B08_Attachment_08_GRTE_237343_-_WY_DEQ_Permit_Application_4-Lazy_F_NPS_signed_07_29_2026.pdf

App. No. ____ _ yoming • • • on for a C • This application is for permits to construct water or wastewater treatment facilities, water distribution or wastewater collection facilities, subdivision reviews, or land application of wastewater. Submit a complete application package {including this form and applicable investigations, design reports, plans, specifications, etc.) as described in Water Quality Rules and Regulations, Chapter 3 to the appropriate District Office address listed below or electronically at:

https://deq.wyoming.gov/water-quality/water-wastewater/permitting/. A District map can be viewed at:

https://gis.deq.wyoming.gov/maps/www districts/index.html

For the Southeast District, submit completed packages to: a-,;.... __ ...;_.;...__;........;=W.;..Q-=-D--U...;s;..;;e ..... O,;;,..n_l..a...::;=,.;;;.;;.;;.-------1

DEQ/ Water Quality Division 200 W 17th Street, Suite 400 Cheyenne, WY 82002

(307) 777-7781 For the Northeast District, submit completed packages to:

DEQ/Water Quality Division 2100 West 5th Street Sheridan, WY 82801 {307) 675-5640 For the Northwest and Southwest Districts, submit completed packages to:

DEQ/Water Quality Division 510 Meadowview Drive Lander, WY 82520 {307) 332-3144

4 Lazy F Ranch

Rehabilitation of Cabins at Grand Teton National Park ubdivision Name: Lot and Block:

Township: 43N Range:

Decimal Latitude: 43.666891 Decimal Longitude: -110.705355

Company Name: Grand Teton National Park

Printed Name:

Title:

Mailing Address: PO Box 170

City, State: Moose, WY Zip:83012

Phone Number: Email:

Printed Name: Celine Saucier Company Name: Morrison Maierle

Title: Design Engineer MailingAddress:2880 Technology Blvd W

116W

Phone Number: 406-922-6822 City, State: Bozeman, MT Zip: 59715

Email: csaucier@m-m.net WY P.E.#:22195 WYP.G.#

June 2024

Authority: The Wyoming Environmental Quality Act, W.S. 35-11-101 and Article 3, W.S. 35-11-301 require a permit for the construction or modification of public water supplies, wastewater facilities, and land application systems. W.S. 18-5-

306 requires the review of the safety and adequacy of proposed sewage systems and water systems in new subdivisions by DEQ. Please select all rules that apply to the permitting of your project from the list below. A list of all current Water

Quality rules and regulations may be found at: https://rules.wyo.gov/Search.aspx?mode=l

[Z] 11

□ 25

□ 26

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Design and construction standards for sewerage systems, treatment works, disposal systems, or other facilities capable of causing or contributing to pollution. This chapter also includes mobile home park and campground sewerage, public water supply distribution systems, road application of wastewater, and reuse of treated wastewater.

Design and construction standards for public water supplies, including subdivision water supplies and water line extensions.

Septic tank and/or soil absorption systems and other small wastewater systems. This form is required for all engineered non-conventional systems. Do not use this form if you are already using a DEQ-designed application package.

Well construction standards for commercial, municipal, and industrial waste wells; special process discharge wells; artificial recharge and miscellaneous discharge wells; geothermal wells; observation and monitoring wells; and test wells.

Permitting, design, and operation standards for commercial oilfield waste disposal facilities.

Other Briefly describe: Well Abandonment

WQD Permit to Construct (Chapter 3 Permit) 15-585 (original ~ 'NWT? permi1 to construct); 15-040 (original Mooae -ter system & line to

WQD Subdivision Recommendation to County

WQD Underground Injection Control (UIC) •

WQD CAFO Permit

WYPDES Discharge Permit

Oil and Gas Commission

Solid .and Hazardous Waste

State Engineers Surface Water Right or Well Permit

US EPA Public Water Supply (PWS) Number

Other

June 2024 Page 2 of 3

As part of this application, the applicant shall certify under penalty of perjury that the applicant has secured and shall maintain permission for Department of Environmental Quality personnel and their invitees to access the permitted site, including (i) permission to access the land where the site is located, (ii) permission to collect resource data as defined by Wyoming Statute §

6-3-414, and (iii) permission to enter and cross all properties necessary to access the site if the site cannot be directly accessed from a public road. A map of the access route(s) to the site shall accompany this application.

All undersigned certify under penalty of perjury that the owner or applicant has secured and shall maintain permission for Department of Environmental Quality personnel and their invitees to access the permitted site, including (i) permission to access the land where the site is located, (ii) permission to collect resource data as defined by Wyoming Statute§ 6-3-414, and (iii) permission to enter and cross all properties necessary to access the site if the site cannot be directly accessed from a public road.

All undersigned agree to comply with all applicable Wyoming Statutes and Regulations and to allow the activities described in this application.

Signature: Date: 07/29/2026

Printed Name: Russel T nt1e: Facility Manager ealEstate/Land/Easement different plicalit)

Signature: Date:

Printed Name: Company:

Mailing Address: Zip Code:

Title: E-Mail: Phone:

Section 35-11-901 of Wyoming Statutes provides that:

*All permit applications shall be signed in accordance with 40 CFR Part 122.22, "for" or "by" signatures are not acceptable.

Section 35-11-901 of Wyoming Statutes provides that: Any person who knowingly makes any false statement, representation, or certification in any application, shall upon conviction be fined not more than $10,000 or imprisoned for not more than one year, or both.

-. - , f, ... ,- -- Persons considered to be 'Authorized Sl1natorles' for this appllcatlon

For corporations: A principal executive officer of at least the level of vice president, or the manager of one or more manufacturing, production, or operating facilities, provided the manager is authorized to make management decisions governing the overall operation of the facility.

For partnerships: A general partner.

For a sole The proprietor.

proprietorship:

For a municipal, state, federal, Either a principal executive officer, public works director, city engineer, or ranking elected or other public facility: official.

June 2024 Page 3 of 3

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