Fillable NVCOG Revolving Loan Fund Pre Application (Naugatuck Valley Council of Governments)

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NVCOG Revolving Loan Fund Pre Application (Naugatuck Valley Council of Governments)

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Eligibility Determination Pre-Application
NVCOG RLF Program
1
NVCOG Revolving Loan Fund Pre Application
Please fill out this entire form to the best of your knowledge. Information contained on this form
will be used by NVCOG in consultation with the United States Environmental Protection Agency
(USEPA) to make an initial determination as to whether the project meets eligibility qualifications to
receive a subgrant or loan from NVCOG's Revolving Loan Fund Program.
Please submit this application via email to Ricardo Rodriguez at RRodriguez@nvcogct.gov
OR send the completed application via mail to:
NVCOG
Attn: Ricardo Rodriguez
49 Leavenworth St, 3rd Floor
Waterbury, CT 06702
If you have questions about filling out the application or need additional assistance,
please contact Ricardo Rodriguez via email or by phone: 203-489-0513
Eligibility Determination Pre-Application
NVCOG RLF Program
2
REVOLVING LOAN FUND PROGRAM
INFORMATION NEEDED TO DETERMINE PROPERTY &
BORROWER/SUBGRANTEE ELIGIBILITY
(Use Tab, arrow keys or mouse to move through questions; use Spacebar or mouse to check boxes)
A. BACKGROUND INFORMATION
Date:
1. Grant number:
2. Grant recipient: Naugatuck Valley Council of Governments
3. Person providing information:
4. Property/site name:
5. Property address:
6. Current property owner:
7. Borrower/Subgrantee applicant name:
8. Borrower/Subgrantee applicant address:
9. Type of action: Loan Subgrant
10. Proposed amount:
B. SITES ELIGIBILE FOR FUNDING
1. Does the site meet the definition of a Brownfields (a real property, the expansion,
redevelopment or reuse of which is complicated by the presence or potential presence of
hazardous substances, pollutants or contaminants)? Yes No
2. Type of contamination present: Hazardous Substances Petroleum Co-Mingled
(If the site has both hazardous substances and incidental petroleum contamination, check the
box the “co-mingled” box. If the site has hazardous substances and distinguishable petroleum
contamination, you must obtain approval from the State and EPA.)
3. Describe the operational history and current use(s) of the site:
Eligibility Determination Pre-Application
NVCOG RLF Program
3
4. Describe the environmental concerns at the site, including when and how the site became
contaminated and, to the extent possible, the nature and extent of the contamination:
5. Describe the proposed cleanup plan, to the extent possible:
6. Describe the proposed expansion, redevelopment or reuse of the site:
C. SITES NOT ELIGIBLE FOR FUNDING
Please answer the following questions to the best of your knowledge:
1. Is your facility listed (or proposed for listing) on the National Priorities List? Yes No
2. Is your facility subject to unilateral administrative orders, court orders, administrative orders on
consent, or judicial consent decrees issued to or entered into by parties under CERCLA?
Yes No
3. Is your facility subject to the jurisdiction, custody, or control the US government? (Land held in
trust by the US government for an Indian tribe is eligible.) Yes No
Note: If you answered YES to any of the above (C. 1-3) your property is not eligible.
D. SITES NOT ELIGIBLE FOR FUNDING WITHOUT A PROPERTY SPECIFIC DETERMINATION:
Certain properties cannot be approved without a “Property Specific Determination”. Please answer
the following questions to the best of your knowledge:
1. Is your site/facility subject to a planned or ongoing CERCLA removal action? Yes No
El
igibility Determination Pre-Application
NVC
OG RLF Program
4
2. Has your site/facility been issued a permit by the U.S. or an authorized state under the Solid
Waste Disposal Act (as amended by the Resource Conservation and Recovery Act (RCRA)), the
Federal Water Pollution Control Act (FWPCA), the Toxic Substances Control Act (TSCA), or the
Safe Drinking Water Act (SWDA)? Yes No
3. Is your site/facility subject to corrective action orders under RCRA (sections 3004(u) or
3008(h))? Yes No
4. Is your site/facility a land disposal unit that has submitted a RCRA closure notification under
subtitle C of RCRA or is subject to closure requirements specified in a closure plan or permit?
Yes No
5. Has your site/facility had a release of polychlorinated biphenyls (PCBs) that is subject to
remediation under TSCA? Yes No
6. Has your site/facility received funding for remediation from the Leaking Underground Storage
Tank (LUST) Trust Fund? Yes No
Note: If you answered YES to any of the above (D. 1-6), please call your Project Officer and she/he
will explain how to prepare a property specific determination.
** For petroleum sites, please proceed to Section F – Petroleum Only Sites
E. PROPERTY OWNERSHIP ELIGIBILITY
1. Are there any known ongoing or anticipated environmental enforcement actions (at the federal,
state or local level) regarding the responsibility of any party for contamination or hazardous
substances at the site? Yes No If yes, please explain:
Information on Liability and Defenses/Protections – Cooperative Agreement Recipient:
1. Has the applicant ever arrange for the disposal of hazardous substances at the site, or transport
hazardous substances to the site? Yes No
2. Did the applicant ever cause or contribute to any releases of hazardous substances at the site?
Yes No
Information on Liability and Defenses/Protections:
1. How was the property acquired (or will it be acquired)?
a. Negotiated purchase from a private entity
b. Purchase or transfer from another governmental unit
c. Tax foreclosure
d. Eminent domain
e. Donation
f. Other (explain):
Eligibility Determination Pre-Application
NVCOG RLF Program
5
2. What was the date when the property was acquired (or the anticipated date when it will be
acquired)?
3. What is the name and identity of the party from whom the property was (or will be) acquired?
4. Describe all familial, contractual, corporate or financial relationships or affiliations the applicant
has or has had with all current and/or prior owners or operators of the property:
5. Did disposal of all hazardous substances at the site occur before the applicant acquired (or will
acquire) the property? Yes No
6. Did the applicant ever arrange for the disposal of hazardous substances at the site, or transport
hazardous substances to the site? Yes No
7. Did the applicant ever cause or contribute to any releases of hazardous substances at the site?
Yes No
8. Did the applicant perform any environmental inquiry prior to the purchase of the property?
Yes No
9. If a pre-purchase inquiry was performed, describe the types and dates of the assessments
performed, indicate on whose behalf the assessments were performed, and indicate whether
the applicant performed the pre-purchase inquiry in accordance with EPA’s All Appropriate
Inquiry rule (or ASTM E1527-05, or its equivalent at the time of purchase):
F. PETROLEUM ONLY SITES - PROPERTY OWNERSHIP ELIGIBILITY
Petroleum-only sites are to be submitted to the state for eligibility determination. Please contact
your state representative to obtain the information they require to determine site eligibility. As a
courtesy, send a copy of the site eligibility information to your EPA Project Officer so he or she is
aware of potential upcoming work. The revolving loan fund grantee must provide their EPA Project
Officer with a copy of the state’s determination letter. The following questions are typical of the
petroleum site information you may need to provide to the state:
1. Did the current and/or immediate past owner dispense or dispose of petroleum or petroleum
products, or exacerbate existing petroleum contamination on the site? Yes No
2. Did the assessment grant recipient dispense or dispose of petroleum or petroleum products, or
exacerbate existing petroleum contamination on the site? Yes No
6
Note: If the answers to questions F.1 and F.2 are no, the site may be eligible.
3. If the answer to either question F.1 or F.2 is yes, did the responsible party take reasonable steps
to address the petroleum contamination on site? Yes No Explain:
4. If the answer to either question F.1 or F.2 is yes, is the responsible party financially capable to
assess and clean up the site? Yes No Explain:
Note: If questions F.1 or F.2 identified a responsible party who is liable for petroleum contamination
at the site, and that party is financially viable to pay for the cleanup costs, then the site is not
eligible. If the identified responsible party took reasonable steps to address the petroleum
contamination at the site, and/or is not financially viable to pay for the cleanup costs, then the site
may still be eligible.
5. Is the site “relatively low risk” compared with other “petroleum-only” sites in the state:
a. Is the site currently being cleaned up using LUST trust fund monies? Yes No
b. Is the site currently subject to a response under the Oil Pollution Act (OPA)? Yes No
Note: If the answers to questions F.5a and F.5b are no, the site would be considered to be of
relatively low risk for purposes of determining eligibility.
6. Has any responsible party been identified for the site through, either:
a. A judgment rendered in a court of law or an administrative order that would require any
person to assess, investigate, or cleanup the site: Yes No
b. An enforcement action by federal or state authorities against any party that would require
any person to assess, investigate, or cleanup the site: Yes No
c. A citizen suit, contribution action or other third party claim brought against the current or
immediate past owner, that would, if successful, require the assessment, investigation, or
cleanup of the site: Yes No
7. Is the site subject to any RCRA orders issued under 9003(h) of the Solid Waste Disposal Act?
Yes No
Note: If the answer to any of the questions in F.6 or F.7 is yes, the site is not eligible.
Eligibility Determination Pre-Application
NVCOG RLF Program
7
G. ELIGIBILITY
(To be filled out by EPA Project Officer)
The above-described property and applicant, is eligible for a RLF loan/subgrant:
Yes No
Project Officer
Need for Attorney Consultation: Yes No Notes:
Additional Information:
H. NATIONAL HISTORIC PRESERVATION ACT (NHPA) COMPLIANCE
1. Is your site currently listed in the National Register of Historic Places and/or is it a designated
National Landmark? Yes No
Note: In order to support your response, please provide any and all documentation from the
Federal Government and/or State Historic Preservation Officer (SHPO). (i.e., SHPO
Determination Letter which you may obtain independent of the EPA or this RLF Loan/Subgrant
process.)
2. Is your site eligible to be listed in the National Register of Historic Places? Yes No
Note: In order to support your response, please provide any and all documentation from the
Federal Government and/or State Historic Preservation Officer (SHPO). (i.e., SHPO
Determination Letter which you may obtain independent of the EPA or this RLF Loan/Subgrant
process.)
3. Is your site part of a designated Historic District? Yes No
4. Will your project impact the viewshed of any adjacent or surrounding designated Historic
Districts or register historic structures? Yes No
5. Does your project have the potential to impact archaeological resources? Yes No
(To be filled out by Applicant)
Eligibility Determination Pre-Application
NVCOG RLF Program
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NVCOG Revolving Loan Fund Pre Application (Naugatuck Valley Council of Governments)

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Completed 28 January 2021

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