LAKE COUNTY GENERAL HEALTH DISTRICT 33 Mill Street

Painesville, OH 44077 (440) 298-3334 (440) 350-2543 (440) 918-2543

APPLICATION FOR

SEWAGE SYSTEM SITE REVIEW

$ $ ______Fee must accompany a complete site review application submittal

Office Use Only Date: Receipt #: Site ID #:

1.) Property Location: (Address: S/L & Street or parcel no.)

City: (Twp, Village)

2.) Requestor: Name Phone:

Mailing Address:

3.) Owner: Name Phone:

Mailing Address:

4.) Send Results to: Requestor Owner Other

Other Name/Address:

5.) Please provide the following complete information with your site review application:

a.) Please be advised that an approved site review is valid for three years from the date of the approval or disapproval until new state rules become effective after January 1, 2012.

b.) Site & Soil evaluation performed by a certified professional soil scientist in accordance with the

Site & Soil Evaluation for Sewage Treatment & Dispersal Instructions required of the LCGHD. c.) Design plan prepared in accordance with Chapter 29-09.1(B). Plans must be prepared by a

professional engineer or surveyor with experience with soil absorption sewage treatment design. A list of designers who have submitted plans to the Health District in the past is included for your convenience. Submit to the Health District 9 copies of the site plan with this application. The Health District retains 3 copies of approved plans for our records. Design plans must include the following information:

1. Topographic site plan, number of bedrooms, lot dimensions, proposed and existing water

supplies, existing adjacent houses or sewage systems. 2. Primary and replacement system areas as designated by soil scientist and designer. 3. System schematics of distribution layouts, pump stations, pretreatment components and

hydraulic calculations/specifications, justification of selection of loading rates, soil depth credits and variances where applicable.

d.) Completed and signed Application for New HSTS Economic Impact Review. 6.) Property lines must be staked and the lot clearly identified prior to requesting an evaluation.

Incomplete applications or unidentified lots will cause delays. 7.) Site reviews are conducted in the order in which they are received. Please allow at least two weeks

for the completion of the review. A $55.00 plan resubmittal fee is charged after the second plan submission.

8.) I authorize representatives of the Lake County General Health District to enter the property

referenced above for the purpose of conducting a site review.

Requestor’s Signature Date Owner’s Signature Date H:\Environmental Health\Liquid, Solid Waste & Water\Liquid Waste\SITE REVIEW\Site Review Application 10-10.doc

LAKE COUNTY GENERAL HEALTH DISTRICT PROCEDURES FOR DEVELOPMENT OF A SEWAGE TREATMENT SYSTEM

ON A RESIDENTIAL BUILDING SITE

The Lake County General Health District rules became effective on July 9, 2007. The process for developing a sewage treatment system on a residential building site has changed in order to comply with the rules. The process as outlined below clearly indicates the order in which the information must be obtained and must be provided to the Health District at the time of site review application.

ALL ITEMS IN SECTIONS A AND B MUST BE COMPLETED BEFORE THE HEALTH DISTRICT WILL PERFORM THE SITE REVIEW

A. SITE & SOIL EVALUATION

1. Must be performed by a certified professional soil scientist in accordance with the LCGHD Site & Soil

Evaluation for Sewage Treatment & Dispersal procedure. 2. Determine the most favorable locations on the site for primary and replacement area. 3. Minimum of two soil borings/test pits detailed on the ODH soil report form in the area of proposed sewage

system location and replacement area. 4. Soil boring locations must be marked/flagged on the site for use by the designer.

B. DESIGN PREPARATION

1. Prepared by sewage system designer who has experience in designing soil absorption sewage treatment systems.

2. Confirm site & soil evaluator’s optimal locations for sewage system and replacement area based on review of soil report and site inspection.

3. Site inspection includes determination of slope, wet areas to avoid, drainage, isolation distances, neighboring wells, existing structures, disturbed and fill areas, etc.

4. Designated sewage system/replacement areas indicated on site and protected (fenced or roped off with caution tape).

5. Meet with prospective homeowner to discuss and select system options. Homeowner to complete and sign the application of new HSTS Economic Impact Review.

6. Topographic site plan must be prepared in accordance with Chapter 29-09.1(B) of the LCGHD Sewage Treatment System Rules. Plans shall include designated primary and replacement system areas, soil boring locations, all necessary system schematics of distribution component layouts, pump stations, pretreatment components and hydraulic calculations/specifications. Designs must justify the selection of loading rates, soil depth credits and variances where applicable.

PRIMARY AND REPLACEMENT SYSTEM AREAS MUST BE LOCATED ON THE PROPERTY PRIOR TO REQUESTING THE SITE REVIEW. SITE REVIEWS WILL NOT BE COMPLETED IF THE SYSTEM AREAS ARE NOT LOCATED.

C. SITE REVIEW PROCESS

1. Health District staff conducts site review on the property. 2. Reviews system proposal (site evaluation, soil report, topographic plans & specifications) to determine

compliance with Sewage Treatment System Rules. 3. Health District keeps three copies of approved plans and specifications. 4. Plans should consider erosion and sediment control specifications to comply with the Lake County Erosion and

Sediment Control Rules.

D. SEWAGE SYSTEM INSTALLATION

1. Registered Lake County Installer qualified for installation option obtains installation permit at Health District. 2. Health District reviews system design with installer. 3. Sewage system installed in accordance with approved design and Sewage Treatment Systems Rules. 4. Health District conducts inspection of system prior to final cover. 5. Health District conducts final inspection once system is backfilled and graded. 6. Health District issues operational permit to homeowner when system installation is approved. 7. Health District conducts operational inspection of sewage system within 12 months of occupancy and requires

an annual operation permit and fee.

H:\Environmental Health\Liquid, Solid Waste & Water\Liquid Waste\SITE REVIEW\Site Review Application 10-10.doc

Information Relevant to the Development of a Sewage Treatment System

On a Residential Building Site

The purpose of this information is to highlight some of the changes in procedures and policies that are a result of the implementation of the Sewage Treatment System Rules that became effective on July 9, 2007. These rules establish requirements for site and soil evaluation, system design, system installation and system operation, maintenance and management in Lake County. The following information is pertinent to the homebuilder and the property owner who will be responsible for the operation and maintenance of the household sewage treatment system.

1. Sub. SB 110 Section 3718.023(D) states that site approvals granted by the Board of Health after September 17, 2010 and prior to January 1, 2012 are valid for 3 years from the date of the approved site application (approved sewage system site plans).

2. One of the most critical changes required in the rules is Section 29-13 (H) (1) concerning soil moisture

conditions. This rule specifically states that the excavation or preparation of the soil infiltration interface such as the construction of a trench or the preparation of a basal area cannot proceed when the soil is wet and will compact or form a ribbon when handled. Based on this rule, builders will need to meet the following:

• Improved planning by the builder and property owner will be necessary when scheduling

the installation of a sewage system. Do not wait until the house is finished before contacting a sewage system installer.

• Contract with the installer to clear and prepare the sewage system area, or at least let the

installer supervise the clearing if he does not clear for his own installations.

• Protect the roped off areas that have been approved for sewage system installation from use in any other manner. There must be no truck or equipment traffic or material storage in those areas.

• Please be advised that the preparation of basal areas for mounds and drip distribution must

take place during dry soil conditions and be approved by the health district. The actual construction of the mound or drip distribution system can be carefully installed during less favorable conditions.

• The installation of evapotranspiration trenches in clay soils during the grace period can only

take place during dry soil conditions. If you do not properly plan and the homeowner must move in, an inclement weather permit condition will be required by the health district. Inclement weather permits require installation of holding tanks, high water alarms and routine septage pumping by a hauler until soil conditions allow the installation of the soil absorption part of the system. Please be advised that the cost of pumping of 2000 gallons of sewage averages approximately $250 to $350 per pumping event. The average family of four would need to pump approximately every 10 days if water conservation is practiced.

H:\Environmental Health\Liquid, Solid Waste & Water\Liquid Waste\SITE REVIEW\Site Review Application 10-10.doc

H:\Environmental Health\Liquid, Solid Waste & Water\Liquid Waste\SITE REVIEW\ECONOMIC IMPACT\Economic Impact Application Residential 2010.doc

LAKE COUNTY GENERAL HEALTH DISTRICT 33 Mill Street

Painesville, OH 44077 (440) 298-3334 (440) 350-2543 (440) 918-2543

APPLICATION FOR NEW OR REPLACEMENT HOUSEHOLD SEWAGE TREATMENT (HSTS) OR

SMALL-FLOW ON-SITE SEWAGE TREATMENT SYSTEMS (SFOSTS) ECONOMIC IMPACT REVIEW STATEMENT

Effective July 2, 2007, Amended Substitute House Bill 119 (Am. Sub. HB 119), also known as the state budget bill, made changes to Ohio’s sewage treatment laws, rules and requirements. Provisions of the bill authorize a local board of health to adopt standards for use in its health district that are more stringent than the rules adopted under division (A) (1) or (2) of Amended Substitute House Bill 119 provided that the board of health, in adopting such standards, considers the economic impact of those standards on property owners, the state of available technology, and the nature and economics of the available alternatives. In addition to ensuring that an STS will not create a public health nuisance, an economic impact review is also required when the LCGHD considers the approval or denial of an STS installation. Am. Sub. HB 119 Section 120.02(C)(4) defines “economic impact” as all of the following with respect to the approval or denial of an STS installation:

1. The cost of the proposed system 2. The cost of an alternative system that will not create a public health nuisance 3. A comparison of the costs of repairing a system as opposed to replacing the system with a new system 4. The value of the dwelling that the system services as indicated on the most recent tax duplicate

In order to comply with this legislation, the property owner must complete the following information for the property and proposed STS at the following address:

1. Current land value from most recent tax duplicate or cost of sublot 2. Current value of building from most recent tax duplicate or estimated cost of proposed house or building 3. Total value (Items 1 + 2) Proposed STS option selected from reverse side of form (new or replacement)

Estimated cost of selected option from STS installer A comparison of alternative system options, their corresponding costs and potential risks for causing public health nuisances are located in the table on the reverse side. I have reviewed the alternative system options and their corresponding costs in the table on the reverse side of this application and have accurately completed the required information.

Signature Of Property Owner Date OFFICE USE ONLY The Application for a sewage treatment system including site and soil evaluation, design plans and economic impact review information has been reviewed and found to be in compliance with the Regulations of the Board of Health of the Lake County General Health District Part 29 and with Am. Sub. HB 119 Section 102.02 (A)(2), (B), (C)(1), (C)(2) and (C)(4).

Reviewed and Approved By Date

H:\Environmental Health\Liquid, Solid Waste & Water\Liquid Waste\SITE REVIEW\ECONOMIC IMPACT\Economic Impact Application Residential 2010.doc

Potential STS option for this site

STS description

Estimated system cost*

Potential risk of malfunction that would cause nuisance conditions**

Septic tank(s), 300-600 ft. soil absorption trenches – in permeable soils

$4,000-$6,000

Less than 2%

Septic tank(s), SDA shallow soil absorption trenches, interceptor drain

$6,300-$16,000

No data as of this date

Aerobic treatment unit, 300-600 ft. soil absorption trenches - in permeable soil

$6,500-$10,000

Less than 2%

Aerobic treatment unit, 600-1500 ft. soil SDA shallow absorption trenches, interceptor drain

$12,500-$18,000

No data as of this date

Septic tank(s), drip distribution at grade or plow in, interceptor drain – severe (silt loam) soil

$16,500-$20,000

Less than 2%

Pretreatment, drip distribution at grade, interceptor drain – severe (silt loam) soil

$18,000- $22,000

Less than 2%

Septic tank(s), drip mound, interceptor drain – severe (silt loam) soil

$18,000- $21,000

Less than 2%

Septic tank(s), Lake County Mound, time dosing, inceptor drain – severe (silt loam) soil

$18,000- $21,000

3-4%

Notes: *Estimated system costs are averaged from a minimum of three estimates obtained from registered STS installers doing business in Lake County. These costs are subject to change based on changes in site conditions or market variables.

**These nuisance risk percentages are based on sewage system surveys conducted by the Lake County General Health District. Survey summaries are available for review. The results of the various surveys and the average failure rates does not grant or imply any guarantee or warranty of the future performance of the sewage treatment system. Data and cost information verified as of September 2007. Section 29-03 (B) of the Sewage Treatment rules provided a “grace period” that allowed for the applicant to contract for the installation of the system options outlined in a site evaluation report or approved plans by December 31, 2009. As of January 1, 2010, the grace period is no longer in effect.

LAKE COUNTY BUILDING DEPARTMENT 27 Woodland Road, Painesville, Ohio 44077

TEL: 440-350-2636 440-918-2636 FAX: 440-350-2660

REQUIREMENTS FOR OBTAINING A BULDING PERMIT ZONING PERMIT Check with the local zoning inspector for requirements.

Bring a copy of the zoning permit to the Building Dept. SITE PLANS Submit required number of site plans to zoning inspector,

Lake County Soil & Water, Lake County Engineer/Stormwater Management, Lake County Health District and the Lake County Utilities for approvals.

WATER SUPPLY If public water is not available, the applicant must supply

acceptable evidence that an adequate supply of potable water is available. A well log approved by the Lake County Health District will be acceptable.

SANITARY SEWERS/ If public sanitary sewers are not accessible, an individual SEPTIC SYSTEMS disposal system must be installed in accordance with the

Ohio State and County Health Departments’ requirements. Contact Lake County Health District or the EPA office. If a septic system is to be installed, the grade/site plan must be approved by the Lake County Health District.

FIRE AUTHORITY For commercial and/or industrial construction, submit one

set of construction documents and the Submittal Form supplied by the Building Department to the local Fire Official for approval. The Submittal Form completed by the local Fire Official must be returned to the Building Department before the building permit will be issued.

BUILDING PERMIT Submit (4) complete sets of plans sealed by a State of Ohio

Registered Design Professional, specifications, and data for commercial and/or industrial construction. Submit (2) sets of plans for residential construction.

Submit a copy of the Zoning Permit. Submit a Site Plan with all the required approvals from the Lake County Engineers/Stormwater Management, the Lake County Soil & Water District and the Lake County Health District if required. Submit a copy of the Approval Letter from the Lake County Soil and Water District. Submit a Well Log approved by the Lake County Health District if using a well instead of public water. Sewer and Water Availability Notice from the Lake County Utilities Department.

All Plumbing Permits are issued by the Lake County Health District 440-350-2543

REVISED 12/2006

ID # BUSINESS NAME / PHONE / CONTACT ADDRESS

Site/Soil EvaluatorsLake County General Health District

33 MILL STREETPAINESVILLE, OH 44077

Phone: 1-440-350-2543 Fax: 1-440-350-2548

2 BAUDER, JAMES R. 6106 ARMISTICE AVENUE N.W.CANTON, OH 447181-330-499-1688

JAMES R. BAUDER

3 BRUG, WILLIAM H. JR. 6365 BYRES ROAD, N.E.NEW PHILADELPHIA, OH 446631-330-343-9570

WILLIAM H. BRUG, JR.

4 FINCHAM, JAMES R. 13915 CLARIDON PARK DRIVECHARDON, OH 440241-440-479-5654

JAMES R. FINCHAM

15 HOUSER, TODD 2781 WADSWORTH ROADNORTON, OH 442031-330-706-9227

TODD HOUSER

5 MAPES, D. REX 41 HIGHMEADOWS CIRCLEPOWELL, OH 430651-740-548-6788

D. REX MAPES

6 MC CLEARY, FLOYD E. 106 EASTWIND DRIVE N.E.WARREN, OH 444841-330-393-7645

FLOYD E. MC CLEARY

7 MICHAEL, DAN R. 248 WEST STREET, RTE 122LEBANON, OH 450361-513-932-1641

DAN R. MICHAEL

8 MILLIRON, E. LARRY 12215 BERLIN STATION ROADBERLIN CENTER, OH 444011-330-547-2475

E. LARRY MILLIRON

9 RUBEL, NEIL 45021 BELMONT-CENTER ROADBELMONT, OH 437171-740-686-2153

NEIL RUBEL

10 SASOWSKY, KATHRYN C. 379 BITTERSWEET ROADAKRON, OH 443331-330-670-0455

KATHRYN C. SASOWSKY

12 STEIGER, JOSEPH R. 3940 DOROTHY DRIVEZAINESVILLE, OH 437011-740-454-3734

JOSEPH R. STEIGER

13 WILLIAMS, NORRIS L. 5138 CLARK ROADMIDDLEFIELD, OH 440621-440-693-4354

NORRIS L. WILLIAMS

14 ZIMMERMAN, TOM L. 2410 OIL CITY ROADWOOSTER, OH 446911-330-264-5521

TOM L. ZIMMERMAN

13 TOTALS:

04/13/2009 Page 1

BUSINESS NAME / PHONE ADDRESS

Previous Submittals of Topographic Site Plans in LAKE County.

The Health District is providing this list as a convenience and does notparticularly recommend or endorse any particular firm on this list.

Topographic Site Plan Preparers

AZTECH ENGINEERING** 5425 WARNER ROAD, SUITE 12VALLEYVIEW, OH 441251-440-602-9071

BABCOCK & JONES** 1924 MENTOR AVENUEPAINESVILLE, OH 440771-440-357-1811

BARRINGTON CONSULTING GROUP, INC.** 9114 TYLER BOULEVARDMENTOR, OH 440601-440-205-1260

BENCHMARK SURVEY COMPANY 5964 SOUTH RIDGE ROADMADISON, OH 440571-440-428-8599

BURGESS & NIPLE, LTD.** 100 WEST ERIE STREETPAINESVILLE, OH 440771-440-354-9700

C.W. COURTNEY COMPANY 700 BETA DRIVE, SUITE 200MAYFIELD VILLAGE, OH 441431-440-449-4005

CRABBS' SURVEYING SERVICE PO BOX 908PAINESVILLE, OH 440771-440-357-5941

CT CONSULTANTS** 8150 STERLING COURTMENTOR, OH 440601-440-951-9000

DAVE RAPP SERVICES** 3406 DAYTON ROADMADISON, OH 440571-440-983-1607

FORESIGHT ENGINEERING** 320 CENTER STREET, UNIT FCHARDON, OH 440241-440-286-1010

G G J, INC. 35585 CURTIS BLVD, UNIT CEASTLAKE, OH 440951-440-953-1567

GUTOSKEY & ASSOCIATES** 17078 MUNN ROAD STE 3CHAGRIN FALLS, OH 440231-440-543-6900

HESS & ASSOCIATES ENGINEERING, INC.** 12121 KINSMAN ROADNEWBURY, OH 440651-440-564-8008

HOWARD R. SELEE & ASSOCIATES, INC. 9701 BROOKPARK ROAD, SUITE 231CLEVELAND, OH 441291-216-398-0280

JACK ALLMAN 2737 WEST STREETGENEVA, OH 440411-440-466-5976

JAMES A. PEZAR 4670 WHITE ANGEL DRIVEPERRY, OH 440811-440-666-0602

JERRY SLAY PO BOX 1252ASHTABULA, OH 440051-440-993-7205

JOHN SKONIECZNY** 7739 VIEWMOUNT DRIVEPAINESVILLE, OH 440771-440-352-7742

KRB ENGINEERING, INC. ** 330 DOWNING DRIVECHARDON, OH 440241-440-286-7150

LAND DESIGN CONSULTANTS** 9025 OSBORNE DRIVEMENTOR, OH 440601-440-255-8463

M NEFF DESIGN GROUP 14855 BROADWAY AVENUE #100-2BMAPLE HEIGHTS, OH 441371-216-663-8820

OXBOW ENGINEERING 10 W. ERIE STREETPAINESVILLE, OH 440771-440-352-9559

POLARIS ENGINEERING & SURVEYING** 34600 CHARDON ROAD SUITE DWILLOUGHBY HILLS, OH 440941-440-944-4433

11/24/2010 Page 1

BUSINESS NAME / PHONE ADDRESS

Previous Submittals of Topographic Site Plans in LAKE County.

The Health District is providing this list as a convenience and does notparticularly recommend or endorse any particular firm on this list.

Topographic Site Plan Preparers

RUDY SCHWARTZ, SURVEYOR 12121 KINSMAN ROADNEWBURY, OH 440651-440-564-7528

SCHADE SURVEYING COMPANY 4043 ERIE STREET, SUITE 3WILLOUGHBY, OH 440941-440-951-6454

STEPHEN HOVANCSEK & ASSOCIATES** TWO MERIT DRIVERICHMOND HEIGHTS, OH 441431-216-731-6255

T-K ENGINEERING 6801 HOPKINS ROADMENTOR, OH 440601-440-205-0484

VILLAGE SURVEYING 622 HIDDEN HARBORFAIRPORT HARBOR, OH 440771-440-357-1359

TOTALS: 28

Firms/individuals noted above (**) have participated in sewage treatment & design training sponsered bythe Lake County General Health District

11/24/2010 Page 2

LAKE COUNTY SOIL &WATER CONSERVATION DISTRICT

Erosion and Sediment Control (ESC) Plans shall be submitted to the LakeSWCD Office for review and approval thirty (30) working days prior tothe start of soil-disturbing activity.

Commercial, Industrial, Recreational individual sites. one (1) acre or greater,shall submit two (2),copies of the completed ESC Plan with the following infonnation:

Completed' Application for Approval' FonnProof of Compliance with OEPA NPDES pennit programProof of Compliance with U.S. Anny Corps of Engineers Section 404 pennitprogram (if applicable)Check payable to Lake County Treasurer

Commercial, Industrial, Residential subdivisions, one (1) acre or greater, shallsubmit two (2) copies of the completed ESC Plan with the following infonnation priorto the approval of the Improvement Plans or Drawings by the Lake County PlanningCommission

Completed' Application for Approval' FonnProof of Compliance with OEPA NPDES pennit program

Proof of Compliance with u.S. Anny Corps of Engineers Section 404 pennitprogram (if applicable)Check payable to Lake County Treasurer

Commercial, Industrial Sublots any acreage OR General Clearin2lGradin!!, Rec-reational, Multi-Familv development within a larger Common Plan of Develop-ment that is 1 acre or greater shall submit two (2) copies of the completedAbbreviated ESC Plan with the following infonnation:

Completed 'Application for Approval' Fonn

Proof of Compliance with OEPA NPDES pennit program (if applicable)Proof of Compliance with u.S. Anny Corps of Engineers Section 404 pennitprogram (if applicable)Check payable to Lake County Treasurer

Residential Sublots any acreage within a larger Common Plan of Development(subdivision) shall submit two (2) copies of the site drawings with Erosion and Sedi-ment Control specifications with the following infonnation:

Completed' Application for Approval' Fonn

Completed 'Residential Sublot Erosion and Sediment Control Site Plan' (ifapplicable)Check payable to Lake County Treasurer

Residential Sublots 1 acre or greater not within a larger Common Plan of Devel-opment shall submit two (2) copies of the site drawings with Erosion and SedimentControl specifications with the following infonnation:

Completed 'Application for Approval' FonnCompleted 'Residential Sublot Erosion and Sediment Control Site Plan' (ifapplicable)Check payable to Lake County Treasurer

Revised 10-05