HomeMy WebLinkAboutSanitary Sewer Permit Application 03-18-20Instructions for State Form 53159, Application for Sanitary Sewer Construction Permit
All of the following necessary items must be submitted or the construction permit application will be
deemed incomplete and will not be reviewed. Only one copy of each necessary item needs to be
submitted.
1. Application for Sanitary Sewer Construction Permit
• Applications from municipalities must be signed and dated by an authorized official and
applications from non -municipalities must be signed and dated by the owner or a
representative.
2. Collection System Design Summary
3. Capacity Certification from the collection and treatment system owner(s) to which the
proposed sanitary sewer and/or force main will be connected
• If more than one utility will be transporting and/or treating the wastewater, a Capacity
Certification from each utility is required.
4. Registered Professional Engineer or Land Surveyor Certification by the applicant's engineer
or land surveyor
5. Final Construction Plans and Specifications
• Every page of the plans as well as the cover page for any specifications should be signed,
sealed, and dated by an Indiana registered professional engineer or land surveyor. Land
surveyors may certify plans and specifications for gravity type sanitary sewers only, not
including lift stations and force mains.
6. Identification of Potentially Affected Persons form and mailing labels
If the completed application does not satisfy all administrative and technical requirements, a
deficiency notice will be sent. If all deficiencies are not adequately addressed within sixty (60) days
from the date of the deficiency notice, the permit application will be denied.
A copy of this application can be found at: www.in.gov/idem/cleanwater/2430.htm
Send construction permit applications to:
Indiana Department of Environmental Management
Office of Water Quality
Facilities Construction Section, Mail Code 65-42FC
100 North Senate Avenue, Room N1255
Indianapolis, IN 46204-2251
For any questions, call the Facility Construction Section at 317/232-5579.
• +
APPLICATION FOR SANITARY SEWER
Indiana Department of Environmental Management
Office of Water Quality
i
° CONSTRUCTION PERMIT PER 327 IAC 3 Facilities Construction Section, Mail Code 65-42FC
State Form 53159 (R5 / 11-19)
100 North Senate Avenue, Room N1255
Indianapolis, IN 46204-2251
APPLICANT
APPLICANT'S ENGINEER OR LAND SURVEYOR
Name N Mr. or ❑ Ms.
Name 0 Mr. or ❑ Ms.
Todd Pyatt
David J. Stoeppelwerth
Name of Organization
Name of Company
PM Development Holdings, LLC
Stoeppelwerth & Associates, Indiana
Address (number and street, city, state, and ZIP)
Address (number and street, city, state, and ZIP)
168 West Carmel Drive
7965 East 106th Street
Carmel, Indiana 46032
Fishers, Indiana 46038
Telephone Number
Telephone Number
(317 ) 379-0184
(317 ) 570-4763
E-Mail Address
E-Mail Address
Todd Pyattbuiders.com
brobinson@stoeppelwerth.com
NAME AND LOCATION OF PROPOSED FACILITY
PROJECT DESCRIPTION
Name
Describe the scope and/or purpose of this project
The Grove at The Legacy, Sections 4A & 4B
The next sections of The Grove at The Legacy.
Location or Project Boundaries
These sections will consist of a total of 75
North side of Cherry Creek Boulevard
single-family residential homes on approximately
approximately 1,000' West of Community Drive.
9.99 acres.
City or Town
Carmel
County
Hamilton
SOURCEOF
❑ IFA's Wastewater State Revolving Fund Loan Program ❑ Local Funds
❑ OCRA's Community Development Block Grant
❑■ Privat:e Funds
❑ USDA's Rural Development Loan and Grant Assistance ❑ Other:
CERTIFICATION
swear or affirm, under penalty of perjury as specified by IC 35-44.1-2-1 and other penalties specified by IC
13-30-10 and IC 13-15-7-1(3), that the statements and
representations in this application are true, accurate,
and complete.
Printed Name of Person Signing
Todd Pyatt
Title
Member
Signature of Applicant 16��kDate
DaSigned (month / day / year)
March/ 18, 2020
0
(Please refer to /C f130-10 for penalties of submission of false information.)
Page 1 of 6
Pert of State Form 53159 (P5 / 1 1-19)
COLLECTION
Description of Units Served
SYSTEM DESIGN SUMMARY
op
Design Flow Per Unit Number of Units
Unit Design Flow
Example: Single family homes
310 gpd/unit
30
9,300 gpd
Single Family HOmes
310 (gpd/unit)
75
23,250 gpd
(gpd/unit)
gpd
(gpd/unit)
gpd
(gpd/unit)
gpd
(gpd/unit)
gpd
Average Design Flow
23,250 gpd
Peaking factor
14.29
Peak Design flow,
99,742.5 gpd
�' ��� ��°''
❑� Applicable ❑ Not Applicable
Length
Diameter
Material
ASTM or AWWA
Standard
SDR or
DR
Pressure
Class (psi)
Installation
Method
Example:
ft
8-inch
PVC
ASTM D3034
SDR-35
N/A
Open Cut
1,713 ft
8 in
PVC
ASTM D3034
SDR-35
N/A
Open Cut
ft
in
ft
in
ft
in
ft
in
❑ Applicable *Not Applicable
Length
Diameter
Material
ASTM or AWWA
Standard
SDR or
DR
Pressure
Class (psi)
Installation
Method
Example:
1, 525 ft
8-inch
PVC
ASTM D2241
SDR-21
200 psi
Open Cut
ft
in
ft
in
ft
in
ft
in
ftj
in
Inspection during construction will be provided by
Maintenance after completion will be provided by
Wastewater treatment will be provided by
❑ Applicable ❑■ Not Applicable
1. Location:
2. Type of pump (example: submersible, dry pit):
3. Number of pumps:
4. Constant or variable speed:
5. Design pump rate (gpm) and TDH (ft):
6. Operating volume of the wet well (gal):
Page 2 of 6
Part of State Form 53159 (P5 / 11-19)
7.
Average detention time in the wet well (min):
8.
Type of standby power/pump provisions:
9.
Type of alarm:
10.
Additional information:
❑ Applicable ❑■ Not Applicable
1.
Number of stations: simplex duplex triplex
2.
Number of residential connections per simplex station (two maximum):
3.
Design pump rate (gpm) at maximum TDH (ft):
4.
Type of alarm:
5.
Privately or utility owned and maintained:
6.
Additional information:
❑ Applicable ❑■ Not Applicable
1.
Location:
2.
Total volume of vacuum tank (gal):
3.
Operating volume of the vacuum tank (gal):
4.
Number and size (HP) of vacuum pumps:
5.
Number and type of sewage pumps:
6.
Constant or variable speed:
7.
Design pump rate (gpm) and TDH (ft):
8.
Type of standby power/pump provisions:
9.
Type of alarm:
10.
Additional information:
Certification Seal, Signature, and Date
Printed Name of Engineer or Land Surveyor
David J. Stoeppelwerth
Signature
Date Signed (month/day/year)
March/18, 2020
f41
Qw � C3.
19358
W -0 STATE OF
DWA
b
��'r0l YHIm , 11t"'
A factor of four (4) is prescribed by 327 IAC 3-6-11. However, an alternative
peaking factor may be justified by other means (327 IAC 3-6-32) or as provided
by Ten State Standards 11.243: Peaking Factor = (18 + SIP) / (4 + �P), where P
= population in thousands.
Provide pump and system curves and design calculations for TDH. If connecting
to an existing force main, provide upstream lift station pump curves and describe
how the proposed flow will affect the lift station performance during
simultaneous operation.
For small diameter low-pressure sanitary sewer systems, provide a spreadsheet
that includes the maximum expected simultaneous operation of the proposed
grinder pumps, maximum expected flow (gpm) and fluid velocity (ft/sec), static
head and accumulated friction loss, and expected accumulated total dynamic
head (TDH).
The average detention time in the wet well (cycle time between pump on/off settings) should be between 5 and 30
minutes. The cycle time may be calculated from the following equation: Cycle Time = (V / (D - Q)) + (V / Q), where D =
discharge flow rate out of the wet well (design pump rate) in gpm, Q = inflow rate into wet well (average design flow) in
gpm, and V = operating volume of wet well (between pump on/off settings) in gallons.
Page 3 of 6
Part of State Form 53159 (R5 / 11-19)
CAPACITY CERTIFICATION
This form must be filled -out in its entirety with no alterations.
Name of Applicant: PM Development Holdings, LLC
Name of Applicant Representative: Todd Pyatt
Name of Project: The Grove at The Legacy, Sections 4A & 4B
CERTIFICATION
, representing the
(Name of individual)
(Name of municipality or utility)
have the authority to act on behalf of the
(title)
, in my capacity as
(Name of municipality or utility)
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.
Peak Design Flow (gallons per day)
99,742.5
Owner of Receiving Collection System
City of Carmel Utilities
Name of Wastewater Treatment Plant
City of Carmel Waste Water Treatment Plant
Mailing Address of Certifying Representative
(number and street, city, state, and ZIP code)
E-mail Address of Certifying Representative
I am certifying for the ❑ Collection System ❑ Treatment Facility
Signature
Date Signed (month/day/year)
(Please refer to /C 13-30-10 for penalties of submission of false information.)
Page 4 of 6
Part of State Form 53159 (R5 / 11-19)
CERTIFICATION OF REGISTERED PROFESSIONAL ENGINEER OR LAND SURVEYOR
This form must be filled -out in its entirety with no alterations.
Name of Applicant: PM Development Holdings, LLC
Name of Applicant Representative: Todd Pyatt
Name of Project: The Grove at The Legacy, Sections 4A & 46
David J. Stoeppelwerth
(Name of Individual)
CERTIFICATION
, representing the project applicant, in my capacity as a
registered professional Engineer
(Engineer or Land Surveyor)
19358
(Indiana registration number)
certify the 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.
Average Design Flow (gallons per day)
23,250
Peak Design Flow (gallons per day)
99,742.5
Owner of Receiving Collection System
City of Carmel Utilities
Name of Wastewater Treatment Plant
City of Carmel Waste Water Treatment Plant
Signature
TA4,�March
Date Signed (month/day /year)
1/8, 2020 /
(Please refer to IC 13-30-10 for penalties of submission of false information.)
Page 5 of 6
Part of State Form 53159 (R5 / 11-19)
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 IDEM's
decision on procedural grounds. To ensure conformance with Administrative Orders and Procedures
Act (AOPA) and to avoid reversal of a decision, 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.
Name
Please see attached
Address (number and street)
City
State
ZIP Code
Name
Address (number and street)
City
State
ZIP Code
Name
Address (number and street)
City
State
ZIP Code
Name
Address (number and street)
City
State
ZIP Code
Name
Address (number and street)
City
State
ZIP Code
Name
Address (number and street)
City
State
ZIP Code
CERTIFICATION
I certify that to the best of my knowledge I have listed all potentially affected parties, as defined by IC
4-21.5-3-5.
Proposed Facility Name
City
The Grove at The Legacy, Sections 4A & 4B
Carmel
Printed Name of Person Signing
County
David J. Stoeppelwerth
_ -
Hamilton
Signature
2) V'_z A;��
Date Signed (month /day/ year)
March /18, 202p
Page 6 of 6
Identification of Potentially Affected Persons Instructions
The Administrative Orders and Procedures Act (AOPA), IC 4-21.5-3-5, 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
The following are the minimum recommendations made as to who should be included in this list:
• All adjoining landowners to the property where the proposed construction is to occur
• All persons or entities with a substantial and direct proprietary interest in the issuance of this
permit
• Anyone who is known to have expressed concern or an interest in this particular project or
projects in this specific area
• Anyone else whom the applicant may feel that might be potentially affected by the issuance of
this permit
IC 13-15-3-1 requires IDEM to provide notice of receipt of a permit application to the following:
• The county executive of a county affected by a permit application
• The executive of a city affected by a permit application
• 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.
Mailing labels are required to be submitted with your project. 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