StormwaterWise Landscapes 2019 Application The 2019 StormwaterWise Landscapes Program application is due by March 15 Name* First Last Co-applicant (spouse, partner, etc.) First Last Organization (if applicable)Email* Phone*Address of Property* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code The property is privately owned by me.*YesNoThe property is a:*Residence: Detached, single-family homeResidence: Duplex or townhomeNot a residence: Commercial, religious, institutional or HOA propertyWhich of the following stormwater issues occur on your property?* Erosion Excessive flow during storms Flooded basements Standing water Other (please specify below) No problems Other stormwater issue:How long have you lived in your home?*Less than 2 years2-5 years5-10 years10-15 years15-20 years20+ yearsN/A - HOADetail how you've attempted to address your stormwater issues up to now.*Which of the following program-supported practices are you most interested in installing on your property?* Conservation landscape Pervious pavers/concrete Rain garden Removal of pavement I don't know Which of the following statements best describes you?*I know a lot about native plants and have already used them in my landscaping.I like to garden and spend a lot of time in my yard, but I have limited knowledge about native plants.I am somewhat interested in gardening.I do not have an interest in gardening.Are you planning any construction projects on your property other than StormwaterWise in the next year?*Yes (if so, please describe in the comment box below).NoPlease describe your construction project below.*How committed are you to installing a StormwaterWise project this year?* I am ready to install this year! I have budgeted or contacted a contractor/designer already I have looked at the project options and narrowed it down to one or two I am mostly interested in the site visit to get ideas I'm not sure if I'm ready to install a project this year Is there anything else we should know about your property?*Have you applied to StormwaterWise Landscapes before?*YesNoHave you previously had a site visit from county staff for your property's drainage or erosion issues? If so, when?*NoYes (please list date of site visit below)If yes, write the date (or month/season and year) of the site visit in the "Other" field.Please confirm that you understand the following: StormwaterWise funds cannot support a project that adds new hardscape (even if it is permeable), such as a larger driveway or walkway, an additional driveway, or a new patio to your property. StormwaterWise funds can only replace existing hardscape (patios, walkways, driveways, etc).*YesNoPlease confirm that you understand the following: Funds received from the StormwaterWise program are considered taxable income. 1099 forms will be issued by EcoAction Arlington for each participant that receives $600 or more in reimbursement. A social security number will be required so that a 1099 can be prepared.*YesNoConfirm that you have read and understand this statement: Residents are provided one opportunity to participate in StormwaterWise.*YesNoIf selected for the program, do you agree to have a signed participant agreement ready at the beginning of the County site visit?*YesNoIf selected for the program, will you commit to installing at least one stormwater practice on your property?*YesNoConfirm that you have read and understand this arrangement: The StormwaterWise Landscape Program is a reimbursement program. Program participants will be reimbursed up to 50% of the installation cost or a predetermined amount of each practice, whichever is less, up to a maximum amount of $2,500 per residential property (or $4000 maximum per HOA). All other costs incurred are the responsibility of the program participant.*YesNoConfirm that you have read and understand this statement: Regardless of the size of the property, the assessment is limited to one acre or less of the property.*YesNoPlease be aware that information submitted through an Arlington County Government website is considered to be a Public Record under the Virginia Public Records Act and may be subject to release by the County in response to a request made under the Virginia Freedom of Information Act.Do not submit any unsolicited personally identifiable information including (but not limited to) your: (1) social security number; (2) driver's license number; (3) bank account numbers; (4) credit or debit card numbers; (5) personal identification numbers (PIN); (6) electronic identification codes; (7) automated or electronic signatures; or (8) passwords; or (9) any other numbers or information that can be used to access your assets, obtain identification, act as identification, or obtain goods or services.Arlington County may withhold your name and contact information in accordance with the Virginia Freedom of Information Act. Please indicate, by checking the box below, if you would like for the County to seek to keep this information confidential.Do Not Disclose Opt-Out Please do not disclose my name and contact information in response to a request under the Virginia Freedom of Information Act. I recognize that the County cannot guarantee the confidentiality of my name and contact information but ask that it do so to the extent permitted by law. PhoneThis field is for validation purposes and should be left unchanged.