New Submission

Use this form to submit emergency funding to the DWI.
This Funding is prioritized for Counties designated under a major disaster declaration by the President of United States.
Request Cycle:*field type drop-down
Applicant Name:*field type drop-down
Project Namefield type single line
Please be advised DWI has a 40 character limit for project names.
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Project Type:*field type drop-down
County:*field type drop-down
Project Description:*field type richtext
Describe how the proposed activities will be directly related to rectifying damages caused by hurricane Helene.
Is this a new Emergency Request for Funding submittal, or are you amending or correcting a previously-submitted Request?*field type radio button
Is this a new Emergency Request for Funding submittal, or are you amending or correcting a previously-submitted Request?New SubmittalAmending a previous submittal
Project Number(s)*field type single line
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Is your project a complete replacement or rehabilitation of existing structures?*field type radio button
Is your project a complete replacement or rehabilitation of existing structures?ReplacementRehabilitation
Is your project "Shovel ready"?*field type radio button
Is your project "Shovel ready"?YesNo
Are you using emergency funds to supplement/bridge another anticipated assistance?*field type radio button
Are you using emergency funds to supplement/bridge another anticipated assistance?YesNo
Funding Amount Requested*field type currency
$
Assessment status of facilities you are seeking funding for*field type radio button
Assessment status of facilities you are seeking funding forNon- operationalPartially operationalOperational
PWSIDfield type single line
(If applicable)
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NPDES discharge permitfield type single line
(If applicable)
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Collection System Permitsfield type single line
(If applicable)
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Name of Authorized Representative*field type single line
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Email of Authorized Representative*field type email
Title of Authorized Representative*field type single line
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Mailing Address of Authorized Representative*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Name of Request Preparer*field type single line
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Email of Request Preparer*field type email
Organization of Request Preparer*field type single line
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Is the engineer the same as the request preparer?*field type radio button
Is the engineer the same as the request preparer?YesNoNot Applicable
Name of Engineer*field type single line
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Email of Engineer*field type email
Engineering Firm*field type single line
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Certification by Authorized Representative

The attached statements and exhibits are hereby made part of this Request for Funding, and the undersigned representative(s) of the Recipient certifies that the information in this Request for Funding and the attached statements and exhibits is true, correct, and complete to the best of his/her knowledge and belief. By initialing each item and signing at the end of this Request for Funding, he/she further certifies that:

Certifications*field type checkbox
Certifications1. As Authorized Representative of the utility named in Applicant Name, I am authorized to file this Request for Funding;2. I acknowledge that this Request for Funding is only for funding assistance from NC Department of Environmental Quality, and does not include a request for funding from other sources, including FEMA. I acknowledge that FEMA requires a separate application process for their public assistance;3. The utility complied with or will comply with all federal, state, and local laws, rules, and regulations and ordinances as applicable to this project;4. If the utility is of a local government, I acknowledge that the Town or County is organized and chartered under the laws of North Carolina. All officials and employees are aware of, and in full compliance with NCGS 14-234, “Director of public trust contracting for his own benefit, participation in business transaction involving public funds, exemptions";5. I acknowledge that loan funding is contingent on debt approval by the Local Government Commission;6. I acknowledge that the loan repayments will start once all DWI funds are disbursed and DWI funded portion of the project is complete;7. The utility will return the funds to DEQ and/or pay-off the debt if any state or federal funding assistance is received from other agencies (e.g. FEMA) for the same incurred costs.
Submitter Email:*field type email
Re-Type Submitter Email:*field type email
Submitters Name:*field type single line
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Submitter Signature:*field type signature
Submittal Date:field type date
For questions or if you need assistance with the request form please contact Renee Parkman, PE of Division of Water Infrastructure at 704-235-2203 or by email Renee.Parkman@deq.nc.gov
Project Budgetfield type file upload
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PDF only
Assessment Report/Scopefield type file upload
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Uploading files may take a few minutes. Please wait until all the files uploaded above show in blue font for their filename and extension (e.g. Filename.pdf) and a bold X appears next to the files before clicking on Next. Files must be smaller than 250 MB in size.
CONFIRMATION OF REQUEST FOR FUNDING SUBMITTAL IS SENT TO THIS EMAIL.
Need to call someone? Contact the Division of Water Infrastructure at 919-707-9160.
Click Submit below when ready, or click Save as Draft if you want to return and complete the request later (it will not be considered complete until you click on Submit). Once you submit an request, you cannot edit your application or files. If you need to make a correction after you submit an request submit a new request and contact the Division.
Web Access URL:field type single line
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Division of Water Infrastructure