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State of Ohio Environmental Protection Agency

 

Division of Surface Water

Supplement to Form A – B1

Division of Environmental & Financial Assistance

 

 

 

Permit-to-Install/Plan Approval Application

Sanitary Sewers

FOR AGENCY USE ONLY

Application Number:

Date Received: /

/

 

 

Applicant:

Facility Owner:

Ultimate owner (if different):

Application/Plans Prepared by:

Project Name:

1. Project Description

a. Describe the location, size and current development of the area to be served. List street address, township, county, and include longitude and latitude coordinates in describing location.

b. What is the possibility that future sanitary sewer extensions will connect to the sanitary sewers which are the subject of this application?

c. Are there any pump stations included as part of this sewer construction? (If Yes, fill out attachment to Form B1)

d. Indicate type(s) of sewers proposed (check all that apply):

Conventional gravity

Small diameter gravity (w/septic tanks)

Vacuum

Siphon

Yes

No

Pressure (GP or STEP)

Force main (must include pump station)

2. Pipe Specifications

Please identify each type (as indicated in 1d above) and size of pipe included in this project.

Type

Pipe

Pipe

Material *

Joint*

Bedding**

Minimum

Size

Material

Specification

Specification

Classification

Slope

 

Pipe

Length

Maximum

Manhole

Spacing

*List ASTM, AWWA, or ANSI specification number. For any specification that does not appear on Ohio EPA’s pipe specification list, the applicant shall submit the standard for approval with the Permit-to-Install.

** 100 percent to pass ¾-1.0 inch sieve. ASTM C-12 (A, B, C), D-2321 (IA, IB, II, III), or other. Ohio EPA Approvable Pipe Specification List: http://www.epa.ohio.gov/dsw/pti/PipeSpecs.aspx

EPA 4309 (rev. 9/09)

Form B1

Page 1 of 4

3. Design Flow in Proposed Sewer

Identify flows expected at start-up (for example, currently existing flows plus design flow for this project) and the flows expected at design (for example, start-up flows plus flows from future phases of development) at terminus of proposed sewer.

 

Average Daily Flow

 

Peak Hourly Flow

Start-Up Flows (based on immediate area served)

 

MGD

 

 

MGD

Design Flows (based on planned area served)

 

MGD

 

 

MGD

 

 

 

Hydraulic Capacity of Sewer

 

MGD

 

 

MGD

 

 

 

 

 

 

 

 

 

Assumptions used to calculate above flows: (check all that apply)

 

Start-Up

 

 

Design

 

Residential Population at:

 

gal/home*

 

homes

 

 

 

homes

 

 

 

 

 

 

 

 

 

 

 

 

Residential Population at:

 

gal/cap/day

 

people

 

 

 

people

 

 

 

 

 

 

 

 

 

 

 

 

Non-Residential Flows (for example commercial, industrial, etc.):

 

MGD

 

 

 

MGD

 

 

 

 

 

 

 

 

 

 

Computer Flow Modeling Results (attach explanation and data)

 

 

 

 

 

 

 

*120 gallon/bedroom in accordance w/ OAC 3745-42-05 unless additional information is submitted

4. Receiving Wastewater Treatment Facility

a. What treatment facility will be receiving flow from these sewers?

Present treatment facility average daily flow

 

MGD (based on

/20

(month/year) ADF)*

 

 

 

 

 

Proposed treatment facility average daily flow (based on present average daily flow plus all connections currently under construction or being designed)

Design average daily flow of the treatment facility

MGD (based on

b.Does the treatment facility have adequate capacity to treat anticipated flows from existing sewers plus the proposed sewers based on the sewer's design capacity?

If No, on a separate sheet, please describe the steps being taken to ensure that the treatment facility has adequate capacity. Include specific work items and schedules as appropriate.

MGD design year)

Yes No

c. Is there intent to expand the treatment facility to treat additional flows?

Yes

No

*Note: Flow data to be no older than one calendar year from date of PTI submission

5. Sewer Design

a. Are the sewers deep enough to serve all adjacent basements?

(refer to GLUMRB, Recommended Standards for Wastewater Facilities, 2004, Section 33.2)

If No, please explain how the basements will be served:

b. Are sewers at a sufficient depth to prevent freezing? (GLUMRB Section 33.2)

If No, please explain how freezing will be prevented:

c. Where small sewers join larger ones, have the inverts of the larger sewers been lowered sufficiently to maintain the same energy gradient? (GLUMRB Section 33.6)

d. Have provisions been made to protect sewers against displacement by erosion and impact at velocities over 15 fps? (GLUMRB Section 33.45)

e. Are sewers with slopes greater than 20 percent secured with concrete anchors (or equal), spaced as required? (GLUMRB Section 33.46)

f. Are there any overflows or bypasses upstream of the point of connection that may be impacted by the flows from the new sewer?

g. Are there any sanitary overflows or bypasses or combined sewer overflows downstream of the point of connection?

* (If Yes to f. or g., on a separate sheet provide a description of the exact location of any overflows or bypasses)

Yes No

Yes No

Yes No

Yes No

Yes No

Yes* No

Yes* No

N/A

N/A

N/A

h. Is the force main designed to withstand water hammer pressures and associated cyclic reversal of stresses that are expected with the cycling of wastewater pump stations?

(GLUMRB Section 49.4)

If No, please explain:

Yes

No

N/A

EPA 4309 (rev. 9/09)

Form B1

Page 2 of 4

(GLUMRB Section 38.2)
(GLUMRB Section 38.1)
(GLUMRB Section 34.2)
(GLUMRB Section 34.6)

6. Stream Protection

a. Are there any stream crossings? (If Yes, fill out the stream evaluation addendum)

 

Yes*

No

 

If Yes,

 

 

 

 

 

1.

How many crossings are made? (GLUMRB Section 36.14)

Number of crossings:

 

 

 

 

 

 

 

 

 

 

2.

Are the crossings perpendicular to the stream? (GLUMRB Section 36.14)

 

 

Yes

No

 

3.

Are crossings to be made at previously disturbed areas?

 

 

Yes

No

 

4.

Is the streambed substrate composed primarily of solid rock, sand and gravel, or silt?

Rock

Sand/gravel

Silt

5.

In areas of steep slope or unstable soils, are the sewers located on more level, terraced areas?

Yes

No

N/A

6.

Are the sewers at a sufficient depth to protect the sewer line? (GLUMRB Section 36.11)

 

Yes

No

N/A

b. Do any sewers run parallel to any streams?

 

 

Yes*

No

 

If Yes,

 

 

 

 

 

1.

Is there any woody vegetation along the stream banks?

 

 

Yes

No

 

2.

Are the sewers and construction easements located outside of the vegetated areas?

 

Yes

No

N/A

3.

In areas of steep slope or unstable soils, are the sewers located on more level, terraced areas?

Yes

No

N/A

*If the response to either a. or b. is Yes, please provide the specific measures in the detail plans and specifications that will be used to ensure that damage to the stream corridor is minimized to the greatest extent possible and that the stream corridor is restored to original condition.

7. Manhole Design

a. Manhole type (precast cast-in-place, etc.):

b. Material specification (ASTM):

c. Joint specification (ASTM):

d. Are watertight frames and covers used wherever manhole tops may be flooded by street runoff or high water?

If No, explain*:

e. Are manholes provided at the upstream end of each line? (GLUMRB Section 34.1)

If No, explain*:

Yes

Yes

No

No

N/A

f. Are manholes provided at all changes in size, grade, and alignment? (GLUMRB Section 34.1)

If No, explain*:

Yes

No

g. Are manholes provided at all sewer intersections? (GLUMRB Section 34.1)

If No, explain*:

Yes

No

h. Are drop manholes provided where the entrance sewer invert is 24 inches or more above the manhole invert?

If No, explain*:

i. Are inlet/outlet pipes connected with gasketed flexible watertight connections? (GLUMRB Section 34.6)

If No, explain*:

* Attach any additional sheets necessary for explanations.

Yes

Yes

No

No

N/A

8. Protection of Water Supplies

a. Are there any physical connections between the sewer and a public or private potable water supply system (including all appurtenances)?

b. Are any existing public waterworks units (for example public supply wells, water treatment facilities, storage facilities) within 200 feet of the proposed sewer or any private wells within

50 feet of the proposed sewer?

Yes

Yes

No

No

If Yes, specify the plan sheets on which the sources are shown:

 

 

 

If Yes, will sewers be encased or constructed of watertight pipe?

Encased

Watertight

 

c. Are the sewers at least 10 feet horizontally separated from water lines? (GLUMRB Section 38.31)

Yes

If No, please specify the plan sheets where these conditions are not met & describe the measures taken to ensure protection of the water system:

No

d. When crossing water mains, are the sewers at least 18 inches below water lines?

Yes

If No, please specify the plan sheets on which these conditions are not met and describe the measures taken to ensure protection of the water system:

No

EPA 4309 (rev. 9/09)

Form B1

Page 3 of 4

9. Installation and Testing

a. Installation Inspector:

Name:Firm:

Street Address:

City:State:

b. What type of sewer leakage test will be used? (GLUMRB 33.9)

Page numbers in specifications for testing requirements of gravity and pressure sewers:

c. Is flexible pipe deflection testing specified? (GLUMRB 33.85)

Page numbers in specifications for testing requirements of flexible pipe:

d. What type of manhole testing will be used? (GLUMRB Section 34.7)

Page numbers in specifications for testing requirements of manholes:

Phone: ( )

-

 

Zip:

 

 

 

 

 

 

 

 

 

Hydrostatic

Air

 

 

 

 

Yes

No

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. Sewer Use Ordinance

A statement that "Roof drains, foundation drains, and other clean water connections to the sanitary sewer system are prohibited" must be shown on the plans. Copies of the ordinances or regulations providing for the enforcement of this requirement must be on file with Ohio EPA.

a. An ordinance/regulation to this effect was adopted on:

/ /

(date).

 

 

 

 

 

 

 

 

 

 

b. Enforcement of this ordinance/regulation is the responsibility of:

 

 

 

 

Name:

 

 

 

 

 

 

 

 

 

 

 

 

Title:

 

 

 

 

 

 

 

 

 

 

c. It is the opinion of the engineer submitting these plans that adequate enforcement

 

 

 

of this ordinance/regulation is being properly carried out.

 

Yes

No

Unknown

11. Authorities

a. Plans for the proposed installation of a county, village, or municipal sewer that is tributary to a sewage treatment plant with another political entity must be accompanied by written consent of both entities.

Is a written inter-municipal agreement attached? If No, state what form of consent is provided:

Yes

No

N/A

12. Submittals:

This application must include the following unless otherwise directed by Ohio EPA:

Four copies of the detail plans including profile and plan views of all sewers (shown on the same sheet), existing (as applicable) and proposed pump station facilities, incorporating all of the details outlined in Section 20.1, 20.2 and 20.3 of Recommended Standards for Wastewater Facilities.

Two copies of complete technical specifications.

Two copies of the Application including Form A, pertinent B & C form(s), and antidegradation addendum (if applicable)

13. The foregoing data is a true statement of facts pertaining to this proposed sanitary sewer installation.

Date:

/

/

Signed:

 

P.E.

 

 

 

 

 

 

Plans prepared by:

EPA 4309 (rev. 9/09)

Form B1

Page 4 of 4

Document Properties

Fact Name Details
Form Title Ohio EPA 4309 - Supplement to Form A – B1 for Sanitary Sewers
Governing Law OAC 3745-42-05 governs the design flow calculations.
Application Purpose This form is used for permit-to-install and plan approval applications for sanitary sewer systems.
Required Submittals Applicants must submit four copies of detailed plans and two copies of technical specifications.
Design Flow Calculation Applicants must provide average daily and peak hourly flow estimates for the proposed sewer.
Stream Protection If stream crossings are present, an evaluation addendum must be completed.
Manhole Requirements Manholes must be provided at all changes in size, grade, and alignment, as per GLUMRB standards.
Water Supply Protection Physical connections between the sewer and potable water systems must be avoided.
Installation Testing Testing methods for sewer leakage and manholes must be specified in the application.
Enforcement of Sewer Use Ordinance Ordinances prohibiting clean water connections to sanitary sewers must be on file with Ohio EPA.

Documents used along the form

The Ohio EPA 4309 form is an essential document for those involved in the planning and installation of sanitary sewer systems. However, it is often accompanied by several other forms and documents that play a critical role in ensuring compliance with environmental regulations and project specifications. Below is a list of related documents commonly used in conjunction with the Ohio EPA 4309 form.

  • Form A: This form serves as the initial application for a Permit-to-Install or Plan Approval. It provides basic information about the project, including the applicant's details and a brief project description.
  • Form B: This form is used to provide detailed technical specifications and design information for the proposed sewer system. It complements the Ohio EPA 4309 by offering more in-depth insights into the engineering aspects of the project.
  • Form C: Often required for projects involving wastewater treatment facilities, this form includes additional data regarding the treatment process and capacity of the facility that will handle the sewage from the new sewer lines.
  • Antidegradation Addendum: This document is necessary when a project may impact water quality. It outlines measures to minimize degradation and protect existing water resources, ensuring that the project complies with state and federal water quality standards.
  • Stream Evaluation Addendum: If the proposed sewer project involves stream crossings, this addendum is critical. It assesses potential impacts on local waterways and outlines necessary protections to mitigate environmental harm.
  • Inter-Municipal Agreement: When a sewer project spans multiple municipalities, this agreement is essential. It documents the consent of all involved parties and outlines responsibilities related to the sewer installation and maintenance.
  • California Motorcycle Bill of Sale: This document is essential for transferring ownership of a motorcycle in California. It includes the vehicle identification number (VIN), sale price, and buyer and seller details, ensuring both parties are protected during the transaction. For a template, you can visit documentonline.org/blank-california-motorcycle-bill-of-sale/.
  • Technical Specifications Document: This document provides detailed guidelines for the materials, methods, and standards to be used in the construction of the sewer system. It ensures that all aspects of the project meet regulatory requirements and industry standards.

Each of these documents contributes to a comprehensive understanding of the project and its environmental implications. Together, they help ensure that the installation of sanitary sewer systems is carried out responsibly and in accordance with Ohio's environmental regulations.

Guidelines on Filling in Ohio Epa 4309

Once the Ohio EPA 4309 form is completed, it should be submitted along with the required attachments to the appropriate agency. Ensure that all information is accurate and that any necessary documents are included to avoid delays in processing.

  1. Fill in the Application Number and Date Received fields for agency use.
  2. Provide the Applicant, Facility Owner, and Ultimate Owner (if different) details.
  3. Enter the Application/Plans Prepared by and Project Name.
  4. In the Project Description section, describe the location, size, and current development of the area served. Include street address, township, county, and longitude and latitude coordinates.
  5. Indicate the possibility of future sanitary sewer extensions connecting to the proposed sewers.
  6. Specify if any pump stations are included in the construction. If yes, fill out the attachment to Form B1.
  7. Check the types of sewers proposed (Conventional gravity, Small diameter gravity, Vacuum, Siphon, Pressure, Force main).
  8. Identify the Pipe Specifications by indicating the type, size, material, joint specification, bedding, slope, and maximum manhole spacing.
  9. Provide the Design Flow information, including average daily flow and peak hourly flow for both start-up and design phases.
  10. Identify the Receiving Wastewater Treatment Facility and provide its average daily flow details.
  11. Answer questions regarding the treatment facility's capacity and any plans for expansion.
  12. Complete the Sewer Design section, ensuring all questions regarding depth, freezing prevention, and protection against erosion are answered.
  13. Address any Stream Protection concerns, including stream crossings and parallel sewer locations.
  14. Fill out the Manhole Design section, providing details about manhole types, specifications, and watertight connections.
  15. Provide information about the Protection of Water Supplies, including any physical connections to potable water systems and distances from waterworks units.
  16. Complete the Installation and Testing section with details about the installation inspector and the type of sewer leakage test.
  17. Include a statement about the Sewer Use Ordinance and provide the adoption date and enforcement responsibility.
  18. Confirm if a written inter-municipal agreement is attached for any proposed installation tributary to another political entity.
  19. Gather and attach the required Submittals, including copies of plans and specifications.
  20. Sign and date the form, affirming that the data provided is accurate.

Common mistakes

Filling out the Ohio EPA 4309 form can be a complex task. Many applicants make mistakes that can delay the approval process. One common mistake is failing to provide complete project descriptions. This includes not detailing the location, size, and current development of the area. It is essential to include specific information such as the street address, township, county, and even longitude and latitude coordinates.

Another frequent error is neglecting to indicate whether there are any pump stations included in the sewer construction. If pump stations are part of the project, the applicant must fill out the necessary attachment to Form B1. Omitting this information can lead to complications later in the review process.

Applicants often miscalculate the expected design flows for the proposed sewer. This includes both start-up and peak hourly flows. It is crucial to provide accurate figures based on the current and planned area served. Inaccurate calculations can raise concerns about the hydraulic capacity of the sewer, leading to potential rejections.

Many people overlook the importance of confirming whether the receiving wastewater treatment facility has adequate capacity. If the facility cannot handle the anticipated flows, the applicant must explain the steps being taken to address this issue. Failure to provide this information can result in delays or denials.

Another common mistake involves the design of the sewers themselves. Applicants sometimes do not ensure that the sewers are deep enough to serve adjacent basements or prevent freezing. These design flaws can lead to significant problems down the line, including potential structural issues.

Inadequate attention to stream protection is also a mistake that applicants make. If there are stream crossings, it is vital to fill out the stream evaluation addendum accurately. Not addressing these concerns can lead to environmental damage and further complications with the application.

Manhole design is another area where errors can occur. Applicants must specify the type of manhole, material specifications, and whether watertight frames and covers are used. Missing this information can result in compliance issues during construction.

Additionally, the protection of water supplies is often overlooked. If there are physical connections between the sewer and a potable water supply system, this must be clearly indicated. Not addressing these connections can lead to contamination risks and regulatory penalties.

Lastly, ensuring that all necessary submittals are included with the application is crucial. Missing documents can lead to delays in processing. Applicants should double-check that they have included all required copies of plans, technical specifications, and any additional forms needed.

FAQ

  1. What is the Ohio EPA 4309 form?

    The Ohio EPA 4309 form is a Supplement to Form A – B1 used for the Permit-to-Install/Plan Approval Application for sanitary sewers. This form is essential for applicants seeking to install or modify sanitary sewer systems in Ohio. It collects detailed information about the project, including its location, design specifications, expected flows, and environmental considerations.

  2. Who needs to complete the Ohio EPA 4309 form?

    Any individual or organization planning to install or modify a sanitary sewer system in Ohio must complete this form. This includes municipalities, counties, and private entities. The form must be filled out by the applicant, who may also need to consult with engineers or environmental specialists to provide accurate and comprehensive information.

  3. What information is required in the project description section?

    The project description section requires details such as the location, size, and current development status of the area to be served. Applicants must provide the street address, township, county, and geographic coordinates (longitude and latitude). Additionally, applicants should address the potential for future sewer extensions and indicate if any pump stations are included in the project.

  4. How are expected flows calculated for the proposed sewer?

    Expected flows are calculated by identifying the average daily flow and peak hourly flow at the start-up and design stages of the project. This includes existing flows from the immediate area and anticipated flows from future developments. Applicants must provide assumptions used for these calculations, such as residential population estimates and non-residential flow rates.

  5. What are the requirements for manhole design?

    Manhole design must adhere to specific standards, including the type of manhole, material specifications, and joint specifications. It is crucial to ensure that watertight frames and covers are used in areas prone to flooding. Furthermore, manholes should be strategically placed at upstream ends of lines, changes in size or alignment, and sewer intersections to maintain system integrity.

  6. What should be included in the installation and testing section?

    This section requires the name and contact information of the installation inspector, the type of sewer leakage test to be used, and details regarding flexible pipe deflection testing. Additionally, it should specify the type of testing for manholes, ensuring that all testing procedures align with regulatory standards.

  7. What are the environmental considerations when completing the form?

    Applicants must assess potential impacts on streams and water supplies. This includes identifying any stream crossings, the depth of sewers to prevent freezing, and the protection of water supplies from contamination. If applicable, specific measures to minimize damage to stream corridors must be detailed in the plans and specifications.

  8. What is the significance of the sewer use ordinance?

    The sewer use ordinance prohibits connections of roof drains, foundation drains, and other clean water sources to the sanitary sewer system. This is crucial for preventing excess water from overwhelming the sewer system. Applicants must provide documentation that this ordinance has been adopted and that enforcement measures are in place.

  9. How can applicants ensure compliance with the form's requirements?

    To ensure compliance, applicants should carefully review the form instructions and include all required documentation, such as detailed plans, technical specifications, and any necessary inter-municipal agreements. Seeking assistance from professionals experienced in environmental regulations and engineering can also enhance the accuracy and completeness of the application.