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Onsite Wastewater Treatment System Construction Permit Form - Rhode Island Department Of Environmental Management Page 2

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ri form - side 2.qxp

1/31/2008

11:11 AM

Page 1

INSTRUCTIONS FOR COMPLETING APPLICATION

1. The owner must complete the owner’s information section of the application, sign in the certification section, and furnish a telephone

number.

2. The licensed OWTS designer must complete the remainder of the application except areas marked FOR RIDEM USE ONLY and

PERMIT APPROVAL SECTION.

3. Check all TYPES OF APPLICATIONS that apply..

4. If an alternative or experimental technology system is proposed, the A/E TECHNOLOGY box must be checked and the TYPE OF

SYSTEM must be completed.

5. All site information including plat and lot, subdivision information, and lot size must be completed.

6. Any previous RIDEM application information must be shown including groundwater table verification and wetlands determination or

permit.

7. Only one box should be checked for BUILDING USE. IF COMMERCIAL, provide a brief description.

8. Only one box should be checked for WATER SUPPLY.

9. Design information must accurately reflect the type and size of the septic system shown on the accompanying plans.

10. RIDEM APPLICATION HISTORY, DESIGN INFORMATION, and Signature of Designer are not needed for a transfer application.

11. IMPORTANT: This application is a part of a design submission that must include 4 (four) copies of the design plan, 4 (four) copies of

any attachments such as calculations or details, a designers checklist, and the appropriate fee.

12. MAIL OR DELIVER TO:

Rhode Island Department of Environmental Management

Onsite Wastewater Treatment Program

Office of Water Resources, Room 260

235 Promenade Street

Providence, Rhode Island 02908-5767

If you have any questions relating to this application, please call (401) 222-6820 Monday through Friday, 8:30 am to 4:00 pm.

Onsite Wastewater Treatment System Construction Permit Form - Rhode Island Department Of Environmental Management Page 2