"Application to Renew 2401 and 2402 Graywater Reuse and Disposal System Wpcf General Permit" - Oregon

Application to Renew 2401 and 2402 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.

Form Details:

  • Released on January 20, 2017;
  • The latest edition currently provided by the Oregon Department of Environmental Quality;
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  • Fill out the form in our online filing application.

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Download "Application to Renew 2401 and 2402 Graywater Reuse and Disposal System Wpcf General Permit" - Oregon

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For DEQ Use Only
For DEQ Use Only
State of Oregon
Department of Environmental Quality
Date
700 NE Multnomah St, Suite 600 Portland, OR 97232
Date Permit Issued
Amount Received
Application to Renew 2401 and 2402
Graywater Reuse and Disposal System WPCF
File No.
General Permit
Check No.
Permit Registrants must complete this form prior to March 2, 2027 to ensure permit coverage following the
expiration date. The applicant must provide all requested information for this application to be considered
complete. An application that is incomplete or unsigned will be returned to the applicant to complete.
A. APPLICANT NAME AND CONTACT INFORMATION
Legal name of applicant:
1.
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:
3.
Township:
Section:
Longitude:
Range:
Tax Lot #:
GRAYWATER RESUSE AND DISPOSAL SYSTEM INFORMATION
bedrooms – (2401 permit)
4.
This is a:
Single family residence with
bedrooms OR duplex with
Other facility that produces graywater – (2402 permit)
Check one:
5.
No changes
Changes made (These changes still meet permit requirements)
ANNUAL REPORT INFORMATION
(Please check one)
6.
Annual Report is Attached
Annual Report Already Submitted
C. 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 is available for review at the request of
the permitting authority. I certify that the system is operated in compliance with this permit and the rules in OAR 340 Division
A wet signature of a legally authorized representative is required in order to process this application.
Please
053.
print out this application and sign.
Signature
Date
20170120~TLB
For DEQ Use Only
For DEQ Use Only
State of Oregon
Department of Environmental Quality
Date
700 NE Multnomah St, Suite 600 Portland, OR 97232
Date Permit Issued
Amount Received
Application to Renew 2401 and 2402
Graywater Reuse and Disposal System WPCF
File No.
General Permit
Check No.
Permit Registrants must complete this form prior to March 2, 2027 to ensure permit coverage following the
expiration date. The applicant must provide all requested information for this application to be considered
complete. An application that is incomplete or unsigned will be returned to the applicant to complete.
A. APPLICANT NAME AND CONTACT INFORMATION
Legal name of applicant:
1.
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:
3.
Township:
Section:
Longitude:
Range:
Tax Lot #:
GRAYWATER RESUSE AND DISPOSAL SYSTEM INFORMATION
bedrooms – (2401 permit)
4.
This is a:
Single family residence with
bedrooms OR duplex with
Other facility that produces graywater – (2402 permit)
Check one:
5.
No changes
Changes made (These changes still meet permit requirements)
ANNUAL REPORT INFORMATION
(Please check one)
6.
Annual Report is Attached
Annual Report Already Submitted
C. 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 is available for review at the request of
the permitting authority. I certify that the system is operated in compliance with this permit and the rules in OAR 340 Division
A wet signature of a legally authorized representative is required in order to process this application.
Please
053.
print out this application and sign.
Signature
Date
20170120~TLB
- IMPORTANT INFORMATION -
Send completed renewal application to:
Oregon Department of Environmental Quality
Attn: WQ Admin Support
700 NE Multnomah Street., Suite 600,
Portland, OR 97232
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.
Please answer all questions and submit your annual report as an attachment. Refer to your permit for more
information regarding your annual reporting requirements.
AN INCOMPLETE APPLICATION WILL NOT BE PROCESSED.
If the information requested is not applicable, please indicate as such.
A. APPLICANT NAME AND CONTACT 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
Enter the street address for the point of graywater generation.
1.
2.
Enter the latitude and longitude of the facility. Latitude and longitude can be obtained from DEQ's location finder
website at
http://deq12.deq.state.or.us/website/findloc/
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 https://www.oregon.gov/deq/FilterDocs/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 list the total number of bedrooms.
Properties with more than four bedrooms are not eligible for coverage under the 2401 General Permit. Other facilities
that produce graywater are eligible for coverage under the 2402 General Permit
Please indicate if there were any changes to the graywater reuse and disposal systems,
5.
Submit your annual report as an attachment. Refer to your permit for more information regarding your annual reporting
6.
requirements.
C. 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. Signature includes certification that operation was in
compliance.
20170120~TLB
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