Generic Pumpout Facility Grant Application

Pumpout Grant Applicant
Facility name:
Address
City / County / State / Zip
Key Contact Person / Title
Telephone / Fax
Federal Employer Identification Number
Name of Owner:
Address
City / County / State / Zip
Telephone / Fax
Pumpout Proposal (circle all that apply)
Pumpout Service now at this site: / Yes / No / If Yes, year began service:
(describe)
Grant request for pumpout which is: / New / Expand existing / Improve existing
Location of new pumpout: / Fuel dock / To all slips / Connecting each liveaboard
On bulkhead / Other dock / Mobile (goes to boats)
Loran/GPS location at proposed pumpout site: / Lat. / Long.
Depth of water at pumpout site: / Less than 4 ft / 4 to 6 ft / Deeper than 6 ft
Type of pumpout planned: / Stationary unit / Dump station
Portable unit on wheels / Pumpout boat
Remote operated multi-station system
Make of new pumpout: / Home made
Pumpout waste will discharge to: / Public wastewater treatment system / Holding (tight) tank
Package treatment plant (NPDES permit) / Septic system (ISDS)
Permit for pumpout construction is: / Approved / Pending / Not yet filed
Grant Money Request
Total Cost of new Pumpout Facility: / $
Amount Federal funds requested (up to 75% total): / $
Important Note: Grant is ONLY made on a Reimbursement Basis against Actual Costs for Pre-approved Project
Matching funds (minimum 25% non-Federal money): / $
Type of matching funds: / Cash / Labor / Site preparation cost
Donation / In-kind-service / Lost dockage fees
Boat value/cost / Other (describe)
Marina/yard / Other (describe)
Pumpout fee to be charged: / Free / $5.00 per use
Type of facility: / Marina / Boatyard / Yacht Club / Dockominium
Mooring field / Landing / Fuel dock only / Boat ramp
Other (describe)
Facility ownership: / Private commercial / Private nonprofit club / Public agency
Other (describe)
Boating season capacity: / Slips / Moorings / Dry & racks / =Total
Number of liveaboard (residential) boats: / None / Liveaboard boats
Number of boats by size (loa): / Under 16’ / 16-25’ / 26 to 40’ / Over 40’
Most customers use this marina: / Year-round / Seasonally / Transient visitors
This marina is best described as a: / Home Port / Destination / Stop-off for transients
Estimated percent of boats with MSDS: / % Type I & II (treatment & discharge) / % Type III (holding tank)
(total to equal 100%) / % with No toilet / % Portable toilet
On a busy weekend, typical percent of boats with customers staying overnight: / %
Restrooms available on site: / Yes / No / Nearby (attach description where)
Slip mooring rental contract contains language prohibiting discharge of sewage into marina waters
Yes / No / Not yet, but will add for 20__
Name of water body at pumpout facility:
Is this a “No Discharge Area”? / Yes / No / Proposed
Water level change (aver. Max. in boat season) / Salt brackish water tide / ______ft or / Freshwater change / _____ ft
Estimated total boat population within 2 mile radius / Under 200 / 200-500 / 500-750
(include own customers in total) / 750-1000 / 1000-2000 / 2000-4000 / Over 4000
Other pumpout services within 2 miles: / Yes / No / If Yes, how many
Pumpout Operation and Maintenance
Who will do the pumpout: / Boater self serve / Marina staff / Contractor
Other (describe)
Boating season months of: / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec
Days of week: / Daily / Or just on: / Sun / Mon / Tue / Wed / Thu / Fri / Sat
Normal hours of operation: / Between / a.m. to / p.m. / or: / 24 hours
Accessible to all recreational vessels: / Yes / No (if No, attach explanation)
Pumpout information sign: / Exists now / To be added as part of this project
Public information via: / Brochure / Newsletter / Advertisement / Cruising Guide List / Press release
How will pumpout be maintained: / In-house staff / Outside contractor or
Source of maintenance funds: / Income / Set aside escrow / Grant / Appropriated
Name of Applicant / Date:
Signature of Applicant