j14 septic.pdf

CEP-5 3/2017

CEP 5

INSTALLER’S ONSITE SEWAGE DISPOSAL

SYSTEM CERTIFICATION

OWNER/APPLICANT’S NAME ___________________________________________________________

PROPERTY (911) ADDRESS ____________________________________________________________

CITY, STATE, ZIP ___________________________________________________________________

SUBDIVISION NAME_____________________________________ LOT________ BLOCK____________

INSTALLATION INFORMATION

Installation Date: ________________________ ( )New ( )Repair

Septic Tank Size: __________gallons Manufacturer’s No.:_________________

Septic Tank Filter (NSF 46) Installed: ( ) Yes ( ) No, not required

Aerobic Sewage Tank: Make ______________________Model ____________________

Type of Distribution System and Lines: ( ) Level Header ( ) Serial Distribution

( ) Gravel Trench Gravel Depth: ( )12” ( ) 24” ( ) Gravel-less- Pipe Dia. __ 8” __10” __ other

Manufacturer: _______________________________ Model/Configuration:___________________

Effluent Distribution Trench

Trench Bottom Depth: ________inches Trench Width: ( ) 18” ( ) 24” ( ) 36” other ________

Length of Installed Effluent Distribution Lines: ______________ linear feet.

Separate Washer Line (If Used): _________ width _________length (linear feet)

NAME OF INSTALLER / COMPANY ___________________________________________________________________

BUSINESS ADDRESS ______________________________________________________________________________

TELEPHONE__________________ CITY _____________________________ STATE ___________ZIP _____________

“I hereby certify that the Onsite Sewage Treatment and Disposal System has been installed and completed in accordance with the construction plan or plot plan and permit issued by the Local Health Department on (insert date)___________,20 _____ and the installation of the OSS is in compliance with Chapter 420-3-1 of the Rules of the Board. I further certify that I am licensed and in good standing with the AOWB in full compliance with Act 99-571 (HB 547), as enacted by the Legislature of the State of Alabama in its 1999 Regular Session, and as implemented.”

______________ County Health Dept.

______________ Permit Number

______________ Date Received

ALABAMA DEPARTMENT

OF PUBLIC HEALTH

DATE _______________ AOWB License No. _________SIGNATURE _______________________________________

Instructions for Systems Not Inspected If you are allowed to cover this installation without an inspection by the Health Department, you are instructed to complete the FRONT and BACK of this form. Please see back of form for details and instructions.

SYSTEM CERTIFICATION

Please certify that the installation is in compliance with the checklist below. Additionally, Large-Flow systems, engineered systems, and some large conventional onsite systems also require coordination with and approval by the design engineer. If you are given permission to cover this installation, please make a sketch of the layout of the system. Record grades of the effluent lines, crossovers, and tank.

SEPTIC TANK: (Mfg. Permit number) ___________________

Tank set level.

Approved manufacturers number engraved inlet end.

Uniform thickness, smooth, free of defects

Proper specified capacity

Inlet tee or ell in place and sealed.

Baffle in place

Outlet tee in place and sealed: 2 inch inlet to outlet drop

NSF Standard 46 effluent filter installed.

EFFLUENT LINE (tank to disposal field)

Solid Schedule 40 pipe, joints sealed.

LEVEL HEADER SYSTEM

Header installed level.

Header on same elevation as effluent distribution line.

Header at least four inches in diameter.

Invert of header at least four inches below invert of septic tank outlet.

Maximum length of effluent distribution line 100 feet.

SERIAL DISTRIBUTION SYSTEM

Invert of uppermost effluent distribution line 8 inches below invert of outlet of septic tank.

Invert of crossovers at least 4 inches below invert of septic outlet.

Undisturbed earthen dam in crossovers.

Minimum of one crossover for 100 feet or less of trench:

two crossovers for more than 100 feet of trench.

Maximum length of effluent distribution line from crossover not more than 100 feet.

EFFLUENT DISTRIBUTION LINES

Trench widths not less than 18 and not more than 36 inches.

Five feet between trench walls minimum.

Trench bottom level.

Minimum back fill/cover over aggregate/product of 12”.

Trench depth between 12” and 60”.

Grade of pipe not exceeding 1” per 100 feet.

Perforated pipe 4” in diameter. Perforations on bottom

(no slits).

Gravel clean and properly sized.

Gravel at least 8” under pipe to top of pipe (min. 12” total).

Barrier cover material over gravel approved (No Plastic /

Polyethylene).

Standard fittings used to connect pipe.

Gravel-less pipe approved 8” or 10” diameter, with fiber wrap. Solid plastic cover removed for installation.

Connectors, end caps used.

Products sized and installed according to Product Permit.

Product approved under current Permit

PUMPS / DISTRIBUTION BOXES

Distribution box set level, stabilized, outlet pipes rigid, laid level or on equal grade for 5 feet.

CHECKLIST

This record of the installation of an onsite sewage disposal system is submitted by:

NAME OF INSTALLER

DATE _______________ AOWB License No. _________SIGNATURE __________________________________

SKETCH

CEP-2 3/2017

CEP-2

APPLICATION

For A Permit To Install (Repair)

SMALL FLOW ONSITE SEWAGE DISPOSAL SYSTEM

For a System of Total Flow < 1801 gpd or < 12 Bedrooms

For Department Use Only

ALABAMA DEPARTMENT ______________County Health Department ______________Date Fee Paid

OF PUBLIC HEALTH ______________Co. Health Dept. I.D. No. ______________Fee Amount

New Repair ______________Date Received ______________Fee Code

______________Receipt No.

PART A To Be Completed and Signed By the Owner/Authorized Agent

(1) Owner Name_________________________________________ (2) Daytime Phone: (___)__________________

(Type or Print) (3) Alternate Phone: (___)__________________

(4) Property’s -E911 Address (or directions if address not available): __________________________________________

(5) City _______________________________ (6) County ___________________ (7) State AL (8) Zip____________

(9) Property Size:___________acre(s) (10) Water System serving site :_____________________________ Public Private

If this property is within a Large Flow Development complete Items 11 – 15:

(11) Name of Development:_____________________________________________________________________

(12) Plat/Phase/Addition/Sector;_____________________________________ (13) Block:____ (14) Lot:_____

(15) Health Dept. Site Development Plan (including CEP-3 Section A Part 3) has been reviewed Yes No

(Note: The Developer can provide Site Development Plan information relative to this lot) If this system will serve a dwelling(s), complete Items16 – 23 with the total quantity of each:

(16) Site built (permanent) Dwelling(s):______ (17) Manufactured Home (mobile, double wide):_________

(18) Number of bedrooms:__________ (19) Basements:________

(20) Garbage Disposals:___________ (21) Spa/Hot Tubs:___________ gallons

(22) Wells/Potable Springs:_______________ (23) Swimming pool:___________

(this includes irrigation wells)

If this system will serve an establishment(s), complete Items 24 – 28 and include a floor plan drawn to scale:

(24) Number of buildings to be affected by this project:__________

(25) Use of Building(s):____________________________________________ (restaurant, church, school, etc.)

(26) Number of Patrons/day:_______ (27) Number of Employees:_______ (28) Number of Shifts:_______ PLEASE READ BEFORE SIGNING: By signing this application, I am stating that the information in this part is complete, true and correct; and that the OSS will be installed according to the design as approved by the ADPH and will be maintained according to the manufacturer’s recommendation, the operation and maintenance plan, and the Permit. I understand that the property named in this application shall not be further divided, or the system thereon modified in any way, without approval by the Health Department. I acknowledge that the person who installs (repairs) and certifies this onsite system must be a licensed installer or individual who is in compliance with the provisions of state law, specifically Act 99-571 (Code of Ala., 1975, Title 34, Chapter 21A, Sections 1-26), as enacted, and as implemented. I do hereby give permission to the health department to enter onto the property, at reasonable hours, for the purpose of processing this application. If this onsite system application is for an engineered system, as defined by the onsite rules, you are hereby informed that the Health Department will only review the application and accompanying documentation for completeness. No site visit or installation inspection will be performed. The Health Department depends on the Professional Engineer to ensure that the system is installed according to the submitted design and is in compliance with the rules. The Health Department assumes no liability.

Owner Authorized Agent: Signature:_______________________________________________ Date:______________________

Mailing Address:____________________________________________________________________________________________

City:_______________________________ State:_________________ Zip:_______________

CEP-2 APPLICATION CONTINUED - Small Flow Owner Name or Location__________________________________________________________________________________________ PART B - System Planning

(29) Designed system is: Engineered Conventional (30) Establishment Estimated Water Usage _______________gallons/day

(31) Size of lot (excluding easements): _________________sq. ft. (32) Sanitary Sewer is NOT available to this lot

(33) Plot plan drawn to scale attached (required with all applications)

Lot dimensions/size/property lines

Location/dimensions of structures

Utilities/easements/water lines

Surface waters/drainage features

Well locations

Landfill, dump, cave, or sinkhole

Location of all soil test sites

Location of OSS & REDF

Layout of OSS

Max/Min Trench Depth Proposed

Aggregate & Cover Recommended./Required.

Depth of fill

% slope & direction

Drainage/Gullies/>25% Slope

Identified

Location of embankments/cut/fill

(34) Construction Plan attached (See attached instructions) Engineered system applications must include a CONSTRUCTION PLAN which shall be certified by an engineer. NOTE: A construction plan is not required for a system generating 1800 gallons or less of sewage (not high strength sewage) a day proposing to use a conventional onsite sewage disposal system.

(35) Soil Survey NRCS

Property Location Information

Vicinity Map If available - Section: _______ T_______ R_______

If available – Latitude (degrees/minutes/seconds)______________ Longitude (degrees/minutes/seconds)______________

Application Attachments:

Legal Description or Copy of Deed Engineer Calculations (engineered design) Establishment ______________ BOD/TSS lbs./day

------------------------------------------------------------APPLICABLE SIGNATURES BELOW-------------------------------------------------------

FOR CONVENTIONAL SYSTEMS:

Engineer Land Surveyor Geologist Soil Classifier PHESS Other ____________________

Last Name - PRINT or TYPE First Name Firm Name (if applicable)

Street or PO Box City State Zip Code Telephone Number

I hereby certify that the information contained in this part of the application, including all related attachments, is complete, true and correct.

Signature___________________________________________ Date _____________

For applicable professionals - AL Registration No.: _____________ License Photocopy attached

FOR ENGINEER DESIGNED SYSTEMS: By signing below, I acknowledge that the Health Department is relying upon my professional license, judgment and skill to ensure that the system is installed according to the submitted design and in accordance with applicable statutes and rules. I further acknowledge that no site visit or installation inspection will be conducted by the Health Department based upon its reliance on this signed certification by me.

Last Name - PRINT or TYPE First Name Firm Name

Street or PO Box City State Zip Code Telephone Number

I certify that the design features of the OSS at the address above have been designed, specified, or approved by me, and conform to design principles applicable to such projects. In my professional judgment, this system, when properly constructed, operated and maintained, will achieve the established performance standards and comply with applicable statutes of the State of Alabama and the ADPH.

Signature___________________________________________ Date _____________

Registration No.: _____________ License Photocopy attached

PART C – Site Evaluation

CEP 2/3 Part C Site Evaluation Form attached

Instructions for CEP-2 Applications

(1) An Application (CEP-2) for a Permit To Install/Repair a Small-Flow OSS shall be submitted for each Small-Flow OSS, and contain the following information.

(a) The address/location (911 address if available) of the site or the proposed dwelling/establishment/development.

(b) The number of bedrooms (dwellings), the number of persons served (establishments), or other information that can be used to establish or determine design flow and strength of sewage as per The Design Section, Rule 420-3-1-.79 Design Flow and Wastewater Concentrations. Where actual flow rates are referenced, these shall be from a similar facility or development and documented for a period representative of 12 consecutive months.

(c) A site evaluation as outlined in The Site Evaluation Section of Chapter 420-3-1, Onsite Sewage Treatment and Disposal rules.

(d) A vicinity map or written directions in sufficient detail to enable a person to find the site.

(e) A legal description or copy of the deed unless already submitted as part of the Large-Flow development process.

(f) The results of all known soil tests conducted on the site.

(g) The site’s source of drinking water (public/private) to include name of water system if applicable.

(h) If the system is within a Large-Flow Development, name of development, location within the development to include the plat/phase/addition/sector, the block and the lot.

(i) If the system will serve a dwelling, provide number of permanent dwellings or manufactured mobile homes, and as applicable, whether or not garbage disposals, basements, swimming pools, spas/hot tubs will be present.

(2) A plot plan (drawn to scale) shall accompany the CEP-2 and include the following items:

(a) Lot dimensions/size, with all property lines identified for lots one acre or less in size; and all lot lines within fifty feet of the OSS, EDF and REDF locations for larger lots.

(b) The location, (relative to the property lines and the proposed OSS), description and dimensions of any existing or proposed structures, decks, patios, paved and/or impervious surfaces, retaining walls, pools, etc.

(c) Location of existing (and proposed) underground and above ground utility lines or easements, such as gas, water, telephone, electric, cable television, other similar lines and any other easements and rights-of-ways on the property. Additionally, water lines (on adjoining property) that are located within 10 feet of system components shall be shown.

(d) Locations of surface waters (including swamps, marshes, wetlands, springs etc.), hydric soils, frequently flooded areas, surface or subsurface drainage features or systems (natural or manmade, including drainage swales, drainage gullies, storm sewers, French or curtain drains, etc.), and storm water retention areas on the property or within 50 feet of any part of the EDF and REDF s.

(e) Locations of any existing or proposed wells on the property or within 100 feet of any part of the EDF/REDF.

(f) A description and location of any landfills or dumps (covered or open); surface mining operations; caves and sinkholes on the property and within 300 feet (measured from the closest edge or entrance) to the closest edge or part of the proposed EDF or REDF, whether or not on the applicant’s property; public or private systems, and/or public water supply sources within 500 feet of the closest edge of the EDF or REDF.

(g) Location/identification of all known soil test sites, pits, etc.

(h) A layout of the proposed OSS, including recommended locations and capacities of treatment tanks, traps, distribution devices, pump chambers, and locations and sizes of the primary EDF and REDF areas.

1. The system layout shall also include the proposed depth of the EDF based on the soil test data; recommended aggregate or EDF product and cover; and the direction and percent of slope.

percent of slope shall be determined as the largest percent of slope measured in the EDF area.

(i) Additionally, any areas on the lot that are over 40 percent slope, and significant landscape features on the lot such as drainage ways and drainage gullies, shall be identified.

2. The EDF and REDF areas located and shown as protected areas.

(i) The locations of the areas with slope in excess of 25 percent, existing or proposed embankments, cut or fill areas (and reasons for cut/fill) located within 25 feet of any part of the proposed primary EDF or REDF.

(ii) If fill is required, the fill depth, natural ground and finished elevation(s) shall be indicated. Proposals using fill in the EDF area shall comply with the applicable parts of Chapter 420- 3-1, Onsite Sewage Treatment and Disposal rules.

(3) The ADPH may determine if additional information such as detailed soils mapping is required to evaluate a proposed OSS site/application.

(4) When the proposed OSS is for buildings other than a single-family dwelling, the following additional information shall be submitted;

(a) Floor plans drawn to scale.

(b) An explanation of the occupancy and use of the building(s).

(c) Number of buildings that are a part of this application.

(5) Construction Plan Requirements for Engineer Designed Systems.

(a) In addition to the items required in Section (4) the Construction Plan will include the following:

1. The location and elevation of a temporary bench mark (TBM).

2. Lot elevations and (original and finished) one foot contours shown for all sections of the lot within 25 feet of, and including, the proposed EDF. Two foot contours may be used for slopes greater than 25 percent.

3. A detailed layout to scale of the OSS including all treatment devices with capacities, filters, access manholes and risers shown, and pipe details including type, sizes, lengths, spacing, etc., and including the following:

(i) Maximum and minimum depths, in relation to the TBM, of trenches, cover, the top of the gravel or other aggregate/filter media, original ground and fill material, etc.

(ii) A cross-section view of the EDF.

(iii) A profile view of the system which shows the sequence of connections and specifies elevations, in relation to the TBM, for the dwelling/facility plumbing stub-out, tank inlet and outlet, pipe inverts, trench bottoms.

(iii) The EDF and REDF areas located and shown as protected areas.

(iv) A listing or description of materials to be used, methods of construction, instructions concerning inspection schedules, and operation and maintenance procedures.

(v) An explanation of the system design, with all design calculations. (including those for pump or siphon sizing, lift stations, dosing tanks, supply manifolds, small-diameter pipe sizing and spacing, EDF sizing, etc. Pump curves, pump or siphon locations, electrical connection details, on/off levels for pumps, high water alarms, and any other information needed to complete the design review.

4. High water alarms shall be located to be easily heard/seen by the owner.

5. If boundaries are an issue the LHD may require a plat.

(b) This section does not have to be executed for lots for single dwellings recorded prior to March 18, 1982 in order to put a system on a lot that is smaller than 15,000 sq ft. For those that were recorded after March 18, 1982 the procedure below shall be executed.

(6) For lots smaller than the minimums set out in Chapter 420-3-1, Onsite Sewage Treatment and Disposal rule there shall be a surveyed boundary plat of the property recorded in accordance with Rule 420-3-1-.54 Recording Requirements, showing the following items surveyed in and on the recorded plat :

(a) Lot dimensions, including total net & gross acreage or square footage.

(b) The dwelling/establishments/structures location, drawn to scale.

(c). The EDF and REDF areas shall be evaluated, designed and drawn to scale and shown as restricted areas.

(7) It shall be demonstrated that the EDF and the REDF are or can be made usable by the design. See Appendix A Table 21 for appropriate testing requirements.

(8) Engineer design is not required for lots recorded prior to March 18, 1982, if the lot can support a full sized conventional OSS as defined by these Rules with no disposal product reductions.

This does not apply to multiple dwellings or establishments on one lot. In those cases engineer design is required.

(9) A written plan describing how the EDF and REDF areas will be protected during lot development.

(10) Wastewater from an establishment shall be characterized by the design engineer in terms of quantity, strength and method of treatment.

(11) All systems designed by an engineer, conventional or engineered, shall be in compliance with Rule 420-3-1-.52 Professional Signatures and Seals

CEP-2/3 3/2017

CEP-2/3 Site Evaluation Data

Name/Establishment/Development

Location/Address

Evaluator

Soil Classifier Engineer Land Surveyor Geologist PHESS – CEP2 only

Method Used

Percolation Unified Mapping Morphology

NOTE: All percolation results shall be reported. All testing methods and results are subject to verification by the ADPH.

1. Unified / Morphology Method / Soil Boring Data for Percolation Method

(Attach Additional Sheets As Needed)

Hole

No.

Layer ID/

Horizon*

Depth Of

Up/Lo

Boundary

Dominant

Color Of Each

Layer

Mottles, Redox, Etc Texture*

Texture

Group*

Other

Field Sizing _______mpi @ _________ Depth (in.)

Restriction

Depth (in.)

Restriction Type (circle): ASHES

Rock Pan Water Indicator

Other_____________

Minimum Vertical Separation

Distance in Appendix A, .Table 19________

Restriction

Depth (in.)

Restriction Type (circle):

ASHES Rock Pan Water

Indicator Other____________

Minimum Vertical Separation

Distance in Appendix A, Table 19_______

CEP-2/3 3/2017

Restriction

Depth (in.)

Restriction Type (circle): ASHES

Rock Pan Water Indicator

Other____________

Minimum Vertical Separation

Distance in) Table 19______

* Required for Unified/Morphology Method only

2. Percolation Test Data (Attach Additional Sheets As Needed)

Extended Saturation

Procedure

Testing

No Yes

Percolation

Hole No.

Date

Of

Percolation

Tests

Beginning /

End Time Of

Saturation

Beginning /

End Time Of

Testing

Total

Depth of Hole

Depth From

Surface

To

Restriction

Stabilized

Percolation

Rate in

Min. per inch

3. Professional Soil Classifier Certified Soil Mapping data attached

SITE EVALUATOR

Primary EDF design is limited by the most restrictive test result, which is recorded as Hole #_________.

I, _______________________________________________a (professional engineer, surveyor, soil classifier or

Print/Type Name geologist) do hereby certify that the above and/ attached soil tests were conducted as specified in the Rule 420-3-1-

.61 thru Rule 420-3-1-.76 and are true and accurate as presented..

Signature______________________________ Date ____________________ Registration No. ______________

Address _____________________________________ City _______________ State _________ Zip ___________

Phone ______________ Fax _______________ E-mail ___________________________________________

Firm Name Address