Application for Certificate of Exemption to Retain a Sewage Ejector System Upon Transfer or Subdivision of Land

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Application for Certificate of Exemption to Retain a Sewage Ejector System Upon Transfer or Subdivision of Land

Onsite Wastewater Management Systems

Applicant Name

This application is made pursuant to section 14.3(2) of MR 83/2003 for a certificate of exemption. I hereby certify that the information contained in this form is correct and in accordance with the Onsite Wastewater Management Systems Regulation (MR 83/2003).

Personal information is collected under the authority of The Environment Act and the Onsite Wastewater Management Systems Regulation (MR 83/2003) and will be used only for administration and enforcement purposes. Information collected is protected by the privacy provisions in The Freedom of Information and Protection of Privacy Act.

I agree to the statement above.

Applicant Information

Mailing Address

City/Town

Province

Postal Code

Phone Number

Email Address

Confirm Email Address

Legal Description Upon Which Sewage Ejector is Located

Rural Municipality

Roll Number (optional)

Manitoba Assessment Map with Roll Numbers.

Winnipeg Assessment Map with Roll Numbers.

Select how you would like to provide the Legal Land Description (Up to 3): Civic Address 911 Address Lot, Block, Plan Lot, Block, Lake Sections, Township, Range River Lot Parish Settlement Coordinates

Civic Address

Street Address

City/Town/Village

911 Address

Street Address

City/Town/Village

Lot, Block, Plan

Lot or Parcel Number	Block Number	Plan Number

Lot, Block, Lake

Lot or Parcel Number	Block Number	Lake

Section, Township, Range

Quarter Section

If Quarter Section does not satisfy your needs, enter information here

Section	Township	Range	Side of Prime Meridian

River Lot

River Lot Number

Parish

Parish Number

Settlement

Settlement Number

GPS Coordinates

Latitude	Longitude
no text	no text

Additional Land Location Information (optional)

0/150

Request for Transfer of land Proposed subdivision of land

Indicate if measurements are metric or imperial Hectares/Metres Acres/Feet

Was a variance to allow the sewage ejector to be located on 5 acres for a farm subdivision previously obtained? Yes No

Property Size

The identified property size does not meet the current requirement, please contact your local environment officer to discuss your proposal.

Is sewage ejector connected to more than one single family dwelling? Yes No

Sewage Ejector Location Information

Is the system located on soil class 6 or 7 or unimproved organic soil?

For help determining soil class, please use the dryland agriculture capability layer in the Detailed Soil Survey or Reconnaissance Soil Survey Data in AgriMaps

Yes No Unsure

Is the system located in the Red River Corridor Designated Area? Yes No

Is the system located in Provincial Park Crown Land Sensitive Area NA

Distance from sewage ejector to

Definitions for the following setback requirements, please refer to the Onsite Wastewater Management Systems Regulation

The identified setback does not meet the current requirement, relocation of the sewage ejector may be required to achieve compliance. Please contact your local environment officer if you have questions.

Nearest property boundary

Dwelling

Well

N/A

Watercourse

N/A

Cut/embankment

N/A

Market Garden

N/A

Boundary of City/Town/Village

Greater than 2km?

Year existing sewage ejector system was installed

Ejector may not be able to be retained since the regulation prohibited the installation of new systems installed after 2009.

Unknown

Site Plan

Attach a site plan.

All documents submitted must be .jpg or .jpeg files and no larger than 3MB each in size.

If you experience issues submitting the form please contact your local environment officer

The site plan must include the following information:

Property size (hectares/acres); dimensions; boundaries
Location of sewage ejector system and distances to any of the following: wells, inhabited buildings, water service pipe, watercourses, cut/embankment, property boundary

A sample site plan and worksheet can be found here.

Application Fee

GST registration number: R107863847

Application Fee plus 5% GST:

$150 registration fee
$7.50 GST
Total: $157.50

Once submitted, the form cannot be saved or printed.