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4. General Information
6. Project Title*
8. Funding Type*

   Check the category for which you are seeking funding. If project meets more than one, check all that apply. 

   1. Road corridor
   2. Water quality
   3. Flood control
10. Amount being requested*
11. Estimated Construction Costs*
13. Project Description*
15. Project location*

    Address, nearest road intersection, township section, or starting and ending points. 

17. City*
18. State
19. Zip Code
21. Please attach a 8.5" x 11" map of the proposed project location*
23. Applicants Name*

    Government agency, local unit of government, etc. 

25. Address*
27. City*
28. State*
29. Zip Code*
31. Project Manager's Name*
32. Title*
34. Phone Number*
35. Email Address*
37. General Questions
39. 1. Does your community have a storm water management, asset management, utility plan, or related? Is the proposed project included in the plan? *
41. Attach a copy of any existing plan and describe the project’s overall system benefit.
43. 2. Please list all confirmed project partners and their anticipated role.*
45. 3. What background work has already been completed for the project?*
47. 4. What background work still needs to be completed for construction to proceed?*
49. 5. How will the proposed match money be funded? List confirmed and proposed funders.*
51. 6. Indicate the federal vulnerability index rating of the area where the project will be conducted. *

    Michigan2020_Washtenaw.pdf (cdc.gov)

53. 7. Do you have site control to construct the project? If not, explain how you will receive permission from applicable property owners to proceed.*
55. Project specific questions (please answer if applicable, otherwise indicate with a NA or TBD)
57. 8. Have there been any hydrologic or hydraulic studies performed to determine storm flows?
59. Provide a copy of such studies and any plans to increase current system capacity.
61. 9. Will the project provide any aspect of sediment capture or pollutant load reduction? If so, please outline the mechanism to do so.
63. 10. Is the project aimed to rehabilitate or renew existing stormwater assets? If so, please provide Level Of Service ratings or grading system used to prioritize assets.
65. 11. Has an engineering cost estimate been performed?
67. If so, please provide.
69. 12. If project will be located with a road right-of-way provide the Average Daily Traffic count for the roadway(s) affected.
71. 13. Summarize any green best management practices to be employed with the project.
73. 14. Summarize all aspects of the proposed project aimed at increasing overall water quality.
75. 15. Summarize all aspects of the proposed project aimed at increasing watershed detention/retention storage or otherwise mitigate existing floodplain or wetlands.
77. 16. Summarize any proposed stream restoration techniques or piped conveyance elimination.
79. Please provide any other cost estimates drafted by a professional consultant, completed studies, engineering drawings, or pre-application documentation not attached above.
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81. 1. Receive an email copy of this form.
82. Email address

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