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HomeMy WebLinkAboutSanitary Sewer Permit Applicaiton 01-16-19Indiana Department of Environmental Management APPLICATION FOR SANITARY SEWER a� • .az Once of Water Quality — Mail Cade 65-42 CONSTRUCTION PERMIT PER 327 IAC 3 Facilities Construction Section State Form 53159 (11-07) 100 North Senate Avenue, Room N 1255 INSTRUCTIONS Indianapolis, IN 46204-2251 1 This form must be filled out completely 2 Additional pages (attachments following this form) are part of this application form and most be filled out completely. 3 Submission of plans and specifications are part of the application 4 Submit the application form, additional pages, plans and specifications to the above address.. 5. If you have any questions regarding this application, call 1DEM's Office of Water Quafity at (317) 232-8670. APPLICANT APPLICANT'S ENGINEER OR LAND SURVEYOR Name Timothy J. Walter Name David J. Stoeppelwerth Company Nameplatinum Properties Management Co., LLC Company Name Stoeppelwerth & Associates, Inc. Address 9757 Westpoint Drive, Suite 600 Address 7965 East 106th Street Address Indianapolis, Indiana 46256 Address Fishers, Indiana 46038 Telephone number (317) 863-2057 Telephone number (317) 849-5935 r r •n 1-0133.701 MOr Name The Amenity Area at The Legacy A Sanitary Sewer Design Summary Form: V Yes Location (Referenced to two existing streets) B Capacity Certification/Allocation Letter: VYes Location The Northwest corner of Larson Drive and C Certificati n of Registered Engineer or Land Surveyor Letter: Yes Location Cherry Creek Boulevard D Plans and Specifications: Oyes City Carmel E Identification of Potentially Affected Persons (see note below): Yes County Hamilton F Mailing Labels for Potentially Affected Persons: Yes Note Regarding item (E) above Fully identify all persons, by name and address, who may be potentially affected by the issuance of this permit, such as adjoining landowners, persons with a propriety interest, andlor persons who have complained or submitted comments about your facility. Under lC 4-21.5- 3-5, IDEM is required to notify potentially affected persons of its permit decision. PERMIT APPLICATION •` CONSTRUCTION,•A•FUNDING OR MODIFICATION OF that apply)(Checlir all A Municipal Collection Facility: ❑Yes SRF Funding: ❑Yes VNo B Semipublic Collection Facility: ❑Yes C New facility: ❑Yes D Expansion or modification of existing facility: {IYes CERTIFICATIONr SIGNATURE Application is hereby made for a Permit to authorize the activities described herein 1 certify that I am familiar with the information contained in this application and to the best of my knowledge and belief such information is true, complete and accurate. Printed name of person signing Title David J. Stoeppelwerth Professional Engineer S' ature f 1plic n Date application signed (month, day, ,year) January 16, 2019 *PI se refer to IC 13.30-10 for penalties of submission of false information* PART CSP STATE FORM 5.3,159 (11-07) Dear Applicant: To complete your construction application, you must submit all of the necessary items. If your application materials are incomplete, you will be sent a deficiency notice, and your application will be retained for 60 days If the information is not received within the 60 day period your application will be denied due to incompleteness. You can get a copy of this application package on the Internet at: www,in.gov/idem/permits/water/wastewater/construction/index html or www.in.gov/idem/publications/forms/index.html#waterforms, Please complete the following steps (only one copy of the requested documents needs to be submitted): • Request that the utility to which you will be connecting your gravity sewer or force main complete the attached Capacity Certification/Allocation Letter. • A completed Certification of Registered Professional Engineer or Land Surveyor Letter must be completed by the professional engineer or land surveyor who designed and stamped the plans. A copy of this letter is attached. • Complete all the information on the sewer design summary and certify it with a professional engineer's stamp (or land surveyor's stamp for gravity sewer projects), signature and date.. • Sign and date the application form and fill it out completely.. Municipal projects must be signed by a city or town official. Others, such as private projects, can be signed by the owner or a representative. • Submit one set of plans with profiles and bedding details. Every page must be stamped and signed by a professional engineer (or land surveyor for gravity sewer projects). • List all affected parties. This list should include: officials of affected counties, cities or towns; adjacent property owners; and all other potentially affected parties, their names and mailing addresses. A competed set of mailing labels with the mailing code of 65-42FC listed above each party on each label is required • Please be advised that if your project will disturb one (1) or more acres of land area, coverage under 327 IAC 15-5 (Rule 5) is required. Rule 5 is the General Permit for Storm Water Runoff Associated with Construction Activity You can review the Rule 5 web site for information at: www.in.gov/idem/permits/water/wastewater/wetwthr/storm/rules html and/or contact David Carr at 317/233-1864 for more information. Please send construction applications to: Indiana Department of Environmental Management Office of Water Quality- Mail Code 65-42 100 North Senate Avenue, Rm N 1255 Indianapolis, IN 46204-2251 Attention: Don Worley Telephone. 3171232-5579 327 IAC 3.5.5 Wastewater Construction Permit Fees (There are currently no fees required for Sewer Projects, either private or public.) Page 2 of 10 PART OF STATE FOR 153159 ('11-07) Design Flow Number of units 1 bedroom apartments 200 gpd/unit gpd 2 bedroom apartments 300 gpd/unit gpd Single family homes 310 gpd/unit gpd Commercial lots gpd 20 Swimmers Swimming Pool / Bathouse 10gpd/swimmer 200 gpd gpd Total average flow 1200 gpd Peaking factor 4.29 Peak flow 858 gpd Sewer ft. 8 -inch (sewer type) ft. 10 -inch 300 % 6" PVC Lateral ft. ft. 300 ft. Total length of sewer The new sewer will be connected to an existing 8" -inch diameter sanitary sewer at approximately 2,300' (referenced to two existing streets) South of East 146th St. & approximately 2,050' West of Community Dr. LM No. 19358 STATEOF �G2G7�r+�i�.rGh_ (IVE. or L '�tmk signature and date} January 1 Lift Station Type (wet/dry, submersible, wet -well mounted, etc.) Number of pumps Capacity of pumps gpm T TDH RPM HP Back-up power source ❑ Yes ❑ No Average wet -well detention time Audio/visual alarm with self-contained power supply or telemetry system Force Main feet of -inch (type) Force main discharge elevation Waste Treatment Wastewater treatment will be provided by CitV of Carmel Waste Water Treatment Plant Inspection/Maintenance Inspection during construction will be provided by City of Carmel Utilities Maintenance after completion will be provided by ICity of Carmel Utilities Page 3 of 10 , 2019 IDART OF STATE FORM 513150 ('11-07) CAPACITY CERTIFICATION/ALLOCATION LETTER This from must be filled -out in its entirety. Name of applicant Platinum Properties Management Co., LLC Name of owner Falcon Nest 11, LLC Name of project the Amenity Area at The Legacy CERTIFICATION I, John Duffy representing the Cit of Carmel in my capacity (Name of individual) (Name of city or town) as Utility Director have the authority to act on behalf of the City of Carmel (Title) (Name of city or town) certify that I have reviewed and understand the requirements of 327 IAC 3 and that the sanitary collection system proposed, with the submission of this application, plans and specifications, meets all requirements of 327 IAC 3 1 certify that the daily flow generated in the area that will be collected by the project system will not cause overflowing or bypassing in the collection system other than NPDES authorized discharge points and that there is sufficient capacity in the receiving water pollution treatment/control facility to treat the additional daily flow and remain in compliance with applicable NPDES permit effluent limitations. I certify that the proposed average flow will not result in hydraulic or organic overload. I certify that the proposed collection system does not include new combined sewers or a combined sewer extension to existing combined sewers. I certify that the ability for this collection system to comply with 327 IAC 3 is not contingent on water pollution/control facility construction that has not been completed and put into operation I certify that the project meets all local rules or laws, regulations and ordinances. The information submitted is true, accurate, and complete, to the best of my knowledge and belief. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment. Gallons per day (Total Average Flow for Project) 200 Wastewater treatment plant (Name of WWTP) _—City of Carmel Waste Water Treatment Plant Sewers (Owners of sewers) Citv of Carmel Waste Water Treatment Plant Signature Date Signed (month, day, year) (Please refer to IC 13-30-10 for penalties of submission of false information.) Page 4 of 10 CERTIFICATION OF REGISTERED PROFESSIONAL ENGINEER OR LAND SURVEYOR LETTER This from must be filled-otit in its entirety Name of applicant Platinum Properties Management Co., LLC Name of owner Falcon Nest II, LLC Name of project The Amenity Area at The Legacy CERTIFICATION I David J. Stoeppelwerth , representing the project applicant, in my capacity as a registered (Name of individual) professional Engineer 19358 certify the (Engineer or Land Surveyor) (Indiana registration number) following under penalty of law: The design of this project has been performed under my direction or supervision to assure conformance with 327 IAC 3 and the plans and specifications require the construction of said project to be performed in conformance with 327 IAC 3-6 The peak daily flow rates, in accordance with 327 IAC 3-6-11 generated from within the specific area that will be collected by the proposed collection system that is the subject of the application, plans, and specifications (when functioning as designed and properly installed), will not cause overflowing or bypassing in the same specific area serviced by the proposed collection system other than from NPDES authorized discharge points. The proposed collection system does not include new combined sewers (serving new areas) or a combined sewer extension to existing combined sewers. The sewer at the point of connection is physically in existence and operational. Based upon information provided by the owner of the Wastewater System, the ability for this collection system to comply with 327 IAC 3 is not contingent on downstream water pollution/control facility construction that has not been completed and put into operation The design of the proposed project meets applicable local rules or laws, regulations and ordinances The information submitted is true, accurate, and complete, to the best of my knowledge and belief.. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment. Gallons per day (Total Average Flow for Project) 200 Wastewater treatment plant (Name of WWTP) City of Carmel Waste Water Treatment Plant Sewers (Owners of sewers) City of Carmel Waste Water Treatment Plant Signature Date Signed {month. clay. year) / January 16, 2019 (Please refer to /C 13-30-10 for penalties of submission of false information.) Page 5 of 10 r 1V1 J 1 0 l i SANITARY SEWER SUBMISSION CHECKLIST 1. Application Check here A. Applicant's name and address B. Applicant's Engineer: company name, engineer's name, address, telephone C Name and location of proposed sanitary sewer D Type of collection facility the project will connect to (municipal or semipublic) E. Signature of applicant or authorized agent including date signed 2. Sanitary Sewer Design Summary Check here A. Design flow 1 Multiply number of units by recommended average flow for that type of unit Refer to 327 IAC 3-6-11 design flow rate requirements for collection systems and water pollution treatment/control facilities. This is a section of the Article 3 Administrative Code and is available on the internet at www.in.gov/legislative/iac/T03270/A00030.PDF . You would need to click under Water and look for Title 327 IAC 3 or Article 3. 2 Total all average flow and enter total average flow 3 Enter peaking factor. If peaking factor and factor is unknown, a factor of 4 is usually sufficient, however, an exact factor may be calculated from the following equation: Peaking factor = 18 * /P Where P is the population in thousands 4*/P �{ w 4 Multiply total average flow by peaking factor and enter product as peak flow B Gravity sewer length and type Please include the length, diameter, and type of sewer pipe with applicable SDR and ASTM specifications, and type of bedding. C. Certifier's seat Sanitary Sewer Design Summary should be sealed and signed by a registered professional engineer or a land surveyor if no lift station is involved. D. Connection Point I Diameter of existing sewer at connection point (unless connection point is at a lift station) Ur 2 Location of connection point relative to an intersection of two (2) streets, i.e so many feet west and so so many feet north of the intersection of street A and street B K E lift station: enter all proposed lift station information, or enter NIA if no lift station is involved. (if an existing lift station is being directly affected, enter existing lift station information and specify that it is an existing lift station and include its current load), ❑ I Number and capacity of pumps. ❑ 2 Provide design calculations for TDH and wet -well detention time ❑ 3 Provide a graph of the pump curves ❑ 4. Specify highest elevation in the force main. El 5. Specify force main length, diameter and material (ASTM and SDR), and bedding. ❑ 6.. Specify an audio and visual alarm with self contained power supply and telemetry, ❑ 7. Specify nature of back-up power source for lift station, if any ❑ F, Waste treatment: enter the name of semipublic or municipal treatment facility which the project will be connecting to: if there is more than one treatment facility in the municipality or sanitary district, please specify which one. G. Inspection/Maintenance: please specify name of company, individual or party responsible for inspection during the construction of the project and maintenance of the project after construction is complete. 3. Capacity certification/allocation letter Check here. Provide the utility that is treating the wastewater the attached capacity certification/allocation letter This letter must be filled out in its entirety. 4. Plans and specifications Check here A Every page of the plans should be signed and sealed, as well as the cover page for any specifications• 1 Professional engineers who are registered within the state of Indiana are eligible to certify plans and specifications for all types of projects, Y� 2 A land surveyor who is registered within the state of Indiana may certify plans and specifications for gravity type sanitary sewers only, and may not certify plans and specifications involving lift stations and force mains. Page 6 of 10 i:., [— ., i T1_'a'i:.jC: 4. Plans and specifications (continued) Check here B. The following items are usually necessary for proper technical review of sanitary sewers and lift stations: 1. Plan view of the sewers including minimum ten foot horizontal separations of sewer and water mains, and connection point of the proposed sanitaa sewer. 2. Profile view of the sewers including: slope, invert elevations, existing grade, proposed grade, distances from manhole to manhole, existence of special features, and a minimum of '18 -inch vertical separation of sewer and water mains. �( 3. Where applicable, details of all appurtenances including manholes, drop manholes, inverted siphons, etc. 4 Bedding details for installation of Sanitary Sewer/Force Main: a Rigid pipe: should be class A, B or C as described in ASTM C 12 b Flexible pipe: should be class I, 11, or III as described in ASTM D 2321 5 Minimum three foot cover depth above the crown of the sanitary sewer force main 6 Automatic Air Relief valves to be placed at all relative high points in the force main to prevent air locking 7 Mechanical joints should be specified for all aerial, river or lake crossings Note: construction within a floodway (river, lake, etc.) must receive approval from Indiana Department of Natural Resources, Division of Water. 5. A List of names and addresses of all persons or parties who may be potentially affected by the issuance..;. of#his project. Please be aware that failure to properly identify and notify these people. could have.the .: result of voiding any decision made regarding this permit. Check here . ' A The applicant must take full responsibility for proper identification of all potentially affected persons or parties. B The following are the minimum recommendations made by this office made as to who should be included in this list: I All landowners adjacent to the property where the proposed construction is to occur 2 All persons with a substantial and direct proprietary interest in the issuance of this permit, such as, nearby businesses that could have their business in some way affected by the issuance of this Construction Permit. 3. Anyone who is known to have complained or otherwise expressed an interest in this particular project or projects in this specific area. 4 Anyone else whom the applicant may feel that might be potentially affected by the issuance of this permit, 6. The Application form must be signed and dated by the applicant or his duly authorized agent. Please note that this checklist is only designed to expedite the review process by assisting the applicant in submission for sanitary sewer construction permits, and in no way is intended to replace the technical review process, nor is it a substitute for the actual Construction Permit Page 7 of 10 OF ;-'' A —E FC�C,NI 53154 l l'i-fj7;1 IDENTIFICATION OF POTENTIALLY AFFECTED PERSONS Please list any and all persons whom you have reason to believe have a substantial or proprietary interest in this matter, or could otherwise be considered to be potentially affected under law. Failure to notify a person who is later determined to be potentially affected could result in voiding our decision on procedural grounds. To ensure conformance with Administrative Orders and Procedures Act (AOPA), please list all such parties. The letter on the opposite side of this form will further explain the requirements under the AOPA Attach additional names and addresses on a separate sheet of paper, as needed. Please indicate below the type of agency action you are requesting. Name Please see attached list. Address (number and street) City State ZIP Name Address (n umber and street) City State ZIP Name Address (number and street) City State ZIP Name - Address (number and street) city State ZIP Name Address (number and street) City State ZIP Name Address (number and street) C ity State ZIP Name Address (number and street) City State ZIP Name Address (number and street) City I j State Zip CERTIFICATION I certify that to the best of my knowledge I have listed all potentially affected parties, as defined by IC 421.5-3-5. Proposed facility name Printed Name The Amenity Area at The Le acv David J. Stoeppelwerth City Carmel Signature County Hamilton Dat (month, day, year) January 16, 2019 Page 8 of 10 P11"RT OF ` T/AI-E FOP.fv1 53.159 (11-07) IDENTIFICATION OF POTENTIALLY AFFECTED PERSONS (continued) To. Applicant Subject. Identification of Potentially Affected Persons The Administrative Adjudication Act IC q-21.5-3-5 requires that the Indiana Department of Environmental Management (IDEM) give notice of its decision on your application to the following persons. • Each person to whom the decision is specifically directed; • Each person to whom a law requires notice be given, • Each competitor who has applied to the IDEM for a mutually exclusive license, if issuance is the subject of the decision and the competitor's application has not been denied in an order for which all rights to judicial review have been waived or exhausted, • Each person who has provided the IDEM with written request for notification of the decision; • Each person who has a substantial and direct proprietary interest in the issuance of the (pen -nit) (variance); • Each person whose absence as a party in the proceeding concerning the (pe rmit) (variance) decision would deny another party complete relief in the proceeding or who claims an interest related to the issuance of the (permit) (variance) and is so situated that the disposition of the matter, in the person's absence may. (1) As a practical matter impair or impede the person's ability to protect that interest, or (2) Leave any other person who is a party to a proceeding concerning the permit subject to a substantial risk of incurring multiple or otherwise inconsistent obligations by reason of the person's claimed interest. Under IC 4-21.5-3-5 (f) IDEM is requesting your assistance in identifying potentially affected persons. IC 13-15-3-1 requires IDEM to provide notice of receipt of a permit application to the following: 1. The county executive of a county affected by a permit application, 2. The executive of a city affected by a permit application, 3. The executive of a town council of a town affected by a permit application. Under IC 13-15-3-1 (b) IDEM is requesting information necessary to provide such notice to the appropriate officials. Page 9 of 10 PART OF STATE %ORIM 5-0159 ("11-07) IDENTIFICATION OF POTENTIALLY AFFECTED PERSONS (continued) Attention: Since ,lune 17, 1999, mailing labels are required to be submitted with your project, Having these labels with your application is helpful to you as well as our office. These mailing labels need to have the names and addresses of the affected parties along with our mailing code (which is 65-42FC) listed above each affected party listing.. For Example: 65-42FC ,JOHN DEERE 111 CIRCLE DR YOUR CITY IN 44444 Page 10 of 10