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The Ohio EPA 4309 form plays a crucial role in the process of applying for a permit to install or seek plan approval for sanitary sewer systems. This form, specifically a supplement to Form A – B1, is designed for applicants looking to ensure compliance with environmental regulations. It requires detailed information about the project, including the location, size, and current development of the area that will be served by the proposed sewer system. Applicants must describe the potential for future sewer extensions and indicate whether pump stations are part of the construction. The form also collects technical specifications, such as pipe types and sizes, design flow estimates, and the capacity of the receiving wastewater treatment facility. Furthermore, it addresses critical considerations like stream protection, manhole design, and the protection of water supplies. Each section of the form is essential for evaluating the project’s impact on the environment and ensuring that it meets state standards. By providing comprehensive information, applicants contribute to a thorough review process that prioritizes public health and environmental safety.

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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

Form Specifications

Fact Name Details
Form Title Supplement to Form A – B1 for Permit-to-Install/Plan Approval Application related to Sanitary Sewers
Governing Laws Ohio Administrative Code (OAC) 3745-42-05 and GLUMRB Recommended Standards for Wastewater Facilities
Application Requirement Must include four copies of detailed plans and two copies of technical specifications
Submission Deadline Flow data must be no older than one calendar year from the date of submission
Manhole Specifications Watertight frames and covers are required where flooding may occur
Stream Protection Specific measures must be taken to minimize damage to the stream corridor if stream crossings are present

Ohio Epa 4309: Usage Guidelines

Completing the Ohio EPA 4309 form is an essential step in the application process for sanitary sewer installations. This form gathers detailed information about the project, including the design, specifications, and anticipated flows. Once the form is filled out correctly, it will be submitted for review by the Ohio Environmental Protection Agency.

  1. Begin by entering the Application Number and Date Received in the designated fields at the top of the form.
  2. Fill in the Applicant and Facility Owner sections with the appropriate names.
  3. If there is an Ultimate Owner different from the Facility Owner, include that information as well.
  4. Provide the name of the Project Name and the individual or company that Prepared the Application/Plans.
  5. In the Project Description section, describe the project location, size, and current development. Include the street address, township, county, and longitude and latitude coordinates.
  6. Indicate the possibility of future sanitary sewer extensions connecting to the proposed sewers.
  7. Answer whether there are any pump stations included in the construction. If yes, complete the attachment to Form B1.
  8. Check all applicable types of sewers proposed in the designated section.
  9. For the Pipe Specifications, identify each type and size of pipe, including material and specifications.
  10. In the Design Flow in Proposed Sewer section, provide expected flows at start-up and design, along with any assumptions used to calculate these flows.
  11. Complete the Receiving Wastewater Treatment Facility section by identifying the facility and its capacity to handle the anticipated flows.
  12. Answer the questions in the Sewer Design section regarding depth, protection against freezing, and other relevant factors.
  13. In the Stream Protection section, indicate whether there are any stream crossings and provide details if applicable.
  14. Fill out the Manhole Design section, specifying the type, material, and any necessary watertight features.
  15. Address the Protection of Water Supplies section, noting any connections to potable water systems and their proximity to the sewer.
  16. In the Installation and Testing section, provide the name and contact information for the installation inspector and detail the types of tests that will be used.
  17. Include a statement regarding the Sewer Use Ordinance and the enforcement details.
  18. Complete the Authorities section by confirming whether a written inter-municipal agreement is attached.
  19. Ensure all required Submittals are included with the application, such as plans and specifications.
  20. Finally, sign and date the form, confirming that all information provided is accurate.

Your Questions, Answered

What is the purpose of the Ohio EPA 4309 form?

The Ohio EPA 4309 form is a supplementary application used for the Permit-to-Install or Plan Approval for sanitary sewer systems. It provides detailed information about the proposed project, including the location, design specifications, and anticipated flow rates. This form is essential for ensuring that the proposed sewer system complies with environmental regulations and meets the necessary standards for public health and safety.

What information is required to complete the Ohio EPA 4309 form?

To complete the Ohio EPA 4309 form, applicants must provide various details. This includes a project description, pipe specifications, expected design flows, and information about the wastewater treatment facility that will receive the sewage. Additionally, the form requires details about sewer design, stream protection measures, manhole design, and any potential impacts on water supplies. It is crucial to ensure that all information is accurate and complete, as this will facilitate the review process by the Ohio EPA.

How does the Ohio EPA evaluate the submitted form?

The Ohio EPA reviews the submitted Ohio EPA 4309 form to assess compliance with environmental regulations and standards. This evaluation includes examining the proposed sewer system's design, capacity, and potential impacts on the surrounding environment. The agency may also consider any existing infrastructure and future development plans. If the application meets all requirements, the Ohio EPA will issue the necessary permits for installation or approval.

What should an applicant do if their project involves stream crossings?

If a project involves stream crossings, the applicant must fill out a stream evaluation addendum as part of the Ohio EPA 4309 form submission. This addendum should detail the number of crossings, their alignment relative to the stream, and any protective measures planned to minimize environmental impact. The applicant should also ensure that the sewer design accounts for the specific conditions of the stream corridor to protect it during construction and operation.

Common mistakes

  1. Incomplete Information: Failing to provide all required details, such as the project description, can lead to delays. Ensure every section is filled out completely.

  2. Incorrect Measurements: Providing inaccurate longitude and latitude coordinates can result in misidentification of the project location. Double-check all measurements before submission.

  3. Missing Attachments: Neglecting to include necessary attachments, like the pump station details, can cause the application to be rejected. Review the checklist to ensure all documents are included.

  4. Failure to Update Flow Data: Using outdated flow data can misrepresent the capacity needs of the treatment facility. Ensure that flow data is current and reflects the latest conditions.

  5. Ignoring Design Standards: Not adhering to the recommended design standards for sewer depth and slope can lead to operational issues. Review guidelines to ensure compliance.

  6. Inadequate Stream Protection Measures: Failing to address stream crossings or parallel sewer lines can result in environmental damage. Include detailed plans to protect water bodies.

  7. Neglecting Manhole Specifications: Not specifying the type and material of manholes can lead to structural failures. Clearly indicate all specifications in the application.

  8. Improper Sewer Use Ordinance: Not including the required statement about prohibiting clean water connections can lead to legal complications. Ensure this statement is clearly stated on the plans.

Documents used along the form

The Ohio EPA 4309 form is an essential document used in the permitting process for sanitary sewer installations. However, it often accompanies several other forms and documents that provide additional information and support for the application. Here’s a list of related documents that may be necessary or beneficial when submitting the Ohio EPA 4309 form.

  • Form A – Application for Permit to Install: This form serves as the primary application for obtaining a permit to install a new sewer system. It requires detailed information about the project, including the purpose and design of the installation.
  • Form B – Design Information: This document provides in-depth technical specifications and design details of the proposed sewer system. It includes information on pipe materials, dimensions, and installation methods.
  • Form C – Construction Plans: Accompanying the application, this form includes detailed construction plans that illustrate the layout and design of the sewer system. It ensures compliance with state regulations and standards.
  • Antidegradation Addendum: This addendum addresses potential impacts on water quality and outlines measures to prevent degradation of water resources during the construction and operation of the sewer system.
  • Environmental Impact Assessment (EIA): An EIA evaluates the potential environmental effects of the proposed sewer project. This document is crucial for identifying and mitigating any adverse impacts on local ecosystems.
  • Stream Evaluation Addendum: If the project involves stream crossings, this addendum assesses the potential effects on streams and outlines necessary protective measures to minimize damage.
  • Inter-Municipal Agreement: When a sewer project involves multiple municipalities, a written agreement is required. This document outlines the responsibilities and commitments of each party involved in the project.
  • Construction Specifications: These specifications detail the standards and requirements for construction practices, materials, and testing procedures to ensure quality and compliance with regulations.
  • Inspection Reports: Reports from inspections conducted during construction provide documentation of compliance with approved plans and specifications, ensuring the project adheres to regulatory standards.
  • Sewer Use Ordinance: This ordinance prohibits certain connections to the sanitary sewer system, such as roof drains and foundation drains. It must be enforced to protect the integrity of the sewer system.

Each of these documents plays a crucial role in the successful submission and approval of the Ohio EPA 4309 form. They collectively ensure that all aspects of the proposed sewer installation are thoroughly evaluated and compliant with state and federal regulations. Understanding these forms and their purposes can help streamline the application process and contribute to the effective management of Ohio’s water resources.

Similar forms

The Ohio EPA 4309 form is crucial for the application process related to sanitary sewer installations. Several other documents share similarities with this form, primarily in their focus on environmental compliance and infrastructure planning. Below are six documents that are comparable to the Ohio EPA 4309 form:

  • Permit-to-Install Application (PTI): Like the Ohio EPA 4309, this application is used to obtain permission for new installations of wastewater treatment facilities. Both require detailed information about project specifications and compliance with environmental regulations.
  • Construction Permit Application: This document is similar in that it addresses the construction of sewer systems and requires plans and specifications to ensure compliance with state standards, much like the Ohio EPA 4309 form.
  • Sanitary Sewer Overflow (SSO) Report: This report shares a focus on sewer systems and their operational integrity. It requires information on existing sewer conditions and potential overflow risks, akin to the flow and capacity assessments in the Ohio EPA 4309.
  • Stormwater Management Plan: Both documents emphasize the need for effective management of water systems. The Stormwater Management Plan details how stormwater runoff will be managed, paralleling the Ohio EPA 4309's focus on sewer design and environmental protection.
  • Environmental Impact Statement (EIS): Similar to the Ohio EPA 4309, the EIS assesses the potential environmental effects of proposed projects. Both documents aim to ensure that infrastructure developments do not adversely affect the environment.
  • Water Quality Management Plan (WQMP): This plan outlines strategies to maintain and improve water quality, paralleling the Ohio EPA 4309's focus on ensuring that sewer systems do not negatively impact water bodies.

Dos and Don'ts

When filling out the Ohio EPA 4309 form, it's crucial to follow certain guidelines to ensure your application is processed smoothly. Here are six do's and don'ts to keep in mind:

  • Do provide accurate and complete information about the project location, including street address, township, county, and coordinates.
  • Do check all applicable types of sewers proposed and ensure that all details are included.
  • Do specify the design flow accurately, including both start-up and peak flows, to avoid delays.
  • Do ensure that any necessary attachments, such as pump station details, are included with your submission.
  • Don't leave any sections blank. Incomplete forms can lead to rejection or delays in processing.
  • Don't forget to provide evidence of any required inter-municipal agreements if applicable.

Misconceptions

  • Misconception 1: The Ohio EPA 4309 form is only for new sewer installations.
  • This form is also used for modifications or expansions of existing sanitary sewer systems. It ensures that any changes comply with environmental regulations.

  • Misconception 2: Completing the form is a quick process.
  • Filling out the Ohio EPA 4309 requires detailed information about the project. This includes technical specifications and flow calculations, which can take time to gather.

  • Misconception 3: Only engineers need to fill out this form.
  • While engineers often complete the form, anyone involved in the project, such as the facility owner or applicant, should understand its requirements and implications.

  • Misconception 4: The form guarantees approval of the project.
  • Submitting the form does not guarantee that the project will be approved. The Ohio EPA reviews each application carefully to ensure compliance with regulations.

  • Misconception 5: You can submit the form without any supporting documents.
  • The Ohio EPA requires specific supporting documents, such as plans and technical specifications, to accompany the form for it to be considered complete.

  • Misconception 6: Once submitted, the form cannot be changed.
  • Applicants can amend the form if necessary. However, it’s important to communicate any changes to the Ohio EPA promptly.

  • Misconception 7: The form is only relevant for large municipalities.
  • Even small towns or individual projects may need to fill out this form. It applies to any sanitary sewer installation or modification.

  • Misconception 8: You don’t need to worry about stream protection unless there’s a stream nearby.
  • Even if a project is not near a stream, the form requires consideration of potential impacts on water supplies and ecosystems. This is to ensure comprehensive environmental protection.

  • Misconception 9: The form is the last step in the permitting process.
  • Filling out the Ohio EPA 4309 is just one part of a larger permitting process. Additional approvals and inspections may be needed before a project can proceed.

Key takeaways

When filling out and using the Ohio EPA 4309 form, there are several key points to keep in mind to ensure a smooth application process. Here are some important takeaways:

  • Understand the Purpose: The Ohio EPA 4309 form is used for applying for a Permit-to-Install or Plan Approval for sanitary sewer systems.
  • Accurate Project Description: Provide detailed information about the project location, size, and current developments. Include specific coordinates and street addresses.
  • Identify Future Connections: Indicate the potential for future sanitary sewer extensions that may connect to the proposed system.
  • Pipe Specifications: Clearly specify the types and sizes of pipes to be used in the project, along with relevant material and joint specifications.
  • Design Flow Calculations: Accurately calculate and report the expected start-up and design flows for the sewer system, including residential and non-residential contributions.
  • Receiving Facility Capacity: Confirm whether the wastewater treatment facility can handle the anticipated flows from the new sewer system.
  • Stream Protection Measures: If applicable, detail any stream crossings and the measures taken to minimize impact on the stream corridor.
  • Compliance with Regulations: Ensure that all ordinances regarding the prohibition of clean water connections to the sanitary sewer system are included in the submission.

By keeping these points in mind, applicants can navigate the Ohio EPA 4309 form more effectively, helping to facilitate the approval process for their sanitary sewer projects.