The Ohio EPA 4309 form serves as a crucial supplement to the Permit-to-Install/Plan Approval Application for sanitary sewers. This form collects essential information about the proposed sewer project, including its design, specifications, and environmental considerations. Completing this form accurately is vital for ensuring compliance with state regulations and facilitating the approval process.
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The Ohio EPA 4309 form is a crucial document for those involved in the planning and installation of sanitary sewer systems in the state. This form serves as a supplement to Form A – B1 and is specifically designed for permit-to-install and plan approval applications. It requires detailed information about the project, including the location and size of the area to be served, as well as the types of sewers being proposed. Applicants must provide specifications for the pipes, expected design flows, and details about the receiving wastewater treatment facility. Furthermore, the form addresses critical design considerations, such as manhole design, stream protection, and the installation and testing procedures for the sewer systems. Each section of the form is designed to ensure compliance with environmental standards, thereby safeguarding public health and the environment. By meticulously completing the Ohio EPA 4309 form, applicants can facilitate a smoother approval process and contribute to the effective management of wastewater in their communities.
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
Material *
Joint*
Bedding**
Minimum
Size
Material
Specification
Classification
Slope
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
Design Flows (based on planned area served)
Hydraulic Capacity of Sewer
Assumptions used to calculate above flows: (check all that apply)
Start-Up
Design
Residential Population at:
gal/home*
homes
gal/cap/day
people
Non-Residential Flows (for example commercial, industrial, etc.):
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
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?
*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
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:
Page 2 of 4
6. Stream Protection
a. Are there any stream crossings? (If Yes, fill out the stream evaluation addendum)
Yes*
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)
3.
Are crossings to be made at previously disturbed areas?
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?
6.
Are the sewers at a sufficient depth to protect the sewer line? (GLUMRB Section 36.11)
b. Do any sewers run parallel to any streams?
Is there any woody vegetation along the stream banks?
Are the sewers and construction easements located outside of the vegetated areas?
*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)
f. Are manholes provided at all changes in size, grade, and alignment? (GLUMRB Section 34.1)
g. Are manholes provided at all sewer intersections? (GLUMRB Section 34.1)
h. Are drop manholes provided where the entrance sewer invert is 24 inches or more above the manhole invert?
i. Are inlet/outlet pipes connected with gasketed flexible watertight connections? (GLUMRB Section 34.6)
* Attach any additional sheets necessary for explanations.
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?
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)
If No, please specify the plan sheets where these conditions are not met & describe the measures taken to ensure protection of the water system:
d. When crossing water mains, are the sewers at least 18 inches below water lines?
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:
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
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.
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:
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:
Page 4 of 4
Completing the Ohio EPA 4309 form is essential for the application process regarding sanitary sewer installations. This form requires detailed information about the project, including specifications, design flows, and treatment facilities. It is crucial to ensure that all sections are filled out accurately to facilitate a smooth review process.
The Ohio EPA 4309 form is a supplement to the Permit-to-Install/Plan Approval Application specifically for sanitary sewers. It serves as a detailed application that provides the Ohio Environmental Protection Agency with essential information about proposed sewer installations, including project descriptions, design flows, pipe specifications, and environmental considerations.
The project description section requires details about the location, size, and current development of the area to be served. Applicants must include the street address, township, county, and geographic coordinates (longitude and latitude). Additionally, it asks about the potential for future sewer extensions and whether any pump stations are part of the construction.
To determine the design flow, applicants must identify the expected flows at start-up and at design. This includes calculating average daily flows and peak hourly flows based on current and projected residential and non-residential populations. The form provides specific guidelines for calculating these flows, including assumptions about residential population and non-residential contributions.
Applicants must identify the types and sizes of pipes included in the project, along with their materials and specifications. Each pipe must meet specific ASTM, AWWA, or ANSI standards, and any non-listed specifications must be submitted for approval. The form includes a table to fill out these details, ensuring compliance with Ohio EPA standards.
When addressing the receiving wastewater treatment facility, applicants must provide information about its current and proposed average daily flows. It's crucial to confirm whether the facility has adequate capacity to treat the anticipated flows from the new sewers. If the facility does not have sufficient capacity, the applicant must describe the steps being taken to remedy this situation.
Stream protection is an important aspect of the application. If there are stream crossings or if sewers run parallel to streams, the applicant must indicate how many crossings are made and whether they are perpendicular to the stream. Additionally, the form asks for measures that will minimize damage to the stream corridor and ensure its restoration after construction.
Manhole design is crucial for the functionality and maintenance of the sewer system. The application requires details about the type and material specifications of manholes, as well as whether watertight frames and covers are used in flood-prone areas. Proper manhole placement and design help prevent issues such as infiltration and ensure effective wastewater management.
The application includes questions about any physical connections between the sewer and potable water supply systems. It requires information about the proximity of public waterworks to the proposed sewer and the measures taken to ensure horizontal and vertical separations. This is critical for preventing contamination and protecting public health.
To complete the application, several documents must be submitted, including four copies of detailed plans, two copies of technical specifications, and the completed application form. It's essential to ensure that all required documents are included to avoid delays in processing the application.
Incomplete Project Description: Failing to provide a comprehensive description of the project location, size, and current development can lead to significant delays. It's essential to include the street address, township, county, and precise longitude and latitude coordinates.
Neglecting Future Extensions: Not addressing the possibility of future sanitary sewer extensions connecting to the proposed sewers can result in inadequate planning. This information is crucial for ensuring the system's long-term functionality.
Missing Pump Station Details: If pump stations are part of the sewer construction, failing to fill out the required attachment can lead to incomplete applications. Ensure that all relevant details are provided to avoid complications.
Incorrect Pipe Specifications: Providing inaccurate information about pipe types, sizes, and materials can cause issues during installation. It's important to refer to the Ohio EPA’s pipe specification list and include all necessary ASTM, AWWA, or ANSI specification numbers.
Ignoring Treatment Facility Capacity: Not confirming whether the receiving wastewater treatment facility can handle the anticipated flows can lead to operational challenges. If the facility lacks capacity, steps must be detailed to address this issue.
Overlooking Stream Protection Measures: Failing to identify stream crossings and their impact can have serious environmental consequences. If there are stream crossings, it's vital to fill out the stream evaluation addendum and provide specific measures to minimize damage.
The Ohio EPA 4309 form is a crucial document for those looking to apply for a permit related to sanitary sewer installations. Alongside this form, several other documents are commonly required to ensure compliance with environmental regulations and to facilitate the approval process. Below is a list of these documents, each described briefly for clarity.
These documents collectively support the application process for the Ohio EPA 4309 form. They provide the necessary information to assess the feasibility and compliance of the proposed sewer installation, ensuring that environmental standards are met and public health is safeguarded.
The Ohio EPA 4309 form shares similarities with the EPA Form 7500-1, which is used for hazardous waste manifesting. Both forms require detailed information about the project, including descriptions of the materials involved and the locations where the work will occur. Just as the Ohio EPA 4309 form asks for specific technical details about sewer installations, the EPA Form 7500-1 requires precise data about the hazardous waste being transported, including its type, quantity, and the parties involved in the process. Both documents serve to ensure compliance with environmental regulations and protect public health.
Another document akin to the Ohio EPA 4309 form is the National Pollutant Discharge Elimination System (NPDES) permit application. This application is necessary for any entity discharging pollutants into waters of the United States. Similar to the Ohio EPA 4309, the NPDES application requires comprehensive information about the project, including the nature of the discharge, the location, and the expected impact on the environment. Both forms are designed to assess potential environmental risks and ensure that appropriate measures are in place to mitigate them.
The Clean Water Act Section 404 permit application is also comparable to the Ohio EPA 4309 form. This application is required for any project that involves the discharge of dredged or fill material into waters, including wetlands. Like the Ohio EPA 4309, it necessitates detailed project descriptions, including the location and the potential impacts on water quality. Both documents emphasize the importance of protecting water resources and ensuring that projects comply with environmental standards.
In addition, the Ohio EPA’s General Permit for Stormwater Discharges Associated with Construction Activities (GP-1) has similarities with the Ohio EPA 4309 form. Both documents require project developers to provide information about their plans, including site details and potential environmental impacts. The GP-1 focuses on stormwater management, while the Ohio EPA 4309 is concerned with sewer installations. However, both serve the purpose of ensuring that construction activities do not adversely affect the environment.
The Ohio EPA 401 Water Quality Certification application is another document that parallels the Ohio EPA 4309 form. This certification is necessary for projects that may impact water quality and is often required for federal permits. Similar to the Ohio EPA 4309, the 401 application requires detailed information about the project, including potential impacts on water quality and proposed mitigation measures. Both forms aim to protect water resources and ensure compliance with environmental laws.
The Ohio EPA’s Air Quality Permit-to-Install application also shares commonalities with the Ohio EPA 4309 form. This application is necessary for facilities that emit air pollutants and requires detailed technical information about the emissions and control measures. Both forms demand thorough project descriptions and technical specifications to assess compliance with environmental standards and protect public health.
Furthermore, the Ohio EPA’s Solid Waste Facility Permit application is similar to the Ohio EPA 4309 form. This application is required for the construction and operation of solid waste facilities and requires detailed information about the facility design, waste types, and environmental impact. Both documents serve to ensure that projects comply with environmental regulations and protect public health and safety.
The Stormwater Pollution Prevention Plan (SWPPP) is another document that aligns with the Ohio EPA 4309 form. The SWPPP is required for construction activities that disturb soil and aims to prevent stormwater pollution. Similar to the Ohio EPA 4309, it requires detailed information about the project, including site conditions and erosion control measures. Both documents emphasize the importance of protecting water quality during construction activities.
Lastly, the Ohio EPA’s Drinking Water Permit application is comparable to the Ohio EPA 4309 form. This application is necessary for public water systems and requires detailed information about the water source, treatment processes, and distribution system. Like the Ohio EPA 4309, it aims to ensure that projects comply with health and safety standards and protect public health by providing safe drinking water.
Do's and Don'ts for Filling Out the Ohio EPA 4309 Form
Understanding the Ohio EPA 4309 form is essential for anyone involved in sanitary sewer projects. However, several misconceptions can lead to confusion. Here are eight common misconceptions about the form, along with clarifications.
This form can also be used for modifications or expansions of existing sewer systems. It addresses various aspects of sewer planning and installation, regardless of whether they are new or existing.
While engineers often prepare the application, anyone involved in the project, including facility owners and applicants, should understand the requirements and details outlined in the form.
In addition to technical details, the form also addresses environmental impacts, capacity considerations, and compliance with local regulations, making it a comprehensive document.
Submission of the form does not guarantee approval. The Ohio EPA reviews each application carefully and may request additional information or modifications before granting approval.
Timely submission is crucial. Projects often have specific timelines, and delays in submitting the form can lead to project setbacks or complications.
Public input may be necessary, especially for larger projects that could impact the community. This ensures that local concerns are addressed during the planning process.
Amendments can be made if necessary. If project details change after submission, it is important to update the Ohio EPA with the new information to ensure compliance.
Other permits and approvals may be required depending on the project's scope and location. It is essential to check for additional requirements that may apply.
The Ohio EPA 4309 form is crucial for applications related to the installation and approval of sanitary sewers. It serves as a supplement to the primary application and requires detailed project information.
Applicants must provide comprehensive project descriptions, including the location, size, and current development status of the area served. Specific coordinates, such as longitude and latitude, are necessary for accurate identification.
Understanding the design flow is essential. The form requires applicants to estimate both start-up and design flows, considering future development and existing conditions. This data is vital for assessing the sewer's hydraulic capacity.
Receiving wastewater treatment facilities must have adequate capacity. If the anticipated flows exceed the treatment facility's capabilities, applicants must outline steps to ensure capacity is sufficient.
Stream protection measures are critical. The form inquires about any stream crossings and requires explanations if certain conditions, such as the depth of sewers or the presence of vegetation, are not met.
Finally, applicants must ensure that a sewer use ordinance is in place. This ordinance should prohibit clean water connections to the sanitary sewer system and must be enforced adequately.