Notice Of Intent To Construct A Watermain Extension {49008}

INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT INSTRUCTIONS FOR COMPLETING THE FORM FOR NOTICE OF INTENT TO CONSTRUCT A WATER MAIN EXTENSION - 327 IAC 8-3.5-4 TYPE OR PRINT ALL ENTRIES. The following numbers refer to the enclosed form. 1. 2. Enter the title of the proposed project (i.e. Meadow Brook Subdivision ­ Phase 2). Enter the county(s) where the water main extension construction will take place. Indicate the location of the project, which includes the city and reference to adjacent streets or roads. Example: "Bowling Green (city), Madison Street, one block east of Eel River, along State Road 46" 3. 4. Enter the name, title, e-mail address and affiliated business name of the responsible person as defined in 327 IAC 8-3.5-6. Enter the telephone number of the responsible person listed in box 4. Enter the address of the responsible person listed in box 4. Enter the name of the public water system providing water service to the water main extension. Enter the Public Water System Identification Number (PWSID) as chartered by the State of Indiana. Enter the address of the public water system listed in box 7. 5. 6. 7. 8. 9. 10. Enter the telephone number of the public water system listed in box 7. 11. Enter the name of the professional engineer and his/her firm name designing this water main extension. 12. Enter the telephone number of the professional engineer listed in box 11. 13. Enter the address and e-mail address of the professional engineer listed in box 11. 14. Enter the name and e-mail address of the developer (if applicable) for the water main extension. 15. Enter the telephone number of the developer (if applicable) listed in box 14. 16. Enter the address of the developer (if applicable) listed in box 14. 17. Check the applicable box for "timing of construction" for the water main extension. For the first check box option, you must enter a start date and an approximate completion date. For the second check box option, you must provide written notification within at least ten (10) working days before construction begins. NOTE: For both options, construction cannot begin less than thirty (30) days after IDEM receives a complete and sufficient NOI application. IDEM receipt date will be either e-mail receipt when submitted via the NOI dedicated e-mail address (dwnoi@idem.in.gov) or certified mail receipt. Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com  18. Check 327 IAC 8-3-7(a) to see if a processing fee is required. Exempt organizations are both a governmental entity and one of the listed categories. If you are not a governmental entity, then you are not exempt from the construction permit processing fee. If you are unsure, contact the Permits Section via e-mail at dwnoi@idem.in.gov or by calling (317) 234-7421, prior to submitting the NOI form. If a processing fee is required, payment must be submitted using one of the following methods: A. Make check/money order payable to IDEM (Acct.#3240-414000-140000) and mail with a copy of the completed first page of the NOI form to: IDEM PO Box 3295 Indianapolis, IN 46206-3295 B. Remit by ACH to: ABA#: 071921891 Bank Account Number: 4620695315 Bank Account Name: State of Indiana AND send a copy of the first page of the completed NOI form, amount of payment and payment date to water@idem.in.gov. C. To pay by credit card, call (317) 234-3099 and leave the information requested in the telephone message and e-mail copy of the first page of the completed NOI, the amount of payment and payment date to water@idem.in.gov. 19. All applicable certifications must be signed and dated. For all water main extensions, there must be a responsible person, professional engineer and public water system official. The developer certification may or may not be applicable. If a person fills more than one certification role, they must sign and date each applicable certification section. 20. Check the appropriate box. Design and construction must follow all technical standards for water main extensions found in 327 IAC 8-3.2. Alternate technical standards are not allowed under an NOI, unless the alternate technical standard has already been approved for this water system by the commissioner in accordance with 327 IAC 8-3.2-20. A copy of this alternative technical standard approval must be submitted with the NOI form. 21. Enter the public water system's daily production firm capacity (see 327 IAC 8-3.3-3) in million gallons per day (MGD) in box A and gallons per minute (GPM) in box B. 22. Enter the public water system's five (5) highest demand days and volumes in the previous two (2) years only. NOTE: the volumes must be in million gallons per day (MGD). The public water system will need to review their demand numbers for the current year, previous year and the year before to determine the five (5) highest demand dates and volumes. For example, if the NOI form was being submitted on August 1, 2014, then the five (5) highest days would be sometime within January 1, 2012 ­ July 31, 2014. Any other days and volumes prior to that date range would not be acceptable. 23. Calculate and enter into box C the average of five highest demand days listed in box 22. 24. Divide box C number by box A number, and then multiply by 100. Enter the calculated percent into box D. 25E. Enter the number of residential homes being provided water by this water main extension into box E. If this water main extension is not adding any new residential homes/customers due to it being a water main replacement only, or if it is only adding commercial and/or industrial customers, then enter 0 into box E. 25F. Enter the Peak Daily Demand Factor, calculated in accordance with 327 IAC 8-3.3-2, into box F. For residential homes, this number must be at least 0.87 gallons per minute/home. Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com  25G. Multiply box E number and box F number and enter result into box G. 25H. For commercial and industrial customers being added as a result of the water main extension, provide a description of each including size of meter and safe maximum operating capacity of the meter. If fire protection is being provided, include appropriate fire flow demand. NOTE: For commercial and industrial customer demand see Table 2-1 in 327 IAC 8-3.3-2(b). 25I. Add box G and box H and enter result into box I. 25J. Divide box I by box B, then multiply by 100. Enter the calculated percent into box J. 26A. Check the appropriate box. If no commercial or industr