State Form 35058 - Application For Construction Permit For Public Water System - 327 Iac 8-3-3(A) - Indiana Department Of Environmental Management Page 2
Download a blank fillable State Form 35058 - Application For Construction Permit For Public Water System - 327 Iac 8-3-3(A) - Indiana Department Of Environmental Management in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete State Form 35058 - Application For Construction Permit For Public Water System - 327 Iac 8-3-3(A) - Indiana Department Of Environmental Management with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
932. Construction Permit Processing Fee Schedule
NOTE: THIS APPLICATION WILL BE RETURNED IF NOT ACCOMPANIED WITH THE REQUIRED FEE UNLESS THE APPLICANT IS
EXEMPTED BECAUSE THEY ARE 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
$
Chemical addition
$
250
1,750
Surface water:
Storage tank
$
200
Up to 500,000 gallons per day
$
1,250
Miscellaneous process modification
$
50
per
process
Greater than 500,000 gallons per day
$
2,500
B. Public water system treatment plant expansion
D. All water distribution system
Up to fifty percent (50%) design capacity
Up to 2,500 linear feet
$
0
Up to 500,000 gallons per day
$
625
2,501 - 5,000 linear feet
$
150
Greater than 500,000 gallons per day
$
1,250
5,001 - 10, 000 linear feet
$
250
Greater than fifty percent (50%) design capacity
Greater than 10,000 linear feet
$
500
Up to 500,000 gallons per day
$
1,250
Greater than 500,000 gallons per day
$
2,500
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.
P.O. Box 6015
Indianapolis, Indiana 46206-6015
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
Department of Environmental Management (DEM) give notice of
concerning the permit / variance decision would deny an-
its decision on your application to the following persons:
other party complete relief in the proceeding or who claims
an interest related to the issuance of the permit / variance
a. each person to whom the decision is specifically directed;
and is so situated that the disposition of the matter in the
b. each person to whom a law requires notice to be given;
person's absence may;
c. each competitor who has applied to the DEM for a mutual-
1 . as a practical matter impair or impede the persons abil-
ly exclusive license, if issuance is the subject of the deci-
ity to protect that interest, or
sion and the competitor's application has not been denied
2. leave any other person who is a party to a proceeding
in an order for which all rights to judicial review has been
concerning the permit subject to a substantial risk of
waived or exhausted;
incurring multiple or otherwise inconsistent obligations
d. each person who has provided the DEM with a written re-
by rea so n of the p erson' s claim ed in terest.
quest for notification of the decision;
IC 4-21.5-3-5(f) provides that we may request that you assist
e. each person who has substantial and direct proprietary
us in identifying these people. Our failure to properly identify
interest in the issuance of the permit / variance;
and notify these people of the decision could result in voiding
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 if there are ten (10) or less
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 and provided mailing labels, as defined by IC 4-
21.5, known to me. 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
ADVERTISEMENT
0 votes
Related Articles
Related forms
Instructions For Completing The Application For Construction Permitfor Public Water System - 327 Iac 8-3-3 (a) - Indiana Department Of Enviromental Management
Legal
Form 12094 - Public Water Supply Application For Water Treatment Plant And Water Distribution System Operator - Indiana Department Of Environmental Management Drinking Water Branch
Legal
State Form 12094-application For Water Treatment Plant And Water Distribution System Operator Certification-indiana Department Of Environmental Management Drinking Water Branch
Legal
Form 49008 - Notice Of Intent To Construct A Water Main Extension - Indiana Department Of Environmental Management
Legal
State Form 43692 - Request For Variance From 326 Iac 4-1 - Indiana Department Of Environmental Management
Legal
State Form 49401 - Npdes General Permit Notice Of Intent Submittal Application - Indiana Department Of Environmental Management
Legal
State Form 50014 - Pollution Complaint Clearinghouse: Pollution Complaint Form - Indiana Department Of Environmental Management
Legal
State Form 44593 - Notification Of Demolition And Renovation Operations - Indiana Department Of Environmental Management
Legal
Related Categories
Parent category: Legal