Nevada Division of Environmental Protection

							                    Nevada Division of Environmental Protection
                       Bureau of Water Pollution Control

                   PERMANENT HOLDING TANK APPLICATION

                            GENERAL PERMIT No. GNEVPHT09

      Note: Permanent Holding Tanks may only be approved for the following: County, state or
      national parks; occasional use facilities such as county fairs and rodeos; or a holding tank
      under the control of a city or other legal entity authorized to construct, operate and maintain
      public sewerage systems.


Applicant: (Agency/Person responsible for the Holding Tank)

Name: _______________________________________________ Phone: ____________________________

Address: ________________________________________________________________________________

City: __________________________________________ State: _________________ Zip: _______________



Site Location(s): If more than one, please attach a legal description of each site.

Project Name_____________________________________________________________________________

Project Address: __________________________________________________________________________

City: ________________________________ County: ____________________ State______ Zip: __________

Latitude: ___________/ __________/ __________            Longitude: ___________/ ________/ ____________
             Deg.        Min.          Sec.                              Deg.      Min.        Sec.

Township_______________       Range________________ Section__________________


Note: Please include a site location map (i.e. USDS quadrangle), and a site layout map.

Description of discharge: Include reason for requesting a temporary/portable holding tank. Also describe
any water management practices, estimated daily flow and how the tank will be maintained to prevent
health hazards or nuisances (pumping schedule, odor control, spill containment, etc). Attach more sheets if
necessary.
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________________________________________________________________________________
                     Nevada Division of Environmental Protection
                          Bureau of Water Pollution Control

                            PERMANENT HOLDING TANK APPLICATION


THE FOLLOWING INFORMATION MUST BE INCLUDED WITH THE APPLICATION:


SITE PLAN:

_______ Site plan drawn to scale

_______ Setbacks shown and in accordance with NAC 445A

_______ Public sewer not available within 5 years and site not suitable for conventional system



DISCHARGE INFORMATION:

_______ Domestic sewage only

_______ Daily flow no greater than 500 gpd

_______ List all fixtures associated with discharge



HOLDING TANK INFORMATION:

_______ Minimum tank capacity of 2,000 gallons

_______ Tank must comply with all standards established in NAC 445A

_______ Tank designed and located for easy pumping

_______ Audible and visible alarm when tank is 75% at capacity

_______ No means of sewage overflow (vents, discharge piping, etc.)

_______ Tank designed for anti-buoyancy (if high groundwater is present)



PUMPING CONTRACTOR:

_______ Name of Pumping contractor

_______ Contractor Permit Number (Health Division)

_______ Copy of the contract with Septic Pumping Contractor

_______ Disposal site

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                              Nevada Division of Environmental Protection
                                  Bureau of Water Pollution Control

                              PERMANENT HOLDING TANK APPLICATION




Certification:

‘‘I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a holding tank designed to assure that it complies with Nevada Division of
Environmental Protection regulations. I also confirm that records will be maintained at the project site from the
start of activities, and that the site will be compliant. Based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the information, 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 fines for knowing violations.”




Printed Name of Applicant (Owner/Operator):_________________________________________________




Signature: ___________________________________________________ Date: ____________________




A copy of the permit will be mailed to you along with your discharge authorization.



Send completed form to:

                                      Nevada Division of Environmental Protection
                                      Bureau of Water Pollution Control
                                      901 S. Stewart Street, Suite 4001
                                      Carson City, Nevada 89701-5249




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