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29. Construction Permit Processing Fee Schedule

NOTE: THIS APPLICATION WILL BE RETURNED IF NOT ACCOMPANIED WITH THE REQUIRED FEE UNLESS THE APPLICANT IS

AN EXEMPTED GOVERNMENT ENTITY, WHICH INCLUDES A COUNTY, MUNICIPALITY, OR TOWNSHIP WHICH IS DEFINED AS A

UNIT UNDER IC 36-1-2-23, A NONPROFIT ORGANIZATION , A CONSERVANCY DISTRICT, A SCHOOL CORPORATION, OR

REGIONAL WATER OR SEWAGE DISTRICT [327 IAC 8-3-7(a)].

A. New public water system treatment plant

C. Other water treatment facilities

Groundwater:

Wells

$ 500

Up to 500,000 gallons per day

875

Pump or pump station

$ 100

Greater than 500,000 gallons per day $ 1,750

Chemical addition

$ 250

Surface water:

Up to 500,000 gallons per day

$ 1,250

Storage tank

$ 200

Greater than 500,000 gallons per day $ 2,500

Miscellaneous process modification

B. Public water system treatment plant expansion

$ 50 per process

Up to fifty percent (50%) design capacity

D. All water distribution system

Up to 500,000 gallons per day

625

Up to 2,500 linear feet

Greater than 500,000 gallons per day $ 1,250

2,501 - 5,000 linear feet

$ 150

Greater than fifty percent (50%) design capacity

5,001 - 10, 000 linear feet

$ 250

Up to 500,000 gallons per day

$ 1,250

Greater than 500,000 gallons per day $ 2,500

Greater than 10,000 linear feet

$ 500

THE COMPLETED APPLICATION, ALONG WITH ALL REQUIRED FEES AND ATTACHMENTS SHOULD BE MAILED TO:

Drinking Water Branch

Indiana Department of Environmental Management

100 N. Senate Ave.

Indianapolis, Indiana 46204

Make checks payable to: Indiana Department of Environmental Management (Account # 3240-414000-140000)

30. Identification of potentially affected persons

The Administrative Orders and Procedures Act requires that the

f. each person whose absence as a part in the proceedings

concerning the permit / variance decision would deny an- other

Department of Environmental Management (DEM) give notice

party complete relief in the proceeding or who claims an

of its decision on your application to POTENTIALLY

interest related to the issuance of the permit / variance and is

AFFECTED PERSONS AS DEFINED BY IC 4-21.5-3-5(b)

so situated that the disposition of the matter in the person's

including:

absence may;

a. each person to whom the decision is specifically directed;

1 . as a practical matter impair or impede the persons abil-

b. each person to whom a law requires notice to be given;

ity to protect that interest, or

c. each competitor who has applied to the DEM for a mutually

2. leave any other person who is a party to a proceeding

exclusive license, if issuance is the subject of the decision and

concerning the permit subject to a substantial risk of

the competitor's application has not been denied in an order for

incurring multiple or otherwise inconsistent obligations

which all rights to judicial review has been waived or exhausted;

by reason of the person's claimed interest.

d. each person who has provided the DEM with a written re-

IC 4-21.5-3-5(f) provides that we may request that you assist

quest for notification of the decision;

us in identifying these people. Our failure to properly identify

e. each person who has substantial and direct proprietary

and notify these people of the decision could result in voiding

interest in the issuance of the permit / variance;

the decision which is made.

List below persons whom you have reason to believe have a substantial or proprietary interest in this matter, or could otherwise be

considered to be potentially affected under the law. Failure to notify a person who is later determined to be potentially affected could

result in voiding our decision on procedural grounds. To ensure conformance with the Administrative Orders and Procedures Act and to

avoid reversal of a decision, you must list all such parties and must provide mailing labels for all potentially affected parties.

The labels shall read as follows: Name of affected party, Address (number and street or rural route number), City, State and ZIP

code.

(Optional) If ten (10) or more potentially affected parties, please indicate name and address of local newspaper(s) covering where the

construction will take place:

Name of local newspaper(s)

Address of local newspaper(s) (number and street)

City, state, ZIP code

I certify, that to the best of my knowledge, I have listed all the potentially affected parties, as defined by IC 4-21.5-3-5(b), known to me

and provided mailing labels. If "NONE" is indicated it signifies that no such parties exist.

Official signature of Public Water System

Date signed (month, day, year)

Printed name and title of official

Page 2

Form 35058 - Application For Construction Permit For Public Water System And Instructions Page 4

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