HomeMy WebLinkAboutApplication_Sanitary Sewer Construction PermitInstructions for State Form 53159
Application for Sanitary Sewer Construction Permit
All essential items listed below must be provided upon initial receipt of a construction permit
application or the application will be deemed incomplete and will not be reviewed. If an application
has been deemed incomplete, an e-mail identifying the missing or incomplete essential items will be
sent to the applicant (with copy e-mailed to applicant’s engineer or land surveyor). As a courtesy,
IDEM will temporarily retain the application and associated plans and specifications. If the identified
essential items have not been received within the allotted time noted in the e-mail, the application will
be void and all associated documents, plans and specifications will be discarded (recycled). The
applicant will then need to reapply with a new, completed application as well as resubmit any
associated plans and specifications. Please submit only one copy of all application items.
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
When all essential items of a construction permit application are received, the project will be
assigned to a project engineer for technical review. If no administrative or technical deficiencies are
found during review, a construction permit will be issued. However, if administrative or technical
deficiencies are found, a deficiency notice will be e-mailed to the applicant (with copy e-mailed to
applicant’s engineer or land surveyor). 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
Facility Construction and Engineering Support Section, Mail Code 65-42FC
100 North Senate Avenue, Room N1255
Indianapolis, IN 46204-2251
For any questions, call the Facility Construction and Engineering Support Section at 317/232-5579.
Page 1 of 6
APPLICATION FOR SANITARY SEWER
CONSTRUCTION PERMIT PER 327 IAC 3
State Form 53159 (R7 / 2-20)
Indiana Department of Environmental Management
Office of Water Quality
Facility Construction and Engineering Support Section,
Mail Code 65-42FC
100 North Senate Avenue, Room N1255
Indianapolis, IN 46204-2251
APPLICANT APPLICANT’S ENGINEER OR LAND SURVEYOR
Name Mr. or Ms.
Brooks Longfellow
Name Mr. or Ms.
William A. Butz, Jr.
Name of Organization
Epcon Carmel, LLC
Name of Company
Kimley-Horn and Associates, Inc.
Address (number and street, city, state, and ZIP)
500 Stonehenge Parkway
Dublin, Ohio 43015
Address (number and street, city, state, and ZIP)
250 E. 96th Street, Suite 580
Indianapolis, Indiana 46240
Telephone Number
(317) 507-0328
Telephone Number
(317) 218-9560
E-Mail Address
blongfellow@epconcommunities.com
E-Mail Address
Bill.Butz@kimley-horn.com
NAME AND LOCATION OF PROPOSED FACILITY PROJECT DESCRIPTION
Name
The Courtyards of Carmel, Section 2
Location or Project Boundaries
Northeast corner of 136th Street and Keystone
Avenue
City or Town
Carmel
County
Hamilton
Describe the scope and/or purpose of this project
Extension of sanitary sewer to serve the next section
of this single-family subdivision.
SOURCE OF FUNDING
IFA’s Wastewater State Revolving Fund Loan Program Local Funds
OCRA’s Community Development Block Grant Private Funds
USDA’s Rural Development Loan and Grant Assistance Other:
CERTIFICATION AND SIGNATURE
I 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
William A. Butz, Jr.
Title
Professional Engineer
Signature of Applicant
Date Signed (month / day / year)
/ /
(Please refer to IC 13-30-10 for penalties of submission of false information.)
Part of State Form 53159 (R7 / 2-20)
Page 2 of 6
COLLECTION SYSTEM DESIGN SUMMARY
Design Flow – Refer to 327 IAC 3-6-11 for Design Flow Rate Requirements
Description of Units Served 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)59 18,290 gpd
(gpd/unit) gpd
(gpd/unit) gpd
(gpd/unit) gpd
(gpd/unit) gpd
Average Design Flow 18,290 gpd
Peaking factor 4.0 Peak Design flow 73,160 gpd
Gravity Sewer Pipe 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 D3034 SDR-35 N/A Open Cut
117 ft 10 in PVC ASTM D3034 SDR-35 N/A Open Cut
3594 ft 8 in PVC ASTM D3034 SDR-35 N/A Open Cut
ft in
ft in
ft in
Force Main Pipe and Low Pressure Sewer 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
ft in
Connection Location(s)
Example: The proposed sanitary sewer shall connect to an existing 8-inch sewer located approximately 10 ft north and 10 ft west of the intersection of
Main Street and Park Avenue and to an existing lift station located approximately 20 ft southeast of the intersection of Oak Lane and Maple Drive.
The proposed sanitary sewer shall connect to an existing 10-inch sewer manhole located approximately 510'
north of 136th Street and approximately 765' east of Keystone Avenue.
Inspection / Maintenance
Inspection during construction will be provided by City of Carmel Utilities
Maintenance after completion will be provided by City of Carmel Utilities
Wastewater Treatment
Wastewater treatment will be provided by City of Carmel Utilities
Lift Station Applicable Not Applicable
1. Location:
Part of State Form 53159 (R7 / 2-20)
Page 3 of 6
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):
7. Average detention time in the wet well (min):
8. Type of standby power/pump provisions:
9. Type of alarm:
10. Additional information:
Low Pressure Sewer Grinder Pump Station 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:
Vacuum Pump Station 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
William A. Butz, Jr.
Signature
Date Signed (month / day / year)
/ /
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 + √P) / (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.
Part of State Form 53159 (R7 / 2-20)
Page 4 of 6
CAPACITY CERTIFICATION
This form must be filled-out in its entirety with no alterations.
CERTIFICATION
I,John Duffy , representing the City of Carmel Utilities , in my capacity as
(Name of individual)(Name of municipality or utility)
have the authority to act on behalf of the City of Carmel Utilities
(Title)(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. I 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.
(Please refer to IC 13-30-10 for penalties of submission of false information.)
Name of Applicant: Epcon Carmel, LLC
Name of Applicant Representative: Brooks Longfellow
Name of Project: The Courtyards of Carmel, Section 2
Average Design Flow (gallons per day) 18,290
Peak Design Flow (gallons per day)73,160
Owner of Receiving Collection System City of Carmel Utilities
Name of Wastewater Treatment Plant City of Carmel Utilities
Mailing Address of Certifying Representative
(number and street, city, state, and ZIP code)
30 W Main St. suite 220
Carmel, IN. 46032
E-mail Address of Certifying Representative
JDuffy@carmel.in.gov
I am certifying for the Collection System Treatment Facility
Signature
Date Signed (month / day / year)
/ /
Part of State Form 53159 (R7 / 2-20)
Page 5 of 6
CERTIFICATION OF REGISTERED PROFESSIONAL ENGINEER OR LAND SURVEYOR
This form must be filled-out in its entirety with no alterations.
CERTIFICATION
I,William A. Butz, Jr., representing the project applicant, in my capacity as a
(Name of Individual)
registered professional Engineer ,PE10606045
(Engineer or Land Surveyor)(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.
(Please refer to IC 13-30-10 for penalties of submission of false information.)
Name of Applicant: Epcon Carmel, LLC
Name of Applicant Representative: Brooks Longfellow
Name of Project: The Courtyards of Carmel, Section 2
Average Design Flow (gallons per day) 18,290
Peak Design Flow (gallons per day)73,160
Owner of Receiving Collection System City of Carmel Utilities
Name of Wastewater Treatment Plant City of Carmel Utilites
Signature
Date Signed (month / day / year)
/ /
Part of State Form 53159 (R7 / 2-20)
Page 6 of 6
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
Name
Address (number and street)
Address (number and street)
City
City
State
ZIP Code
State
ZIP Code
Name
Name
Address (number and street)
Address (number and street)
City
City
State
ZIP Code
State
ZIP Code
Name
Name
Address (number and street)
Address (number and street)
City
City
State
ZIP Code
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
The Courtyards of Carmel, Section 2
City
Carmel
Printed Name of Person Signing
Brett A. Huff
County
Hamilton
Signature
Date Signed (month / day / year)
/ /
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
Part of State Form 53159 (R7 / 2-20)
Page 8 of 6