"Application for 2401 Tier 1 Graywater Reuse and Disposal System Wpcf General Permit" - Oregon

Application for 2401 Tier 1 Graywater Reuse and Disposal System Wpcf General Permit is a legal document that was released by the Oregon Department of Environmental Quality - a government authority operating within Oregon.

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For DEQ Use Only
For DEQ Use Only
State of Oregon
Department of Environmental Quality
700 NE Multnomah St, Suite 600
Date
Portland, Oregon 97232
Date Permit Issued
Application for 2401 Tier 1
Amount Received
Graywater Reuse and Disposal System WPCF
File No.
General Permit
Check No.
A. Applicant Information
1. Legal name of applicant:
2. Is the applicant the owner of the property?
Yes
No
3. Email:
Telephone
No email address or do not wish to correspond by email.
4. Mailing address:
City:
State:
Postal Code:
B. Graywater Reuse and Disposal System Information
Location of System (Point of Graywater Generation)
1. Street Address:
City:
State:
Postal Code:
County:
2. Latitude:
degrees
minutes
seconds
3. Township:
Section:
Range:
Tax Lot #:
Longitude:
degrees
minutes
seconds
Graywater System Information
4. This is a:
Single family residence with:
1
2
3
4 bedrooms, OR
Residential duplex with:
1
2
3
4
bedrooms.
5. Wastewater disposal:
sewer connection
onsite wastewater treatment (i.e., septic system)
Graywater Reuse Information
6. Planned graywater reuse activities (select all that apply)
Subsurface irrigation of gardens, lawns, and landscape plants (not including vegetable gardens)
Subsurface irrigation of food crops, except root crops or crops that have edible portions that contact graywater
Subsurface irrigation of vegetated roofs that do not drain to stormwater management structures, such as swales,
infiltration basins, rain gardens, or similar stormwater structures.
Compost
7. Estimated maximum quantity of graywater needed for reuse (in gallons per day):
8. Location of graywater reuse (select all that apply):
On the property on which it was generated.
On an adjacent property within the written approval of the property owner.
20190619 (IIL)
1
For DEQ Use Only
For DEQ Use Only
State of Oregon
Department of Environmental Quality
700 NE Multnomah St, Suite 600
Date
Portland, Oregon 97232
Date Permit Issued
Application for 2401 Tier 1
Amount Received
Graywater Reuse and Disposal System WPCF
File No.
General Permit
Check No.
A. Applicant Information
1. Legal name of applicant:
2. Is the applicant the owner of the property?
Yes
No
3. Email:
Telephone
No email address or do not wish to correspond by email.
4. Mailing address:
City:
State:
Postal Code:
B. Graywater Reuse and Disposal System Information
Location of System (Point of Graywater Generation)
1. Street Address:
City:
State:
Postal Code:
County:
2. Latitude:
degrees
minutes
seconds
3. Township:
Section:
Range:
Tax Lot #:
Longitude:
degrees
minutes
seconds
Graywater System Information
4. This is a:
Single family residence with:
1
2
3
4 bedrooms, OR
Residential duplex with:
1
2
3
4
bedrooms.
5. Wastewater disposal:
sewer connection
onsite wastewater treatment (i.e., septic system)
Graywater Reuse Information
6. Planned graywater reuse activities (select all that apply)
Subsurface irrigation of gardens, lawns, and landscape plants (not including vegetable gardens)
Subsurface irrigation of food crops, except root crops or crops that have edible portions that contact graywater
Subsurface irrigation of vegetated roofs that do not drain to stormwater management structures, such as swales,
infiltration basins, rain gardens, or similar stormwater structures.
Compost
7. Estimated maximum quantity of graywater needed for reuse (in gallons per day):
8. Location of graywater reuse (select all that apply):
On the property on which it was generated.
On an adjacent property within the written approval of the property owner.
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Graywater Source Information
9. Fixtures from which graywater is collected (select all that apply):
Fixture
Number of fixtures
Estimated graywater flow (gallons per day)
Shower/bath
1
2
3
4
5
Bathroom sink
1
2
3
4
5
Kitchen sink
1
2
3
4
5
Laundry
1
2
3
4
5
Total estimated daily graywater flow (in gallons per day):
System Description
10. Briefly describe the graywater reuse and disposal system (including but not limited to information on the type of
primary treatment, if used, use of surge tanks, and a short description of the irrigation system.):
C. Graywater Reuse and Disposal System Documents
1. The following information is complete and available for review on request:
System design plan
Graywater irrigation site evaluation
Operation and maintenance manual
2. List all other DEQ or public agency permits issued to or applied for with this project, such as onsite wastewater
treatment systems and plumbing permits:
Permit
Issuing Agency
Inspection Date
D. 2401 Permit Notification
1. Please indicate how you would like to receive notification of coverage under the 2401 permit:
I would like notification of coverage and a copy of the permit sent to the email address provided on this application.
(If DEQ is unable to contact me via email, I understand I will be notified at the mailing address provided.)
I would like notification of coverage and a copy of the permit sent to the mailing address provided on this
application.
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E. Signature Of Legally Authorized Representative
I hereby certify that the information in this application is true and correct to the best of my knowledge and belief. I
understand that graywater may only be used for the reuse activities identified above and graywater unsuitable for reuse or
in excess of the volume required for the identified reuse activities will be sent to the sanitary sewer or a functioning onsite
wastewater treatment system (i.e., septic tank). The graywater reuse and disposal system permit documentation listed in
Section C is available for review at the request of the permitting authority.
A wet signature of a legally authorized representative is required in order to process this application. Please print
out this application and sign.
Title
Name of Legally Authorized Representative (Type or Print)
Date
Signature of Legally Authorized Representative
Important Information
DEQ permit fees: send check or money order payable to DEQ with signed application.
Permit application fees are published in OAR 340-045-0075 in Table 70G.
Available online at: https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=250408.
Scroll down to find Table 70G and look for the permit number in the left-hand column. New permits require payment
of both the permit application fee and the first year permit fee before the permit can be processed.
Send completed application and permit fees to:
DEQ Headquarters
700 NE Multnomah St, Suite 600
Portland OR 97232
503-229-5696 or 800-452-4011
Other Agency Requirements
You must comply with all applicable local, state, and federal laws and regulations. All pipes, valves, and other plumbing
appurtenances of the graywater collection system must comply with the requirements of the Oregon Plumbing Specialty
Code. The necessary permits must be obtained from the local building authority. DEQ permit fees do not apply toward any
permits required by local authorities.
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Please answer all questions and submit with the required permit application fees.
An incomplete application or application with incorrect fees will not be processed.
If the information requested is not applicable, please indicate as such.
A. Applicant Information
1. Enter the legal name of the applicant. The permit will be issued to this entity. This is typically the owner of the
property.
2. Indicate if the applicant is the owner of the property.
3. Provide the email address and telephone number for the applicant. Routine correspondence with the applicant will
occur by email unless otherwise indicated.
4. Enter the mailing address for the applicant.
B. Graywater Reuse and Disposal System Information
1. Enter the street address for the point of graywater generation.
2. Enter the latitude and longitude. Latitude and longitude can be obtained from Google Earth website at
https://earth.google.com/web/
or from the United States Geological Survey (USGS) quadrangle maps. Instructions
on obtaining latitude and longitude data from USGS maps can be obtained from DEQ's website at
http://www.deq.state.or.us/wq/pubs/guides/latlonginstr.pdf.
3. Enter the township, range, section, and tax lot information for the property.
4. Indicate if the property is a single family residence or residential duplex, and select the total number of bedrooms.
Properties with more than four bedrooms are not eligible for coverage under the 2401 General Permit.
5. All graywater reuse and disposal systems covered under a 2401 general permit must connect to a wastewater
disposal system, either by a sanitary sewer connection or a functioning onsite wastewater treatment system (i.e.,
septic system). If the disposal system is a septic system, additional documentation may be needed to verify the
septic system will not be adversely affected. Select only one option.
6. Indicate how graywater will be used. Multiple selections may be made.
7. Provide an estimate on the maximum amount (in gallons per day) of graywater that will be diverted to reuse for the
identified uses.
8. Indicate where graywater will be used. Graywater used on adjacent properties requires the written approval of the
property owner.
9. Identify the fixtures from which graywater will be collected. Indicate the number of fixtures and provide an
estimate of the total amount of graywater that will be collected from those fixtures. Finally provide an estimate of
graywater in gallons per day that will be diverted from all fixtures.
10. Provide a brief description of the graywater reuse and disposal system. If graywater is diverted from a kitchen
sink, please describe the physical treatment system that will be used to reduce the grease, floatable and settleable
solids from the graywater.
C. Graywater Reuse and Disposal System Documents
1. Persons covered under the 2401 WPCF general permit must document and maintain documentation on the system.
The following documentation must be complete and available for review on request of the permitting authority:
System design plan. Including the following information at a minimum: location of the system; a list
of the intended uses of graywater; design flow of the graywater reuse and disposal system based on the
identified uses of graywater; fixtures that are the source of graywater, including flow and usage
information; a description of any graywater treatment used; a description and diagram of the
distribution and reuse (i.e., irrigation and ponds) system, including any storage or surge tanks.
Graywater irrigation site evaluation report. Where graywater is used for irrigation purposes, a site
evaluation report containing the following information in required to demonstrate safe reuse of
graywater:
o a diagram of the property receiving graywater showing the location of area and slope of the
graywater reuse area; surface streams, springs, or other bodies of water; onsite wastewater
treatment systems; stormwater management structures or stormwater collection systems
(e.g.,bioswales, raingardens, stormdrains); existing and proposed wells; escarpment, cuts and
fills; and any unstable landforms;
o parcel size
o soil profile descriptions, including infiltration rates
o water table levels
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o description of vegetation in the reuse area
o evapotranspiration rates for vegetation during the period of reuse
o any other information relevant to evaluation of the site, including offsite features
Operation and maintenance manual. The operation and maintenance manual must provide practical
information on operating and maintaining the graywater reuse and disposal system. Examples of
operation and maintenance activities include but are not limited to: steps for turning on the system,
operating the graywater diversion device, cleaning filters, flushing distribution lines, and draining
irrigation lines before winter.
2. In order for DEQ to coordinate with other DEQ activities and public agencies, please list all permits issued to or
applied for with this project, including onsite wastewater treatment system permits and plumbing permits. Please
list the permit, the issuing agency, and the date of inspection.
D. 2401 PERMIT NOTIFICATION
The applicant must select how to receive notification of coverage under the 2401 permit, either via email or standard
first-class mail. If DEQ is unable to contact the applicant by email, notification will be sent to the mailing address
provided in Section A of the permit application.
E. SIGNATURE OF LEGALLY AUTHORIZED REPRESENTATIVE
The signature of a legally authorized representative must be provided in order to process this application. If the
property has more than one owner, each owner must sign the application.
Applying for Coverage under the 2401 Tier 1 Graywater Reuse and Disposal
System WPCF General Permit
How do I obtain coverage under the 2401 General Permit?
1. Complete a 2401 application form.
2. Submit the complete 2401 application and permit fees.
a.
Permit application fees are published in OAR 340-045-0075 in Table 70G.
https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=250408.
Available on line at:
Scroll down to find Table 70G and look for the permit number in the left hand column.
b.
New permits require payment of both the permit application fee and the first year permit fee before the
permit can be processed.
3. If the permit application and fees are accurate and complete, coverage under the 2401 is granted and DEQ will
send notification of coverage and a copy of the 2401 permit as requested on the application. If the application
or fee is incomplete or the system is ineligible for coverage under the 2401 general permit, DEQ will do one of
the following:
a. Deny coverage under the 2401 general permit. The applicant will be notified if the applicant's
operation cannot be approved for coverage under the 2401 general permit and that the applicant may
need to obtain a 2402 general permit or an individual permit.
b. Request additional information. An application that is incomplete, unsigned, or does not contain the
required fee will be returned to the applicant. DEQ requires a complete application and fee in order to
assign coverage under the 2401 general permit.
The DEQ 2401 general permit is considered valid when the applicant receives the DEQ confirmation notification.
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