Renewal Term
LICENSE No.
installrenew.pdf
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TAX CERTIFICATION Any person applying for any license or permit to conduct a business or occupation within Rhode Island or any
person renewing a motor vehicle operators license or motor vehicle registration within Rhode Island must have filed all required state tax
returns and paid all taxes due the state or must have entered into a written installment agreement to pay delinquent state taxes that is
satisfactory to the Tax Administrator.
I hereby declare, under penalty of perjury, that I have filed all required state tax returns and have either paid all
taxes due the state or have entered into a written installment agreement with the Rhode Island Division of Taxation.
Telephone: 401-222-3961; Rhode Island Relay: 711
Fees - Including Late Fee Information
Submitted between 01/01/23 and 12/31/23
For office use only
Date ________________ Amount ________________ Ck# ________________ Note ______________
INSTALLER LICENSE RENEWAL APPLICATION FEES
RHODE ISLAND DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Office of Water Resources - Groundwater and Freshwater Wetlands Protection
Onsite Wastewater Treatment System Program
235 Promenade Street, Providence, RI 02908
License Term: January 1, 2021 through December 31, 2023
APPLICATION FOR OWTS INSTALLER LICENSE RENEWAL
3 Years
2021, 2022, 2023
(Next renewal
due by 12/31/23)
For applications submitted by 12/31/20
Submitted between 01/01/21 and 12/31/21
Submitted between 01/01/22 and 12/31/22
No Renewals After 12/31/23; License Expired over 3 years
SIGNATURE
Renewal Fee = $150.00.
Renewal+Late Fee = $250.
Renewal+Late Fee = $350.
Renewal+Late Fee = $450.
Reapply & Take Exam
BUSINESS PHONE WITH AREA CODE
RESIDENTIAL PHONE WITH AREA CODE
RESIDENTIAL EMAIL
BUSINESS EMAIL
BUSINESS ADDRESS
Or address, phone & email for listing on RIDEM website
RESIDENTIAL ADDRESS
If you want home address on website, write it in space at left!
NEW ADMINISTRATIVE PROCESS: Upon receipt of this form and required fee, your application will be reviewed for completeness
and compliance with
OWTS Rule 6.14.
You will receive a written notice only for expiration, citing the reason for the expiration. Any
valid license, for which a complete renewal application is submitted on or before December 31, 2020, shall be considered valid.
An email will be sent to the business email provided below to inform you of continued active license status and the updated List of
Licensed OWTS Installers will be posted on RIDEM's OWTS Licensing website in January 2021.
NOTE: that there will be NO GRACE PERIOD. As of January 1, 2021, if an Application for OWTS Installer License Renewal is not received
by this office the license will be expired. Forms that are post-marked or received by drop-off at RIDEM after December 31, 2020 will be late
renewals and a late fee will be due.
Visit our OWTS Licensing webpage at: dem.ri.gov/owtslicensing
Please subscribe to our OWTS info E-mail list service to stay informed on current program information.
ONLINE PERMIT SEARCHES provide permit status, historical information and downloadable documents at: dem.ri.gov/waterpermits
INSTRUCTIONS: Submit completed form and a check made payable to the RI General Treasurer, to the address above.
BUSINESS CITY, STATE ZIP
RESIDENTIAL CITY, STATE ZIP
DATE
APPLICANT'S SIGNATURE
PRINT NAME