hydrologic, geologic, and topographic features;
3. Relevant ground and surface water resources; and
4. Existing and relevant measures or works related to the proposed project B. Land use, land use trends, and relevant adjacent land uses C. Current population and future population projections Source Characteristics, Existing Conditions, and Current Water Quality A. Surface water and groundwater resources in the project area B. Current water quality, variations in water quality, and beneficial uses C. Flow quantity and variations in flow quantity
. Sources of pollution and current control measure
. Past efforts at source control or other corrective measure F. Other plans for source control or corrective measures III. Objectives
A. Reason for the project, performance goals, and expected benefits B. Method(s) of verification
C. Beneficial uses and protection criteria
Financial Assistance Application Page 10 of 17 echnical Package Applicati (Rev. 10/2020) ean Water State Revolving Fur
D. Required water quality characteristics to meet beneficial uses E. Required health-related water characteristics or requirements F. Anticipated changes in water quality or health-related requirements Project Alternatives Analysis
A. Planning and design parameters and assumptions
1. Relevant design criteria
2. Cost index, discount rate, useful lives
3. Planning period
B. Detailed alternatives analysis, including the no actionalternative
1. Comparison of all alternatives based on the life cycle costs for each alternative with breakdown of total capital, operation and maintenance (O&M), upkeep, and replacementcost
2. Comparison of how the project alternatives address the state planning priorities in section 65041.1 of the Government Code and sustainable water resource managementpriorities
3. Climate change analysis for each alternative
V. Selected Project
A. Detailed description of the most feasible, cost-effective alternative, including:
1. All entities, including affected home and land owner categories involved in implementing the project, their level of participation, and the means to achieve the level of participation necessary to make the project successful;
2. Management of residual or waste material;
3. Overview of any long-term management plan for operation, maintenance, monitoring, inspection, record keeping, repair, and replacement related to the project;
4. Identify agency(ies) or organization(s) responsible for long-term management and the means to ensure that the management plan will be implemented; and
5. Identify permits, approvals, ordinances, regulations, and reports required for the project Identify how and when these actions will be completed, and describe how compliance will be achieved and maintained.
B. Detailed schedule
C. Description of any key issues to be resolved, particularly items likely to significantly impact the project budget or schedule, i.e., environmental review, land acquisition, etc.
D. Project Eligibility
1. For Non-Point Source projects, identify the section of the Five-Year Implementation Plan the project will implement and explain how the project helps implement the Plan. Explain how the project addresses a regional or area wide water quality problem.
2. For Estuary projects:
a. Identify the estuary the project addresses, i.e., San Francisco Bay, Morro Bay, or b. Identify the section of the estuary's Comprehensive Conservation and Management Plan
the project will help implement;
c. Describe how the project helps implement the Plan; and d. Describe efforts to work with the estuary sponsor.
Financial Assistance Application Page 11 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund
Technical Package Form
Applicant (Entity) Name: CITY OF GONZALES
Project Title: ALPINE CAMP SYSTEM CONSOLIDATION
Contact Person: PATRICK DOBBINS, PUBLIC WORKS DIRECTOR Phone: ( 831) 675-5000 I. WATER RIGHTS
1. Will the Project change the point of discharge, place of use, or purpose of use of treated wastewater anc decrease the flow in any portion of a watercourse per Water Code section 1211? KINO (If NO, proceed to question 2.)
LYES - IF YES, has a Petition for Change been filed with the State Water Board, Division of Water Rights? •YES - Provide a copy of the Petition for Change (label as Attachment T5a).
NO - Provide the date you anticipate submitting the Petition for Change:
2. Will the Project divert flow from a stream or other surface water body to another location? /NO (If NO, proceed to question 3.)
LYES - If YES,
a. Has a Petition for Change been filed with the State Water Board, Division of Water Rights? •YES • NO LIN/A
b. Has an application for a water right been filed with the State Water Board, Division of Water Rights, or does the entity hold sufficient water rights for the project? LYES — NO •N/A
Provide copies of the Petition for Change, application for a Water Right or Change of Use approval, or Water Right permit or license, as appropriate (label as Attachment T5b), or Provide the date you anticipate submitting the petition or application:_
3. Is the entity a water diverter and subject to section 5103 of the Water Code? •]YES NO II. DELTA PLAN
1. Is the project a "covered action" under section 85225 of the Water Code? •YES ENO
For items 2 and 3 below, please check "N/A" if the project is not a "covered action".
2. Have you submitted the consistency certification required by section 85225 of the Water Code? •YES •NO
Financial Assistance Application Page 6 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Func
3. Has any person appealed the consistency certification per section 85225.10 of the Water Code? DYES •NO LINA
III. ARCHITECTURAL AND ENGINEERING (A/E) PROCUREMENT
o you follow a qualifications-based procurement process for A/E procurement (for services such as progra anagement, construction management, feasibility studies, engineering, design, surveying, or mapping MYES _NO
If yes, check below to indicate if your A/E procurement process complies with one or both:
40 United States Code Section 1101 et seq.
[ California Government Code Section 4525 et seq. (as it relates to state agencies) IV. GREEN PROJECT RESERVE (GPR
1. Is this project, or a portion of this project, eligible forthe CWSRE GPR? YEs /NO If no, skip to Section VI
2. Which GPR Category(ies) are applicable and identify whether the project is categorically eligible or requires a business case to demonstrate eligibility.
% of Total Project Cost Category Categorically Eligible Business Case Attached Green Infrastructure
Water Efficiency
Energy Efficiency
Environmentally
Innovative
Total
Financial Assistance Application Page 7 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund
V. ATTACHMENT CHECKLIST
Check the box next to each item attached to your application. If an item is not attached at the time you submit the Technical Application form, please indicate in the space provided below when you anticipate submitting it.
I T1 - Project Report
/ T2a - General Plan Compliance Certification
M T2b - Certification for Compliance with Water Metering Form T2c - Certification for Fiscal Sustainability Plan IN/A 2d - Certification for Cost and Effectiveness and Water and Energy Conservation and Efficiency N/A T3 - Climate Change Worksheet
T4 - Regional Water Quality Control Board Requirements
• Waste Discharge Requirements, NPDES Permit or Water Recycling Requirements • Amended Basin Plan or Total Maximum Daly Load
• Enforcement Orders
• Not Applicable - Explain:
T5a - Petition for Change and Order N/A
T5b - Petition for Change/Water Right Application, Permit or License/Change of Use Approval [ZN/A / T6 - Certification for Water Conservation and Water Management Water Recycling Funding Program Only
T12 - Recycled Water Market Assurances
T13 - User Connection Schedule
Financial Assistance Application Page 8 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund
Attachment T2a
GENERAL PLAN COMPLIANCE CERTIFICATION
PROJECT NO.
APPLICANT: ("the Entity")
onzale
Check first box below if the applicant is responsible for adopting the General Plan (typical of cities and counties).
Check second box if the applicantis not responsible for adopting the General Plan (typical for special districts).
I certify that the Entity has adopted the land use and housing elements of its General Plan and that the proposed project is consistent with the adopted General Plan. • I certify on behalf of the Entity that at least seventy-five (75) percent of the area affected by the project includes cities and counties with adopted land use and housing elements. I have attached documentation that the Entity has notified the cities and/or counties responsible for adopting the applicable plan (s) and provided a reasonable opportunity to comment on the project's consistency with the plan (s). I certify that the Entity considered those comments during development of the project.
City Manager
Name of Authorized Representative Title
(Please print)
Signature of Authorized Representative Date
Financial Assistance Application Page 12 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund
Attachment T2b
CERTIFICATION FOR COMPLIANCE WITH WATER METERING
REQUIREMENTS FOR FUNDING APPLICATIONS
ALANDARI
Nater Board
Funding Agency Name: State Water Resources Control Board Funding Program Name: Clean Water State Revolving Fund
Applicant: City of Gonzales
Please check one of the boxes below and sign and date this form.
Z. As the authorized representative for the applicant, I certify under penalty of perjury that the applicant is not an agricultural or urban water supplier, as that term is understood pursuant to the provisions of section 529.5 of the Water Code.
El As the authorized representative for the applicant, I certify under penalty of perjury that the applicant has fully complied with the provisions of Division 1, Chapter 8, Article 3.5 of the California Water Code (sections 525 through 529.7 inclusive) and that the ordinances, rules, or regulations submitted with this certification as listed below have been duly adopted and are in effect as of this date.
I understand that the Funding Agency will rely on this signed certification in order to approve funding and that false and/or inaccurate representations in this Certification Statement may result in loss of all funds awarded to the applicant for its project.
Additionally, for the aforementioned reasons, the Funding Agency may withhold disbursement of project funds, and/or pursue any other applicable legal remedy.
City Manager
Name of Authorized Representative Title
(Please print)
Signature of Authorized Representative Date
Financial Assistance Application Page 13 of 17 Technical Package Applicatior (Rev. 10/2020) Clean Water State Revolving Func
Attachment T2d
CERTIFICATION FOR COST AND EFFECTIVENESS AND
WATER AND ENERGY CONSERVATION AND EFFICIENCY
REQUIRED FOR ALL CWSRF FUNDING APPLICATIONS CALIFORNIA
FROM MUNICIPAL, INTERMUNICIPAL, INTERSTATE AND Water Boards
STATEAGENCY APPLICANTS
Funding Agency: State Water Resources Control Board Funding Program: Clean Water State Revolving Fund (CWSRF)
Applicant (Agency Name): City of Gonzales
As the engineer in responsible charge of the project for the applicant agency, I certify that the agency has complied with Section 602(b)(13) of the Clean Water Act.
Please check the boxes below to indicate that the agency has completed the required analyses for the proposed project:
M The agency has studied and evaluated the cost and effectiveness of the processes, materials, techniques, and technologies for carrying out the proposed project or activity for which assistance is sought under this title; and The agency has selected, to the maximum extent practicable, a project or activity that maximizes the potential for efficient water use, reuse, recapture, and conservation, and energy conservation, taking into account i. the cost of constructing the project or activity;
ii. the cost of operating and maintaining the project or activity over the life of the project or activity; and
ii. the cost of replacing the project or activity.
Andrew A. Sterbenz, PE C 69703, 6/30/2024
Engineer in Responsible Charge of the Project Registration Number & Expiration Date (Please print)
Engineer's Signature Date
Financial Assistance Application Page 15 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund
Attachment T3
CLIMATE CHANGE WORKSHEET
1. Vulnerability (Check all that apply)
IT Sea Level Rise IT. Air Quality IT Saltwater Intrusion Water Quality I Water Supply Depletion • Heat Island I Flooding/Storm Surges I Drought
IT Other:
(Label as Attachment A) Provide a detailed description of all effects of climate changes that the Prepaid or is ari use pt seni, lude critical Threshold conditions that may cause damage to I Attachment A included
II. Adaptation
M Alternative Energy Sources • Drought and Flooding Contingency • Permeable Pavements L. Elevated construction, Sea Walls, and Levees • Green Roofing
• Other:
(Label as Attachment B) Provide a detailed description of all applied adaptation measures considered by the applicant. Include adaptation measures deemed unnecessary and explain why such measures were eliminated.
• Attachment B included
III. Mitigation
El Renewable Energy Sources • Energy Conservation
I Water Conservation • Methane Harvesting
• Other:
(Label as Attachment C) Provide a detailed description of all mitigation measures considered by the applicant. Include mitigation measures deemed unnecessary and explain why such measures were eliminated.
•. Attachment C included
Financial Assistance Application Page 16 of 17 Technical Package Applicatior (Rev. 10/2020) Clean Water State Revolving Func
Attachment T6
WATER CONSERVATION & WATER MANAGEMENT CERTIFICATION FORM FOR COMPLIANCE WITH DIVISION 6 OF THE CALIFORNIA WATER CODE
REQUIRED FOR ALL CWSRF FUNDING APPLICATIONS
CALIPDISIE
Water Boards
Funding Agency Name: State Water Resources Control Board Funding Program Name: Clean Water State Revolving Fund
Applicant: City of Gonzales
Please check one of the boxes below and sign and date this form.
M As the authorized representative for the applicant, I certify under penalty of perjury that the applicant is a water supplier, as that term is understood pursuant to the provisions of the California Water Code and has complied with all applicable provisions of Division 6 of the Water Code. • As the authorized representative for the applicant, I certify under penalty of perjury that applicant is not a water supplier, and the applicant certifies that the water suppliers in its service or project area have complied with all applicable provisions of Division 6 of the Water Code.
I understand that the Funding Agency will rely on this signed certification in order to approve funding and that false and/or inaccurate representations in this Certification may result in loss of all funds awarded to the applicant forits project.
Additionally, for the aforementioned reasons, the Funding Agency may withhold disbursement of project funds, and/or pursue any other applicable legal remedy.
Name of Authorized Representative Title
(Please print)
Signature of Authorized Representative Date
nancial Assistance Applicatio Page 17 of 17 Technical Package Application Rev 10/2020 Clean Water State Revolving Fund
Attachment T2c
not required
CERTIFICATION FOR FISCAL SUSTAINABILITY PLAN
REQUIRED FOR ALL CWSRF FUNDING APPLICATIONS
FOR TREATMENT WORKS PROJECTS CALIFORNIA
Water Boards
Funding Agency: State Water Resources Control Board
Funding Program: Clean Water State Revolving Fund (CWSRF) Applicant (Agency Name):
Section 603(d)(1)(E) of the federal Clean Water Act (CWA) requires a CWSRF financing recipient with a project involving the repair, replacement, or expansion of a treatment works' (including treatment, pumping, collection, distribution and storage facilities etc.) to develop and implement a fiscal sustainability plan or certify that it has developed and implemented such a plan.
1 "Treatment works" is defined in section 212(2)(A) of the CWA. (33 U.S.C. § 1282[2][A]) Please check one of the boxes below and sign and date this form:
L. As the authorized representative for the applicant agency, I certify that the agency shall develop and implement a fiscal sustainability plan as set forth in section 603(d)(1)(E)(i) of the Clean Water Act no later than _that includes:
(I) an inventory of critical assets that are a part of the treatment works; (II) an evaluation of the condition and performance of inventoried assets or asset groupings; (lI) a certification that the agency has evaluated and will be implementing water and energy conservation efforts as part of the plan; and
(IV) a plan for maintaining, repairing, and, as necessary, replacing the treatment works and a plan for funding such activities
L. As the authorized representative forthe agency, I certify that the agency has developed and implemented a fiscal sustainability plan that meets the requirements of section 603(d)(1)(E)(i) of the federal Clean Water Act (33 U.S.C. § 1383[d]|1][E]i]).
I understand that the Funding Agency will rely on this signed certification in order to approve funding and that false and/or inaccurate representations in this Certification may result in loss of all funds awarded to the applicant for its project. Additionally, the Funding Agency may withhold disbursement of project funds, and/or pursue any other applicable legal remedy.
Name of Authorized Representative Title
(Please print)
Signature of Authorized Representative Date
Financial Assistance Application Page 14 of 17 Technical Package Application (Rev. 10/2020) Clean Water State Revolving Fund