"Application for 2402 Tier 2 Graywater Reuse and Disposal System General Permit" - Oregon

Application for 2402 Tier 2 Graywater Reuse and Disposal System 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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  • Released on June 19, 2019;
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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 2402 Tier 2
Amount Received
Graywater Reuse and Disposal System
File No.
General Permit
Check No.
A. Applicant Information
1. Legal name of applicant:
2. Is the applicant the owner of the facility?
Yes
No
3. Legal status of applicant:
Federal
State
Public
Private
Other, specify:
4. Name of facility (if different than legal name):
5.
Facility SIC code:
or
NAICS code:
B. Facility Location
1. Physical Street Address:
City:
State:
Postal Code:
County:
3. Township:
Section:
2. Latitude:
degrees
minutes
seconds
Range:
Tax Lot #:
Longitude:
degrees
minutes
seconds
C. Contact Information
1. Responsible Official:
Email:
Telephone:
No email address or do not wish to correspond by email.
Mailing Address:
City:
State:
Postal Code:
County:
Same as responsible official
2. Facility Contact:
Email:
Telephone:
No email address or do not wish to correspond by email.
Mailing Address:
City:
State:
Postal Code:
County:
Same as responsible official
3. Invoice To:
Email:
Telephone:
No email address or do not wish to correspond by email.
Billing Address:
City:
State:
Postal Code:
County:
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 2402 Tier 2
Amount Received
Graywater Reuse and Disposal System
File No.
General Permit
Check No.
A. Applicant Information
1. Legal name of applicant:
2. Is the applicant the owner of the facility?
Yes
No
3. Legal status of applicant:
Federal
State
Public
Private
Other, specify:
4. Name of facility (if different than legal name):
5.
Facility SIC code:
or
NAICS code:
B. Facility Location
1. Physical Street Address:
City:
State:
Postal Code:
County:
3. Township:
Section:
2. Latitude:
degrees
minutes
seconds
Range:
Tax Lot #:
Longitude:
degrees
minutes
seconds
C. Contact Information
1. Responsible Official:
Email:
Telephone:
No email address or do not wish to correspond by email.
Mailing Address:
City:
State:
Postal Code:
County:
Same as responsible official
2. Facility Contact:
Email:
Telephone:
No email address or do not wish to correspond by email.
Mailing Address:
City:
State:
Postal Code:
County:
Same as responsible official
3. Invoice To:
Email:
Telephone:
No email address or do not wish to correspond by email.
Billing Address:
City:
State:
Postal Code:
County:
20190619 (IIL)
1
D. Graywater Reuse and Disposal System Information
1. Facility Information
Primary Structure Type
This facility is a:
Estimated Graywater Flow
(see lists on pages 5-6 for options)
residential structure:
commercial or institutional structure:
Total estimated graywater flow:
Submit Graywater Flow Worksheet with application. Download the application from
DEQ's Domestic Permit Application Forms and Fees page.
2. Wastewater disposal:
sewer connection
onsite wastewater treatment (i.e., septic system)
3. Graywater reuse information
Planned graywater reuse activities (select all that apply)
Type 1 or Type 2 Graywater:
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
Type 2 Graywater only:
Landscape ponds not intended for human contact
Surface drip irrigation of gardens, lawns, living walls, greenhouses and landscape plants
4. Location of graywater reuse (select all that apply)
On the property on which it was generated.
On an adjacent property with the written approval of the property owner.
5. Graywater Information
Total estimated quantity of graywater needed for use (in gallons per day):
Graywater generated will be:
Type 1
Type 2
Both
For Type 2 graywater, please indicate the type of treatment:
Performance-based treatment
Technology-based treatment
Please specify the manufacturer and model of the treatment system:
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6. System Description
Briefly describe the graywater reuse and disposal system, including, but not limited to, any physical, chemical, or
biological treatment methods, use of storage surge tanks, and a brief description of the irrigation system.
E. Graywater Reuse and Disposal System Documents
1. Attach the following information:
System design plan
Graywater flow worksheet
Operations and maintenance manual
Site evaluation report
For systems using performance-based treatment, treatment system plans and specifications; and
For systems diverting graywater from an onsite wastewater treatment system (i.e., septic system), the system
design plan must include the signature of a professional engineer registered in accordance with ORS 672 or a
wastewater specialist registered in accordance with ORS 700 that the graywater system has been designed to not
result in a septic tank effluent concentration that exceeds the criteria for residential strength wastewater.
2. List all other DEQ or public agency permits issued to or applied for on this project, such as onsite wastewater
treatment systems and plumbing permits:
Permit
Issuing Agency
Date
F. Signature Of Legally Authorized Representative
I hereby certify under penalty of law that this document and all attachments were prepared under my direction or supervision.
The information submitted is, to the best of my knowledge and belief, true, accurate and complete . I am aware that there are
significant penalties for submitting false information, including the possibility of fi ne and imprisonment for knowing
violations. I agree to pay all permit fees required by Oregon Administrative Rules 340-045, 340-053, and 340-071, including
new application fees to obtain the permit and an annual compliance determination fee invoiced annually by DEQ to maintain the
permit. 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
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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 in the person, business, public
organization, or other entity that controls the facility described in this application and will be responsible for
complying with the conditions of the permit. This must be the legal Oregon name (e.g., Acme Products, Inc.) or
the legal representative of the company if it operates under an assumed business name (e.g., John Smith, dba
Acme Products, Inc.). The name must be a legal active name registered with the Oregon Department of
Commerce, Corporation Division (503-378-4752), unless otherwise exempted by their regulations.
2. Indicate if the applicant is the owner of the facility.
3. Provide the legal status of the applicant. Indicate "public" for a facility solely owned by local government.
4. Enter the common name of the facility or operation if different from the legal name of the applicant.
5. Enter the Standard Industrial Classification (SIC) four-digit code or North American Industry Classification
system (NAICS) for the facility. These codes are used to describe the primary activity at the facility and may be
found on fire marshal reports, insurance papers, or tax forms. The NAICS codes replaced the SIC system in 1997,
however, in is usually easy to convert between the two systems so either code is acceptable. SIC or NAICS
information is also available from the U.S. Census Bureau at 1- 888-756-2427 or at
http://www.naics.com/search.htm. For single family dwellings, use SIC code 4952 or NAICS 221320.
B. Facility Location
1. Enter the physical location of the facility (street address, not mailing address), including city, state, postal code,
and county.
2. Enter the latitude and longitude of the approximate center of the facility or site in degrees/minutes/seconds.
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 numbers for the regulated site.
C. Contact Information
1. Enter the name, email address, telephone number, and mailing address of the Responsible Official. The
Responsible Official is the person that receives official correspondence from DEQ, such as renewal notices or
notices of noncompliance, and may be contacted if there are questions about this application.
2. Enter the contact information of the Facility Contact if different from the Responsible Official. The Facility
Contact is the person located at the facility that has specific knowledge of the facility or operation under permit
(e.g., the treatment plant operator), and may be contacted if there are specific questions about this application.
3. Enter contact information for the person responsible for billing purposes if different from the Responsible Official
(e.g., "Invoice to: Business Office - Accounts Payable").
D. Graywater Reuse and Disposal System Information
1. Indicate if the facility is a “residential structure” or a “commercial or institutional structure”, the primary use of
the structure, and the estimated graywater flow. If the structure includes both residential and commercial or
institutional functions, both types of structures may be selected. Fill out the Graywater Flow Worksheet and
provide summary information. Attach the Graywater Flow Worksheet with your application.
Residential structure types:
Boarding house
Rooming house
Condominium or multiple family dwelling, including apartments
Single family dwelling
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