SEWAGE PERMIT APPLICATION PERMIT NUMBER: RECEIPT NUMBER: AMOUNT PAID: DATE: SECTION 1: OWNER - APPLICANT INFORMATION Registered Owner - Last Name First Name Corporation or partnership Mailing Address Email City/Town/Municipality Province/State Postal Code/Zip Code Telephone number Fax Site Location - Legal Description of Property including PIN# Cell Number Municipality/Town/Township In the District of: KENORA RAINY RIVER OWNER S AUTHORIZATION: Permission to send a copy of permit to your Contractor: Yes No Will the Contractor/Installer be acting with Owner s full consent: Yes No NWHU Worksheet attached: Yes No DECLARATION OF HOMEOWNER: The information contained in this application, plans, specifications, and other attached documentation, is true to the best of my knowledge. If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership. The proposed construction will not contravene any applicable law as outlined in 1.3.1.3. (5) of Division C of the Building Code. Registration Number(s) for Tarion New Home Warranty are included (if applicable). Signature of Applicant: Date: SECTION 2: INSTALLER INFORMATION (print clearly) Qualified Installer: Last Name First Name Company Name BCIN # of Qualified Installer and BCIN # of Designer if not the Installer Company BCIN# Mailing Address Email City/Town/Municipality Province Postal Code Telephone number Fax Cell Number Personal information on this form is collected, under the authority of the Ontario Regulation 350/06 Building Code to ensure compliance with legal and regulatory requirements. Questions about this collection can be mailed to: Freedom of Information Officer, Northwestern Health Unit, 210 First Street North, Kenora, ON P9N 2K4 or by telephone at 807-468-3147 or toll free at 1-800-830-5978. 05/2013 1 of 4
SECTION 3: SEWAGE SYSTEM INFORMATION Permit #: Purpose of Application: New Construction Alteration/Repair Amendment Transfer System Information Class Number of bedrooms: Dwelling Information 2 Greywater Design Flow (Q) (L/day) Residential area: (m 2 ) 3 Cesspool Design Flow (Q) (L/day) Fixture units of plumbing: 2/3 Greywater/Cesspool sidewall area (m 2 ) Walk out basement? Yes No 2/3 Greywater/Cesspool trench length proposed (m) Soils Information Perc. Rate (T) 4 Septic System Design Flow (L) Design Soil T D 4 Septic tank volume proposed (L) Mantle Soil T M 4 Trench length proposed (m) Native Material T N 4 Filter bed effective size (m 2 ) * Include lab report for design sand/soil. 4 Filter bed extended area (m 2 ) Test Pit Information Required Pit 1 Pit 2 4 Trench or Filter bed mantle area (m 2 ) Depth to groundwater? 4 Tertiary System Design & Drawing attached? yes no Seasonal high groundwater? 5 Holding tank proposed volume (L) Depth to bedrock? System Profile Septic Tank: Gravity or * Pump * Pump systems require permit from the Electrical Safety Authority 1-877-372-7233 Is the use of a BMEC Authorization proposed? yes no, if yes, attach copy and indicate Product Name: Benchmark for installation: (e.g. header to be level with top of deck) Is a deep burial tank proposed? yes no Is the effluent filter accessible? yes no Indicate most appropriate design: fully raised with mantle partially raised with mantle in-ground, no mantle Water Supply Directions to property: Dug well Drilled well Surface water Hauled, and is water supply: Existing or Proposed *Water Treatment: None Existing Proposed * Water treatment backwash is not permitted in septic systems Additional Requirements: Permit issuance constitutes permission to construct up to substantial completion. Permit Reviewed by: Date: (Signature of Inspector/Technician) Permit Issued by: Date: (Signature of Chief Building Official) On-site copy of issued permit provided to: Applicant/Owner Installer 05/2013 2 of 4
SECTION 4: LOT DIAGRAM Permit #: Drawing 1 - Absorption Trench Proposal or Drawing 2 - Filter Bed Proposal from Worksheets must be attached to permit. Drawings must be close to scale and show the following information accurately: the entire property showing lot size and dimensions including existing or proposed buildings, wells, travelled roadways, test pits and any existing sewage systems. All important topographical information including streams, rivers, lakes, steep embankments and bedrock outcroppings. Location of the proposed sewage system components on the property, clearance distance between the system and all site features noted above. Include neighbouring wells, if known. Tank Model: NB* This plan represents approved design. Unauthorized changes may result in refusal of application. Any changes must be approved by the Northwestern Health Unit. CERTIFICATE OF COMPLETION This certifies that the constructed treatment works have been inspected and approved at substantial completion. Remaining work includes: providing effluent filter access to grade, drainage, final grading, cover and seeding. Other: Recommended By: SIGNATURE OF INSPECTOR/TECHNICIAN DATE Issued By: SIGNATURE OF CHIEF BUILDING OFFICIAL DATE GPS Coordinates: N: W: 05/2013 3 of 4
Northwestern Health Unit 210 First Street North Kenora, ON P9N 2K4 SEWAGE PERMIT APPLICATION PROCESS All applications must be completed in full and have all required signatures. Failure to provide a complete application will result in a delay processing. Required Attachments: Completed Application Applicable Fee payable to the Northwestern Health Unit Land Survey (or copy, letter or legal size) Lab Report for Design Soils BMEC Authorization, if applicable * Drawing 1 - Absorption Trench Proposal from Worksheets, if applicable OR * Drawing 2 - Filter Bed Proposal from Worksheets, if applicable * Drawing of Tertiary System, if applicable Contact Information: Doug Vergunst, Chief Building Official Office: 210 First Street North, Kenora, P9N 2K4 Phone: 807-468-3147 ext 3225 Toll Free: 800-830-5978 Fax Line: 807-468-3914 Email: dvergunst@nwhu.on.ca
Applicant Name: WORKSHEET Installation of a Sewage System Consult Code and/or Backgrounder Document for more complete details. SECTION 3: SEWAGE SYSTEM INFORMATION Step 1: On page 2 of the Permit Application, System Information, circle which type of system (Class) you plan to install then determine the Flow Rate (Q). Step 2: Determine the Flow Rate (Q) Use steps below for Residential Occupancies only. For all other Occupancies see Tables 8.2.1.3.A. & B. of the Building Code. The Total Daily Design Sewage Flow Rate (Q) is obtained by first establishing a base flow rate (BFR) based on bedrooms, up to five and then adding additional flow for: (a) bedrooms over five; or (b) living area over 200 square metres; or (c) fixture units of plumbing over 20 fixtures. Residential Occupancy Litres per day (L/d) DWELLINGS a) 1 bedroom dwelling 750 b) 2 bedroom dwelling 1100 c) 3 bedroom dwelling 1600 d) 4 bedroom dwelling 2000 e) 5 bedroom dwelling 2500 f) Additional flow for i) each bedroom over 5, or 500 ii) a) each 10 m 2 (or part of it) over 200 m 2 up to 400 m 2, 100 b) each 10 m 2 (or part of it) over 400 m 2 up to 600 m 2, and 75 c) each 10 m 2 (or part of it) over 600 m 2, or 50 iii) each fixture unit over 20 fixture units 50 Transfer all information from the Worksheets to the permit in the appropriate sections. CLASS 2 & 3 SYSTEMS - GREYWATER/CESSPOOL DESIGN FLOW Fixtures of Plumbing and Flow Rate Table for Greywater Systems Pressurized Water Supply Non-Pressurized Water Supply Number Fixture Totals Number Fixture Totals Sinks @ 300 litres each Sinks @ 187.5 litres each Shower @ 300 litres each Shower @ 187.5 litres each Q = Q = Daily Flow Rate Q (from table) Q = L Sidewall Loading Rate: L R = 400/T L R = L/m 2 Sidewall Area Required: A = Q/ L R A = m 2 Length of Trench (300mm high, 500mm wide) L T = A/(0.3+0.3+0.5) = m
CLASS 4 SYSTEMS Fixture Units of Plumbing for Class 4/5 Systems Fixture Fixture Unit Bathroom Group (3 piece) 6 Bathtub with/without shower Clothes washer Dishwasher ½ Shower not in bathroom group Extra shower head Sinks not in bathroom group Toilets not in bathroom group 4 Calculation of Flow Rate (Q) Number TOTAL FIXTURE UNITS OF PLUMBING Number of bedrooms = Base Flow Rate based on number of bedrooms (up to 5) BFR = L/d Living area of dwelling(s) = m 2 (round up to next 10m 2 ) Fixture Units of Plumbing = (from above) 1A - BFR L/d + L/d for bedrooms over 5 = L/d 1B - BFR L/d + L/d for living area over 200 m 2 = L/d 1C - BFR L/d + L/d for fixture units over 20 = L/d Q = L/d (highest of 1A, 1B or 1C) Total SEPTIC TANK VOLUME PROPOSED Minimum Tank Volume for Residential Occupancies: 2 times Q = litres. Minimum Tank Volume for Non-Residential Occupancies: 3 times Q = litres. Proposed Tank Volume: litres. Note: minimum allowable tank volume is 3,600 L TRENCH LENGTH PROPOSED The formula for calculating the length of pipe (L) is L=QxT D /200. L= metres. Proposed Length: L =. Note: Minimum length is 40 metres. Complete where patented product is proposed: Name and model of product:. (Attach BMEC authorization) Length of trench based on BMEC authorization = metres. FILTER BED EFFECTIVE SIZE, FILTER BED EXTENDED AREA, MANTLE AREA Effective area = Q/75 = m 2 where Q is 3000 litres or less. Effective area = Q/50 = m 2 where Q is over 3000 litres. Min. Extended Filter Sand Area (A) A = Q x T N / 850 = m 2 Mantle area = Q / LRM = m 2.
CLASS 5 SYSTEMS HOLDING TANK PROPOSED VOLUME Minimum volume of holding tank is 7 times Q. Proposed Tank Volume litres. Note: Minimum allowable tank volume is 9,000 litres. TERTIARY SYSTEM DESIGN Attach to permit application Step 3: Dwelling Information - required. Step 4: Soils Information: How to Determine Soils to be Used The Northwestern Health Unit requires documentation on the soils that are to be used by a certified soil technician to determine the T time for conventional type fields or suitability as filter bed sand for filter bed systems. A Laboratory report must be attached to Sewage Permit Application. Guide for Estimating Percolation Rate of Native Soil Loading Rates for Fill-Based Trenches and Filter Beds ESTIMATED ASSIGNED SOIL TYPE T Time Min/cm Percolation Time (T N ) of Native Soil, min/cm Loading Rates LRM (L/m 2 ) /day Coarse gravel, no fines 0 1 1 < T 20 10 Gravel, some small rocks 1 5 20 < T 35 8 Gravel sand mix, some fines 5 10 35 < T 50 6 Sand, uniform, some fines 10 15 T > 50 4 Sand/loam mix 15 25 Loading Rate of Mantle (LRM) from above table: Clay Mixtures 25 50 LRM = L/d /m 2 / day Clay > 50 The Design Soil (T D ), Mantle Soil (T M ) and the Native Material (T N ) information is entered on the Soils Information of the sewage permit. Step 5: Test Pit Soil Information Required: Except as otherwise directed by the Northwestern Health Unit, a minimum of two (2) test pits must be used. The soil profile from the test pits and any percolation results must be included as part of the plans submitted for approval. The soil profile must be to a depth that is at least 1.0 metre below the bottom of the proposed field bed or trench. TEST PIT 1 TEST PIT 2 Depth in metres Description of soil. List colour and type. Depth in metres - - Description of soil. List colour and type. - - - - - -
DRAWING 1 Absorption Trench Proposal Applicant Name: 1. lines = m (3) 2. Dimensions of field area X 3. Dimensions of field area with slopes X 4. Header on end or centre 5. Total system area Q / LRM = mantle minimum 250 mm thick sand Depth of excavation Depth of fill under trench Height of final grade m m m * Attach this page to Permit * Pg 4 of 4
DRAWING 2 Filter Bed Proposal Applicant Name: 1. Area of stone & pipe Q / 75 = m x m 2. lines on centres 3. Area of extended filter sand QT / 850 = x 4. Total system area Q / LRM = 5. Header on end or centre Mantle minimum 250 mm thick sand QT / 850 750 mm thick filter sand Depth of excavation Height of top of stones above grade Proposed top of final grade m m m * Attach this page to Permit * Pg 4 of 4