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Minnesota Pollution CWP Loan Application <br />Control Agency <br />520 Lafayette Road North Minnesota Clean Water Partnership (CWP) <br />5t. Paul, MN 55155-4194 Nonpoint Source Pollution Project <br />Doc Type: Application <br />• Before submitting the application form, review the Clean Water Partnership (CWP) Loan Program Request for <br />Proposals (RFP). <br />• This form must be submitted electronically as per instructions listed in Section IX of the RFP. <br />Project title <br />Keep the title descriptive and short. You will be using it many times. It should include the water body name (if applicable) and the <br />type of activity. There is a maximum of 50 characters, including spaces. (Examples: Lake Smith Diagnostic Study; Brown Creek <br />Implementation Project) <br />Project title: H2OPP (HOPP) Water Preservation Project <br />Sponsoring organization <br />Sponsoring organization (See Section III of RFP for applicant eligibility): <br />Citv of Mounds View <br />Primary contact person (The primary contact person is the person who can be contacted for additional information): <br />Nyle Zikmund <br />Street address: 2401 Mounds View Boulevard <br />City <br />Mounds View <br />Phone: 612-860-7442 <br />Fax: <br />Project budget projection <br />State the amount of the loan funds requested. <br />Loan funds requested: <br />Match funds, including <br />cash and in-kind services (if applicable): <br />Total project cost (sum of other 2 lines) <br />Project location <br />State: MN <br />$2,000,000.00 <br />$2,000,000.00 <br />Zip: 55112 <br />Email: nyle.zikmund@moundsviewmn.org <br />You must include all project location information that is applicable. Be sure to select a basin. If applicable, attach a map of the <br />application area. <br />Major watershed: Rice Creek Watershed 8 -digit Hydrologic unit code: <br />Sub -watershed: <br />12 -digit <br />Hydrologic <br />unit code: <br />What type of water body does it affect? (check all that apply) <br />❑ Stream ❑ Lake ❑ River ® Groundwater <br />Water body name(s): <br />Basin (check all that apply): <br />❑ Lake Superior ❑ Lower Mississippi/Cedar ® Upper Mississippi ❑ Minnesota ❑ Rainy <br />❑ Red River ❑ Des Moines ❑ Missouri ❑ St. Croix <br />Is the water of concern a drinking water source? ® Yes ❑ No <br />www.pca.state.mn.us 651-296-6300 • 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-cwp7-35e • 9114116 Page 1 of 5 <br />❑ Other <br />GPS location: <br />