DEQ Home - Oklahoma Department of Environmental Quality



REQUESTER INFORMATION(If you are a certified installer, please fill out certification number, first/last name, and any changes to your contact information)Certification Number: FORMTEXT ????Installer’s First Name: FORMTEXT ?????Installer’s Last Name: FORMTEXT ?????Contact First Name: FORMTEXT ?????Contact Last Name: FORMTEXT ?????Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ??Zip: FORMTEXT ?????Contact Phone Number:( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Fax Number:( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Email Address: FORMTEXT ?????PROPERTY INFORMATIONCurrent Property Owner First Name: FORMTEXT ?????Last Name: FORMTEXT ?????Property Owner’s Email Address: FORMTEXT ?????Property Address: FORMTEXT ?????County Where Property is Located: FORMTEXT ?????City: FORMTEXT ?????State:OKZip: FORMTEXT ?????Phone Number:( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Subdivision: FORMTEXT ?????Lot: FORMTEXT ?????Block: FORMTEXT ?????***The following information must be completed in order for DEQ to process the request for services form.The information may be obtained from the deed or the county assessor’s office.***Section: FORMTEXT ????Township: FORMTEXT ????Range: FORMTEXT ????REQUESTED SERVICEREQUESTED SERVICES FEES EFFECTIVE JULY 1, 2022 THROUGH JUNE 30, 2023For expedited service the DEQ recommends paying online at:, please select all services being requested at this time and then select a form of payment. If you choose Visa or MasterCard, or purchase order you may fax this request to (405)702-7120. If not, mail this request and your check or money order made payable to DEQ to the address below.OK Department of Environmental QualityAdministrative Services – Accounts ReceivablePO Box 2036Oklahoma City, OK 73101-20362929301415-100070 FORMCHECKBOX Soil Test (DEQ augered)$324.772929301415-100071 FORMCHECKBOX Soil Test (pits provided by applicant)$194.85Type of system to be installed: FORMCHECKBOX Conventional Subsurface Absorption/Shallow Extended FORMCHECKBOX Evapotranspiration/Absorption (ETA) FORMCHECKBOX Lagoon FORMCHECKBOX Aerobic-Spray FORMCHECKBOX Aerobic-Drip FORMCHECKBOX Low Pressure Dosing (LPD)Installer is certified to self-inspect the system2929301415-100102 FORMCHECKBOX Authorization/Permit to Construct Design Flow < 1500 gpd$324.772929301415-100106 FORMCHECKBOX Authorization to Construct a Modification of Existing System$194.85Installer is not certified to self-inspect the system2929301415-100103 FORMCHECKBOX Authorization/Permit to Construct Design Flow <1500 gpd$454.672929301415-100105 FORMCHECKBOX Authorization/Permit to Construct Design Flow >1500 gpd$584.562929301415-100104 FORMCHECKBOX Authorization to Construct a Modification of Existing System$324.77Alternative system review (not required for systems installed in accordance with 641)2929301415-100101 FORMCHECKBOX Alternative System Plan Review$259.79TOTAL: FORMTEXT ?????PAYMENT INFORMATION FORMCHECKBOX Check if billing address is same as requester. If not, complete the following:Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ??Zip: FORMTEXT ?????Phone Number: FORMTEXT ????? FORMCHECKBOX Check made payable to DEQ FORMCHECKBOX Money Order made payable to DEQ FORMCHECKBOX Credit Card (Visa or MasterCard ONLY)Name on Card: FORMTEXT ?????Signature of Authorized User:Card Type: FORMCHECKBOX Visa FORMCHECKBOX MasterCardExpiration Date: FORMTEXT ??/ FORMTEXT ????MonthYearCard Number: FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? ................
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